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Mental Health Services in the Juvenile Court: An Overview By EDWARD PABON Since its inception, the juvenile court has had a strong linkage with mental health services. The founders of the child guid- ance movement had a deep interest in juvenile delinquency. The Institute of Juvenile Research in Chicago and the Judge Baker Guidance Center in Boston provided substantial services to delinquent youth and stimulated much psychological- ly oriented research in delinquency. With the help of mental health professionals, staff of the first courts evaluated the child’s developmental and family problems and his areas of adjustment and non-adjust- ment. Within the limits of their time, staff tried to help the child gain insight into his behavior, resolve his conflicts, and adopt an adjustment more in line with communi- ty values. In addition, mental health per- sonnel were used as consultants, or occa- sionally as staff. Psychiatric clinics in juvenile courts have expanded greatly since the inaugura- tion of the first advisory court clinic estab- Author’s address: Edward Pabon Program Coordinator for Youth Community Service Society 105 East 22nd Street New York, New York 10010 lished by William Healy in Chicago in 1909. The court clinics in Massachusetts, for example, expanded from a single clinic to fifteen clinics within a fourteen year pe- riod.’ According to a recent study of the juvenile court system in the United States, mental health services are provided in 133 courts as part of the court service system.2 At first devoted largely to diagnosis, such clinics have gradually taken on treatment responsibilities as well. Prior to the injection of due process measures into the juvenile justice system through a number of court decisions in the 1960s and early 1970s, there seems to have been little concern with the role of mental health services in the juvenile court. This may have been due to the conception of the juvenile court as a non-adversarial, pater- nal body concerned with the well-being of the troubled youth brought before it. However, with the movement of due pro- cess into the juvenile court system and the critical questioning of the role of thejuve- nile court in society, issues centering on the function of mental health services within a n established legal system for children have begun to elicit scrutiny by reform- minded legal and mental health pro- fessionals. February, 19801 Juvenile & Family Court Journal 23

Mental Health Services in the Juvenile Court: An Overview

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Mental Health Services in the Juvenile Court: An Overview

By EDWARD PABON

Since its inception, the juvenile court has had a strong linkage with mental health services. The founders of the child guid- ance movement had a deep interest in juvenile delinquency. The Institute of Juvenile Research in Chicago and the Judge Baker Guidance Center in Boston provided substantial services to delinquent youth and stimulated much psychological- ly oriented research in delinquency. With the help of mental health professionals, staff of the first courts evaluated the child’s developmental and family problems and his areas of adjustment and non-adjust- ment. Within the limits of their time, staff tried to help the child gain insight into his behavior, resolve his conflicts, and adopt a n adjustment more in line with communi- ty values. In addition, mental health per- sonnel were used as consultants, or occa- sionally as staff.

Psychiatric clinics in juvenile courts have expanded greatly since the inaugura- tion of the first advisory court clinic estab-

Author’s address: Edward Pabon Program Coordinator for Youth Community Service Society 105 East 22nd Street New York, New York 10010

lished by William Healy in Chicago in 1909. The court clinics in Massachusetts, for example, expanded from a single clinic t o fifteen clinics within a fourteen year pe- riod.’ According to a recent study of the juvenile court system in the United States, mental health services are provided in 133 courts a s part of the court service system.2 At first devoted largely to diagnosis, such clinics have gradually taken on treatment responsibilities as well.

Prior to the injection of due process measures into the juvenile justice system through a number of court decisions in the 1960s and early 1970s, there seems to have been little concern with the role of mental health services in the juvenile court. This may have been due to the conception of the juvenile court as a non-adversarial, pater- nal body concerned with the well-being of the troubled youth brought before it. However, with the movement of due pro- cess into the juvenile court system and the critical questioning of the role of thejuve- nile court in society, issues centering on the function of mental health services within a n established legal system for children have begun to elicit scrutiny by reform- minded legal and mental health pro- fessionals.

