An Evaluation of the Nation's First An Evaluation of the Nation's First Juvenile Mental Health Court for Juvenile Mental Health Court for

Delinquent Youth With Chronic Mental Delinquent Youth With Chronic Mental Health NeedsHealth Needs

Monic P. Behnken, J.D., Ph.D.Monic P. Behnken, J.D., Ph.D.Iowa State UniversityIowa State University

David E. Arredondo, M.D.David E. Arredondo, M.D.Applied NeuroscienceApplied Neuroscience

Wendy L. Packman, J.D., Ph.D.Wendy L. Packman, J.D., Ph.D.Pacific Graduate School of PsychologyPacific Graduate School of Psychology

Authors’ Note: This presentation contains material from a forthcoming Authors’ Note: This presentation contains material from a forthcoming publication. Full Citation: Behnken, M. P., Arredondo, D. E., & Packman, publication. Full Citation: Behnken, M. P., Arredondo, D. E., & Packman, W. L. (in press). Reduction in recidivism in a juvenile mental health W. L. (in press). Reduction in recidivism in a juvenile mental health court: A pre- and post-treatment outcome study. court: A pre- and post-treatment outcome study. Juvenile and Family Juvenile and Family Court JournalCourt Journal, Summer 2009. Wiley-Blackwell Publishing., Summer 2009. Wiley-Blackwell Publishing.

What is a Juvenile Mental Health Court?What is a Juvenile Mental Health Court?

Specialty court model Specialty court model (Goldkamp & Irons-Guynn, (Goldkamp & Irons-Guynn, 2000)2000)

Specific offender populationSpecific offender population(Poythress, Petrila, McGaha & Boothroyd, 2002)(Poythress, Petrila, McGaha & Boothroyd, 2002)

Emphasis on psychiatric treatmentEmphasis on psychiatric treatment(Wolff & Pogorzelski, 2005)(Wolff & Pogorzelski, 2005)

Voluntary participation Voluntary participation (Arredondo et al., 2001)(Arredondo et al., 2001)

Therapeutic Jurisprudence principlesTherapeutic Jurisprudence principles(Wexler & Winick, 1991)(Wexler & Winick, 1991)

Santa Clara JMHC - CITASanta Clara JMHC - CITA

Focuses on interdisciplinary cooperation Focuses on interdisciplinary cooperation

Promotes a child-centered, multidisciplinary, Promotes a child-centered, multidisciplinary, and family focused approach to treatmentand family focused approach to treatment

Provides integrated and coordinated servicesProvides integrated and coordinated services

Culturally sensitive community resourcesCulturally sensitive community resources

Caregivers involved in treatmentCaregivers involved in treatment

Protects the rights of the child and the communityProtects the rights of the child and the community

Simplified Traditional Court StructureSimplified Traditional Court Structure

CITA StructureCITA Structure

Study DesignStudy Design

Demographic characteristicsDemographic characteristics Descriptive StatisticsDescriptive Statistics

Recidivism rates for Recidivism rates for graduatesgraduates McNemar Tests and Paired T-TestsMcNemar Tests and Paired T-Tests Wilcoxon Signed-Rank Test Wilcoxon Signed-Rank Test

N = 133N = 133

Overall DemographicsOverall Demographics

DemographicsDemographics 15 years old (11-18)15 years old (11-18)

RaceRace34% Caucasian34% Caucasian33% Hispanic33% Hispanic13% Biracial13% Biracial9% African American9% African American6% Asian6% Asian5% Other5% Other

Sex Sex 67% male67% male33% female33% female

58% female single 58% female single parent homeparent home

99thth grade grade

90% with school 90% with school behavior problemsbehavior problems

87% abuse substances87% abuse substances

31% gang involvement31% gang involvement

M Diagnoses = 4 (1-12)M Diagnoses = 4 (1-12)

M Medication = 2 (1-11)M Medication = 2 (1-11)

M Offenses = 4 (1-17)M Offenses = 4 (1-17)

52% exposed to 52% exposed to domestic violencedomestic violence

DiagnosesDiagnoses

ADHD ADHD 60.15%60.15%Sub. Abuse/Dep. Sub. Abuse/Dep. 46.62%46.62%Bipolar DO Bipolar DO 41.36%41.36%Major Dep. DO Major Dep. DO 34.59%34.59%Oppos./Defiant DO Oppos./Defiant DO 30.08%30.08%Adjustment DO Adjustment DO 25.56%25.56%Mood DO NOS Mood DO NOS 19.55%19.55%Depressive DO NOS 15.54%Depressive DO NOS 15.54%PTSDPTSD 15.04%15.04%Learning Disorders Learning Disorders 15.04%15.04%AXIS II features AXIS II features 14.29%14.29%Parent/Child ProbParent/Child Prob 13.53%13.53%