February, 19801 Juvenile & Family Court Journal 23

EDWARD PABON

24 Juvenile & Family Court Journal1 February, 1980

THE ORIGINS OF THE JUVENILE COURT

The creation of the juvenile court grew out of concerns as well as aspirations of nineteenth-century social reformers. They sought to advance the welfare of children by removing them from the jurisdiction of the criminal court and by providing new institutional mechanisms whereby the state would intervene for rehabilitative rather than punitive purposes. But a t the same time, these reformers were also concerned about social control and the moral devel- opment of immigrant and working class children who were flooding the cities. They believed that the state had the right t o in- tervene benevolently to see that children were “properly” socialized to assume the adult roles needed in a n industrializing society.

The establishment of the juvenile court in 1899 provided a legal mechanism for broad control over children. The court was to be a humanitarian institution dedicated to helping children. This outlook for the court was aptly expressed by the Chicago Bar Association:

The whole trend and spirit of the 1899 lllinoisjuvenile court act is that the State, acting through the Juvenile Court , exer- cises that tender solicitude and care over its neglected, dependent wards that a wise and loving parent would exercise with refer- ence to his own children under similar cir- cumstances.3

O n the basis of the concept of parens patriae, the juvenile court was authorized to intervene wherever a juvenile’s behavior was problematic for the child, family, o r society. Thus, behavior such as truancy, curfew violation, being unruly, incorrigi- bility, o r even “idling one’s time away” were as sufficient a basis for a juvenile court t o adjudicate a youth delinquent as commission of a felony or misdemeanor. Because delinquency was viewed as a dis- ease or a malady caused by social inequi- ties, juveniles were to be diagnosed and treated by “helping professionals.” Even judges were to conceive of their role in this

way - t o identify through diagnostic in- terviews the causative factors behind a juvenile’s challenge to authority.

The invention of the juvenile court by the state of Illinois in 1899 was hailed al- most universally as a triumph of benevo- lent progressivism over the forces of reac- tion and i g n ~ r a n c e . ~ By 1920, all states except three had enacted juvenile court laws, although it was not until almost mid- century that Wyoming became the last state to join the movement. Meanwhile, it became a success in many other countries as well.

The rehabilitative philosophy of the juvenile court not only spread geographi- cally, but its jurisdiction over adults, as well asjuveniles, was greatly extended. The tendency in most states was to raise the upper limit of childhood from sixteen to eighteen, and even to twenty-one in a few states. The definition of delinquency was broadened to include cases of illegitimacy and mental o r physical defectiveness. Adults could be brought into court charg- ed with contributing to the delinquency of a minor. Some cities created family or do - mestic relations courts designed to deal with family problems of any kind: depen- dency and neglect, illegitimacy, adoption, nonsupport by a father, o r crimes commit- ted by one family member against another. Article one of the New York State Family Court Act indicates that the Family Court has exclusive original jurisdiction over the following:

( 1 ) abuse and neglect proceeedings; (2) support proceedings; (3) proceedings to determine paternity

and for the support of children born out-of-wedlock;

terminate custody of a child by reason of permanent neglect;

( 5 ) proceedings concerning juvenile delinquency and whether a person is in need of supervision; and

(4) proceedings permanently to

(6) family offense proceedings.5

MENTAL HEALTH SERVICES IN THE JUVENILE COURT: AN OVERVIEW

THE REHABILITATIVE IDEOLOGY

The beliefs and assumptions that sus- tained this movement are best understood as a n ideology, a s a kind of visionary theo- rizing about children and the best way to nurture and to protect them. The strength of this ideology was derived primarily from the following assumptions inherent in the modern concept of childhood:

I . Children are qualitatively different from adults - innocent, fragile, and un- calculating - and are entitled to special care.

2. Children are more malleable than adults and , thus, a re more susceptible to helpful intervention.

3. Problems during childhood leave a lasting imprint. The earlier the interven- tion, therefore, the greater the chances for rehabilitation.

The emerging status of social science during the first half of this century also reinforced the juvenile court movement. But the theories of delinquency that were most supportive of it were primarily those of a control variety, particularly psychobi- ological theories that concentrated on the defects of the individual. Hence, in addi- tion t o suggesting that delinquent behavior is due to causes over which the child has little control, they also suggested that the primary problem is defective intelligence, uncaring parents, and a poor home envi- ronment. The only way to deal justly with delinquents, therefore, was to adapt legal responses to their moral, hereditary, and emotional problems. Little thought was given to societal defects, to differential op- portunities, o r t o the pluralistic nature of American culture.

“Recently, as legal and mental health pro- fessionals have come to recognize the tre- mendous impact of the clinic’s diagnostic and evaluation role in the outcome of a court’s dispositional decision, questions as to the appropriateness of this impact have aroused examination.”

According to the rehabilitative ideology, then, officials could not react uniformly to different children for the same delinquent act because each offender was unique and because each one’s behavior required spe- cial diagnosis and treatment. Further- more, differential responses to children were the only rational way to protect soci- ety. Unless the factors that caused individ- uals to violate the law were isolated and removed, legal processing and punishment would d o no good. Short of killing off all delinquents or of incarcerating them per- manently, the only way the citizenry could be protected in the long run was to cure delinquents of their tendencies to violate the law. If this was not done, they would eventually be released only to prey upon innocent victims once again.

Since, in theory, the purpose of the juve- nile court was not to convict children of crimes but to protect, aid, and guide them, it was not viewed as unconstitutional if it denied them certain rights that were guar- anteed to adults. If disturbed and ignorant children were properly treated, they could be saved and made into healthy and law- abiding adults. Indeed, rather than taking issue with this ideology, important higher court decisions served only to sustain it.

To save a child from becoming a criminal, o r f rom continuing in a career of crime, to end in maturer years in public punishment and disgrace, the legislatures surely may provide for the salvation of such a child, if its parents or guardians be unable to unwill- ing to d o so, by bringing it into one of the courts of the state without any process a t all, for the purpose of subjecting it to the state’s guardianship and protection. . . . The act simply provides how children who ought t o be saved may reach the court to be saved (Commonwealth v. Fisher, 1905).6

Although this judicial statement was made in 1905, the ideology upon which it was based had changed little by 1962. In that year, Orman Ketcham, judge of the juvenile court in Washington, D.C., ob- served that “the juvenile in America may still be brought within the protective power

February, 19801 Juvenile & Family Court Journal 25

EDWARD PABON

of the juvenile court without the operation of legal safeguards customarily offered to a person accused of law violation.’7

Almost to the present day, then, the view of the juvenile court as a rehabilitative in- strument has not only provided the agents of juvenile justice with a broad mandate but with awesome responsibilities. On the one hand, i t has suggested that problem children should be treated in a much more thoughtful and humane way than adult of- fenders. Retribution, in particular, should be avoided; the care, custody, and disci- pline provided for delinquents should ap- proximate that of loving parents. O n the other hand, officials should not wait until children become criminal in taste and habit before they act. Rather, they should re- spond a t the first sign of parental neglect or of departure on the part of any child from accepted moral and legal standards, even if stern and arbitrary methods were required. It mattered little whether children were de- pendent and negelected, status offenders (PINS), or young criminals. Using the same methods, all were to be saved.

THE COURT CLINIC

When Chicago’s juvenile court recog- nized that no judge alone could encompass all the skills and knowledge essential t o case appraisal, it called upon Dr. William Healy to establish the first court psychiat- ric clinic. Today, almost every juvenile court has its own court clinic or access to specialized psychiatric services for the eval- uation or diagnosis of individuals before the court. Over the years mental health services have come to be provided in four ways.

MENTAL HEALTH SERVICES WITHIN JUVENILE COURTS

Many courts have employed a psychol- ogist on a part- or full-time basis and re- tained a psychiatrist to provide diagnostic service and a limited amount of treatment t o juveniles, as well as consultation to the

judge and his staff. Frequently the court’s psychologist has less than doctoral train- ing and is somewhat isolated from other practitioners in the field of mental health. He may have insufficient opportunity to interact with professionals whose training is equal to or better than his own. As one of the few professionals on the court staff, he often has to provide training and consulta- tion to probation counselors and, accord- ingly, may develop the self-image of a n expert though lacking any real quality of expertise.