Dysthymic DO Dysthymic DO 12.03%12.03%Conduct DO Conduct DO 12.03%12.03%MR/Borderline IQ MR/Borderline IQ 9.77%9.77%Psychotic DO Psychotic DO 8.27%8.27%Anxiety DO NOS Anxiety DO NOS 6.77%6.77%Inter./Explosive DO Inter./Explosive DO 6.02%6.02%Enuresis/EncopresisEnuresis/Encopresis 5.26%5.26%Disruptive Beh. DO Disruptive Beh. DO 4.51%4.51%Reactive/Attach. DOReactive/Attach. DO3.76%3.76%OCDOCD 3.76%3.76%Amph Abuse/DepAmph Abuse/Dep 3.01%3.01%Gen. Anxiety DO Gen. Anxiety DO 3.01%3.01%

MedicationsMedicationsWellbutrin 24.06%Wellbutrin 24.06%

Depakote 22.56%Depakote 22.56%

Ritalin 18.80%Ritalin 18.80%

Risperdal 17.29%Risperdal 17.29%

Prozac 15.04%Prozac 15.04%

Concerta 14.29%Concerta 14.29%

Zoloft 14.29%Zoloft 14.29%

Seroquel 12.78%Seroquel 12.78%

Lithium 10.53%Lithium 10.53%

Strattera 9.77%Strattera 9.77%

Klonapin 9.02%Klonapin 9.02%

Zyprexa 9.02%Zyprexa 9.02%

Adderall 8.27%Adderall 8.27%

Paxil 8.27%Paxil 8.27%

Trazedone 8.27%Trazedone 8.27%

Abilify 7.52%Abilify 7.52%

Geodon 7.52%Geodon 7.52%

Celexa 6.02%Celexa 6.02%

Effexor 6.02%Effexor 6.02%

Topomax 5.26%Topomax 5.26%

Risk FactorsRisk FactorsRisk Factors For Violence And Psychiatric Disturbance

0 10 20 30 40 50 60 70 80

Prior Psychiatric Hospitalization 67 (50.38%)

Exposure to Domestic Violence 65 (51.88%)

Family History of Mental Illness 58 (43.61%)

Physical Abuse Victim 54 (40.60%)

Prior Suicide Attempt 46 (34.59%)

Gang Affiliation 42 (31.58%)

Run Away History 40 (30.08%)

Self-Mutilation History 39 (29.32%)

Sexual Abuse Victim 36 (27.07%)

Perpetrates Violence Against Family 34 (25.56%)

Partner Violence 17 (12.78%)

Family History of Gang Affiliation 7 (5.26%)

Most Common OffensesMost Common Offenses

Assault/BatteryAssault/Battery 56.39% 56.39%

Violation of Probation Violation of Probation 44.36% 44.36%

Theft Theft 27.07% 27.07%

Bench WarrantBench Warrant 21.05% 21.05%

Escape from Detention Escape from Detention 16.54% 16.54%

Burglary Burglary 15.04% 15.04%

Terrorist Threats Terrorist Threats 13.53% 13.53%

Vandalism Vandalism 13.53% 13.53%

Dirty Drug Test Dirty Drug Test 12.78% 12.78%

Poss. Dangerous Weapon 12.78%Poss. Dangerous Weapon 12.78%

Theft of a Vehicle Theft of a Vehicle 12.03%12.03%

Drug Possession Drug Possession 10.53%10.53%

Robbery Robbery 6.77%6.77%

Public Dist./Intox. Public Dist./Intox. 5.26%5.26%

Curfew ViolationCurfew Violation 4.51%4.51%

Sell/Rec Stolen Prop. Sell/Rec Stolen Prop. 4.51%4.51%

Threatened OfficialsThreatened Officials 4.51%4.51%

Arson Arson 3.76%3.76%

Runaway Runaway 3.76%3.76%

Car Jacking Car Jacking 2.26%2.26%

Main CITA StepsMain CITA Steps

ArrestArrest Mental Health ScreenMental Health Screen Mental Health AssessmentMental Health Assessment Multi-disciplinary TeamMulti-disciplinary Team CITACITA Court Ordered ProbationCourt Ordered Probation Mental Health TreatmentMental Health Treatment

InterventionsInterventions PsychoeducationPsychoeducation

Domestic Violence/Teen BatterersDomestic Violence/Teen Batterers Anger ManagementAnger Management ParentingParenting Job TrainingJob Training Independent Living SkillsIndependent Living Skills Problem SolvingProblem Solving Victim AwarenessVictim Awareness Substance AbuseSubstance Abuse

InterventionsInterventions

MedicalMedical Neurological EvaluationNeurological Evaluation Psychiatric EvaluationPsychiatric Evaluation Medication EvaluationMedication Evaluation Medical/Dental EvaluationMedical/Dental Evaluation

SchoolSchool Individualized Education ProgramIndividualized Education Program Regular School AttendanceRegular School Attendance

InterventionsInterventions

Court Ordered SanctionsCourt Ordered Sanctions Drug TestingDrug Testing Restraining OrderRestraining Order RestitutionRestitution Community ServiceCommunity Service Electronic MonitoringElectronic Monitoring Home DetentionHome Detention

InterventionsInterventions

PsychologicalPsychological IndividualIndividual GroupGroup Therapeutic Behavior Therapeutic Behavior