SERVICES I N CHILD GUIDANCE A N D

UNIVERSITY DEPARTMENTS

Child guidance clinics have been helpful in providing services for delinquent youth and have developed the model of working with the family as well. But there has been too little interest in shifting the target t o work with the community diversions of delinquency, with the peer groups of delin- quent individuals, and with delinquent groups or gangs.

Furthermore, not all child guidance clin- ics have been receptive to court referred delinquents. At least one comparative study of referrals of problem youth to child guidance clinics and court clinics indicated that lower class youth formed only a small percentage of the applicants t o child gui- dance clinics but a n overwhelming majori- ty of those referred to court clinics. The child guidance agencies studied did not give priority to delinquent youth in select- ing their cases nor did they accept very difficult cases a s a rule.* Non-court clinics more frequently worked with children under juvenile court age and with children exhibiting symptoms of a more clearly psychological nature.

PRIVATE MENTAL HEALTH PRACTITIONERS

It is difficult to judge how widespread and how effective are the mental health services rendered to delinquents by private practitioners. Undoubtedly, in view of the

26 Juvenile & Family Court Journal/ February, 1980

MENTAL HEALTH SERVICES IN THE JUVENILE COURT: AN OVERVIEW

cost of their services, they have worked mainly with middle-class and upper class delinquents.

COMMUNITY MENTAL HEALTH CLINICS

The community mental health clinics which have been developed in considerable number have in effect replaced the child guidance clinics as a source of services to court-referred youngsters. Thus far, they have provided the court with more in the way of diagnosis than of treatment. Yet, results have been poor as community clin- ics have not been anxious to accept refer- rals from the courts, and have been used to operating only under conditions of volun- tarism on the part of their clients.

The shortcomings and resistance of community mental health services to pro- vide services to court referred youngsters has provided impetus to the establishment of mental health clinics within the juvenile court setting. The services provided by court clinics are as follows:

1 . To provide mental examinations, when indicated by law, of persons referred by the court.

2. To examine individuals on request of the court a s a n aid in its planning for their rehabilitation.

3. To provide consultation to judges and probation officers in legal-psychiatric matters. 4. T o provide psychiatric treatment and

other mental health services to juveniles and their families referred by the court.

5. In probation-clinical conferences, to share professional knowledge in the diffi- cult tasks of managing and helping court- referred individuals.

6. To provide consultation and evalua- tion services, when requested, to court- sponsored programs and facilities.

7. T o maintain working relationships with mental health and other community agencies, facilities, and programs con- cerned with the welfare of court clients.

The model for mental health services in the juvenile court has typically included the following suggested organization:

I . Apsychologist with a master’s degree and additional work toward the doctorate. Such training would give him diagnostic and treatment skills and the ability to de- sign and conduct research. In addition, he needs to have the ability to communicate with the probation staff easily and without arrogance. This ability would be essential to the training role which he will need to undertake.

2. A psychiatrist, preferably a specialist in child psychiatry. He would have skills similar to those of the psychologist to offer the team, except for research.

3. A graduate social worker. The social worker would have skills similar to the other professional members of the team except for testing and research. 4. Aides. With less training, aides would

function under the direction of the profes- sionals. They would perform certain “leg work,”such a s visiting the home and inter- viewing the family. They could be trained to d o testing under the supervision of the psychologist, and they could perform the “activity therapies.”

The first step in the clinic’s evaluation would usually be the social worker’s inter- view of the juvenile and the family to dis- cover the underlying facts of the case and the social history and background of the individuals involved. Generally, the social worker would be the only professional staff member of the clinic who works full time. The psychiatrists and psychologists would be part-time employees with addi- tional commitments to other institutions or private practice. The social worker(s) would make appointments, conduct pre- liminary interviews, make and follow-up referrals, and handle the administrative chores of the clinic. When a psychiatrist interviews the individuals, often he has time for only one hurried interview with each individual. The social worker would prepare a report for the court which in-

February, 19801 Juvenile & Family Court Journal 27

EDWARD PABON

28 Juvenile & Family Court Journal/ February, 1980

cludes the clinic’s evaluation and recom- mendation. However, the formal decision making authority over cases would remain the province of the psychiatrist or psy- chologist.

Professional team members would need to perform crisis therapy and short-term treatment for the more difficult cases. However, their major function would be to act as the central information source and referral aid for all staff. They would have a n important role in inservice training and providing on-going consultation to proba- tion staff. Long-term treatment and com- plicated diagnostic study would generally be allocated to other public and private psychiatric services. Cases with mental health disturbance but without serious or repeated delinquency would be diverted to non-court mental health agencies at the point of intake. Allocation to other agen- cies of cases which need specialized or long-term treatment would leave to the court mental health service major respon- sibility for diagnosis and short-term treat- ment of those youngsters and their families whom it is best equipped to handle.

The court clinic can exercise decisive in- fluence on the ultimate outcome of many cases referred to it, but like all other juve- nile court services, clinics are often over- burdened and inadequately staffed. They are under great pressure not to get deeply involved in psycho-dynamic diagnosis and treatment. Their function is to evaluate the juvenile and the family before the court quickly and to make a realistic disposi- tional recommendation.

AN EXAMPLE - THE NEW YORK CITY COURT CLINIC

Section 251 of the New York State Fam- ily Court Act provides that “after the filing of a petition under this act over which the family court appears t o have jurisdiction, the court may cause any person within its jurisdiction and the parent or other person legally responsible for the care of any child

within its jurisdiction to be examined by a physician, psychiatrist o r psychologist ap- pointed or designated for the purpose by the court when such an examination will serve the purposes of this act.”9 The first juvenile court mental health service in New York City was established in 1916, long before the court had its present form. It was essentially diagnostic and sought orig- inally to identify mental defectives. With the growth of the mental hygiene move- ment, its diagnostic skills were deepened, but it did not evolve its treatment role until 1937. In fact, this phase of the work was developed by a voluntary group and was not fully supported by public funds until 1942.

Despite severe limitations of resources, the early court mental health service had played a pioneering role in its field and over the years had demonstrated how mod- ern psychiatric and psychological knowl- edge might be applied to diagnosis of de- linquent children and their parents, as well a s in cases of neglect. Its staff had contrib- uted to the development and adaptation of social work treatment methods for this group. Valuable experiments were con- ducted in the use of group therapy with parents and children, and there were inno- vations in group “intake” interviews and remedial reading. A special project tested ways of introducing clinical skills into court intake and offering consultation ser- vices to judges in emergencies. The re- search and writing of staff members had broad influence. There were periods, too, during which the clinical staff contributed significantly to the inservice training of probation staff.10

However, for many years this clinic has lacked resources and personnel for more than a small portion of the service sought by the judges. In 1970, a plan was prepared for the reorganization and enlargement of the mental health service.11 Prior to this plan, the service had two independent branches in Manhattan and Brooklyn, and a n independent consultation service a t the

MENTAL HEALTH SERVICES I N THE JUVENILE COURT: AN OVERVIEW

Bronx and Queens court, providing service in the Juvenile Term (delinquency). In ad- dition, a centralized service was provided for the Family Offense Terms of the juve- nile courts in each borough. This unit ren- dered service to all neglect and dependency cases, support cases, and concilliation problems of families.

The plan was based on the following assumptions: (1) That all existing mental health services to the court would be uni- fied, and a central unit with satellites would be established; (2) That the unified service would be placed under the central direction of a single qualified professional responsible to the presiding judge of the highest court in the state; and (3) That a service would be developed that would combine consultation, evaluation, rehabil- itation, and prevention in a coordinated and efficient manner.