ServicesServices FamilyFamily Intensive Home ServicesIntensive Home Services Wraparound servicesWraparound services

SettingsSettings Community Community

OutpatientOutpatient Group HomeGroup Home ResidentialResidential Juvenile HallJuvenile Hall RanchRanch

N = 64N = 64

Graduates’ RecidivismGraduates’ Recidivism

Overall Offense HistoryOverall Offense History

Number of Offenses Before CITA Admission

Mean 2.98SD 2.05Lower Limit/Upper Limit 0/11

Number of Offenses After CITA Admission

Mean 1.14SD 1.41Lower Limit/Upper Limit 0/6

Difference in Number of Offenses Before and After CITA Admission

Mean 1.84***SD 2.26***Significant T-Test p value < .001***Significant McNemar Test p value < .001

OffensePre-Admission

OffensesPost-Admission

OffensesMcNemar’s Test

p ValuesViolent OffensesAssault/Battery 34 (53.13%) 7 (10.94%) <.001***Att. Kidnapping 1 (1.56%) 0 0.317*Burglary 8 (12.50%) 3 (4.69%) 0.096*Carjacking 1 (1.56%) 0 0.317*Hit & Run 0 1 (1.56%) 0.317a

Indecent Exposure 2 (3.13%) 0 0.157*Obstr/Resist Arrest

1 (1.56%) 1 (1.56%) 1.000

Pos. Dng. Weapon 9 (14.06%) 1 (1.56%) 0.011***Reckless Driving 1 (1.56%) 0 0.317*Robbery 0 1 (1.56%) 0.317a

Stalking 1 (1.56%) 0 0.317*Threat. Officers 0 1 (1.56%) 0.317a

Terrorist Threats 7 (10.94%) 1 (1.56%) 0.034****** Significant Change at p < .05* Change trends in the positive directiona Post admission increases

OffensePre-Admission

OffensesPost-Admission

OffensesMcNemar’s Test

p ValuesProperty Crimes

Arson 2 (3.13%) 0 0.157*Forgery 1 (1.56%) 0 0.317*Sell/Rec Stol Prop 3 (4.69%) 1 (1.56%) 0.317*Theft 18 (28.13%) 5 (7.81%) 0.002***Theft (Vehicle) 4 (6.25%) 1 (1.56%) 0.180*Vandalism 11 (17.19%) 1 (1.56%) 0.002****** Significant Change at p < .05* Change trends in the positive directiona Post admission increases

OffensePre-Admission

OffensesPost-Admission

OffensesMcNemar’s

p ValuesMiscellaneous Offenses

Bench Warrant 6 (9.38%) 4 (6.25%) 0.527*Curfew Viol. 0 3 (4.69%) 0.083a

DUI 2 (3.13%) 0 0.157*Drug Poss. 2 (3.13%) 5 (7.81%) 0.257a

Escape/Detention 8 (12.50%) 5 (7.81%) 0.405*Dirty Drug Test 6 (9.38%) 5 (7.81%) 0.739*Pub. Dist./Intox. 3 (4.69%) 2 (3.13%) 0.564*Runaway 0 1 (1.56%) 0.317a

Viol. of Prob. 18 (28.13%) 18 (28.13%) 1.000*** Significant Change at p < .05* Change trends in the positive directiona Post admission increases

Interval DifferencesInterval DifferencesNumber of Days Between First Documented Offense and CITA Admission

Mean 552.08 (18.4 months)SD 560.93Lower Limit/Upper Limit 298/500

Number of Days Between CITA Admission and CITA GraduationMean 698.32 (23.26 months)SD 465.71Lower Limit/Upper Limit 512/751

Interval Difference in Time Before and After CITA AdmissionMean -146.24 (4.87 months)*SD 764.15Lower Limit/Upper Limit -331/-94* Marginally significant Wilcoxon Signed-Rank p value = .072

SummarySummary

Risk factors for offendingRisk factors for offending Mental illnessMental illness Family/EnvironmentFamily/Environment Prior arrestPrior arrest 99% recidivism while on traditional 99% recidivism while on traditional

probationprobation

SummarySummary

Reduced RecidivismReduced Recidivism Assault & BatteryAssault & Battery Violent ThreatsViolent Threats Possession of a Dangerous WeaponPossession of a Dangerous Weapon TheftTheft VandalismVandalism

Results trended toward reductions in Results trended toward reductions in other offensesother offenses

Researcher CommentsResearcher Comments

Multidisciplined but not integratedMultidisciplined but not integrated

Different documentation standardsDifferent documentation standards

Not all files availableNot all files available

No recidivism data past age 18No recidivism data past age 18

Researcher CommentsResearcher Comments

CITA participation appears linked to CITA participation appears linked to decreased recidivismdecreased recidivism

Violent offenses reducedViolent offenses reduced Effective multi-disciplinary Effective multi-disciplinary

cooperation is possiblecooperation is possible Cost effective alternativeCost effective alternative Humane treatment of mentally illHumane treatment of mentally ill