The Fishman plan anticipated the estab- lishment of a central administrative and clinical unit with satellites in each bor- ough. The local clinics would provide con- sultation and liaison with court officials, short evaluations, and emergency support- ive contact. The central unit would assume responsibility for administration, supervi- sion, intake, diagnostic and evaluation re- ports, and specialized services, such as a n alcoholism treatment and research unit.

Less than three years later, the Spanier report presented their results of a study of services delivered and organization of staff in the mental health service.12 The report was extremely critical of the organization- al framework and performance of the clin- ic, pointing out ( I ) the poor quality of ser- vice because of a lack of accountability in the units for case preparation and process- ing, (2) the lack of priorities for service, (3) the lack of a n interdisciplinary approach to cases, and (4) the lack of coordination.

In addition to recommendations ad- dressed to the development of uniform pol- icies and procedures for administration, supervision, communication, staffing, and services, the Spanier report called for a

restructuring of the organization of the clinic. The report recommended the estab- lishment of intake teams of social workers and mental health aides in each local unit t o establish initial contact with the client, provide information and orientation to the referred client, and provide temporary as- sistance. Full evaluation and treatment teams were to be organized to provide full evaluative services to the court. In addi- tion, psychologist-psychiatric social work- er teams were to assume responsibility for case evaluation and such short-term treat- ment as was consistent with clinic policy. A non-clinical social worker and one or more mental health aides were to be assigned on a permanent basis t o each team. Finally, a community resource development and liai- son team, comprised of social workers and aides, was to be established to develop and maintain communication with community resources.

In May, 1972, a specialized federally funded (LEAA) crisis intervention pro- gram was established to reduce the flow of “inappropriate” remands to city hospitals and to detention or shelter facilities.13 Technically, the director of the court men- tal health service was the immediate super- visor of the project director; but the project essentially operated independently of the court service. The Rapid Intervention Proj- ect was to reduce the flow of remands in essentially two ways: (1 ) diagnoses on-the- spot t o recommend alternatives to re- mands; and (2) referrals t o appropriate out-patient mental health resources.

Units, consisting of interdisciplinary teams of psychiatrists, psychologists, so- cial workers, para-professional mental health aides, and a clerical contingent, were located in the court buildings of each borough. The psychiatrists and psycholo- gists executed short evaluations a t the re- quest of judges. They were assisted in for- mulating future plans for the clients by the psychiatric social workers and the aides. Cases came to the project through many routes - a client may exhibit bizarre be-

February, 19801 Juvenile & Family Court Journal 29

EDWARD PABON

30 Juvenile & Family Court Journal/ February, I980

havior in the courtroom or his offense may have been exceptionally violent or strange; the judge would send all of the parties in the case to the clinic, requesting on a check- list that clinic members address specific questions - Should this man be hospital- ized?, Is this person suicidal, homicidal? The psychologist o r psychiatrist would d o a brief emergency interview, and wouId confer with the social workers and aides in the formulation of a treatment plan. He would then address the court, providing a verbal psychiatric evaluation of the client(s), answering any of the judge’s ques- tions, and outlining the clinic staff‘s recom- mendations. If a more extensive examina- tion was required, the case would be referred to the Full Evaluation and Treat- ment section of the court mental health service. Project staff was also available for consultation with all court personnel, such as law guardians, probation officers, court connected agencies, and corporation counsel.

The function of the short evaluation was to ( 1 ) determine whether the petitioner or a member of the family was a danger to self or other persons and would require a re- mand for in-patient diagnosis for that rea- son; (2) determine whether further psychi- atric or psychological intervention for diagnostic purposes was appropriate or was likely to be productive; o r (3) deter- mine whether the primary problem before the court was unlikely to benefit fromjudi- cia1 intervention or in what ways judicial intervention might be beneficial. In those cases where a remand appeared necessary, the project’s role was clear - to diagnosti- cally justify the appropriateness of the re- mand to a mental hospital or t o a detention facility. However, where there was no question of the necessity of a remand, the role of the project was to indicate to the judge how a remand could be avoided by follow-up and referral.

The Rapid Intervention Project was terminated in 1975 as the result of a deci- sion not to seek additional federal funding

and not to institutionalize the program with city funds. Although the project was viewed a s a prototype for a n anticipated reorganization of the court mental health service, the relationship between the two services could be described as one of mutu- al criticism. The court mental health ser- vice saw the project as a n elite group who sought t o undermine the dedication and quality of the regular court service.

Today, the New York City Family Court Mental Health Service continues to be the subject for much criticism in terms of its organizational framework and perfor- mance. However, in addition to the tradi- tional criticism that the clinic lacks re- sources and personnel for more than a small portion of the services sought by the judges, the service faces fundamental ques- tions about its role in a legal system for children.

TREAT MEN.^ CLINICS IN THE

JUVENILE COURT?

Although the concept of a mental health clinic in a juvenile court has been the sub- ject of critical concern for many years, in the past such concern has been limited to a narrow question of the clinic in a n author- itative setting and its relationship to the other court services. However, with the in- jection of due process measures into the juvenile justice system, broader issues as t o the role of mental health services in juve- nile courts in terms of children’s rights and fairness in a n adversarial legal system have aroused the scrutiny of legal and mental health professionals.

In the past, doubts about the role of the court clinic have been limited to efforts t o create treatment clinics in a juvenile court. There are those who hold, for example, that the close relationship with the court represents a n obstacle to the progress of treatment, since parents and child remain suspicious of court intent, hesitate in form- ing relationships, and are not free in their expression. Others add that the presence of a court clinic in which the bulk of treat-

MENTAL HEALTH SERVICES I N THE JUVENILE COURT: AN OVERVIEW

ment is actually rendered by clinic staff tends to divert attention from the need to convert probation into a n effective case- work treatment program. The proponents of a court based treatment clinic cite the experiences in rendering sucessful treat- ment in authoritarian settings and view the clinic’s contribution to probation in terms of consultation and training.

Recently, as legal and mental health pro- fessionals have come to recognize the tre- mendous impact of the clinic’s diagnostic and evaluation role in the outcome of a court’s dispositional decision, questions as t o the appropriateness of this impact have aroused examination.

Working within the court system en- courages the clinic personnel to anticipate decisions of the court. They make theirjob easier, and they minimize friction with other court professionals with whom they must work daily by not challenging the prevailing opinion on a case and by ac- knowledging the predictable outcome of the case.

Operating within the court atmosphere creates many problems for the clinic per- sonnel. In some courts the written report is presented to the judge without the psychia- trist o r social worker being present t o interpret o r expand on it. The result, of necessity, must be a superficial under- standing of the juvenile and his family. Accordingly, the clinic personnel come to see themselves a s a source of quick and convenient evaluations of individuals. What little treatment they provide is aimed a t modifying immediate misbehavior rath- er than toward improving long term development.

Because the juvenile’s subsequent mis- conduct discredits anyone who has spoken in support of him, they are unlikely to make a strong effort t o save a juvenile un- less he has made a n unusual impression on them. Instead, they feel they must make realistic proposals in handling difficult juveniles.

The contingencies surrounding the prac- tice of psychiatry in the juvenile court set- ting undermine the independence of the clinic. Diagnoses tend to reflect prior as- sessments of delinquent character com- municated to the psychiatrist by probation officers. The clinic’s ability and inclination t o resist the momentum generated by prior court involvement in cases are eroded by dependence on court personnel incurred in carrying out daily clinic operations. The psychiatrist’s recommendations are conse- quently pulled in a conservative direction, coming to conform to prevailing court standards of what is reasonable and to eschew risk-taking. These factors severaly restrict psychiatric reassessment and redef- inition of criminal like character, and hence psychiatric “saving” of hardcore de- linquents from incarceration. Only occa- sionally does the clinic perform its “last chance” function.’4

Juveniles referred to the court clinic real- ize that they a re still within the court set- ting and are, therefore, justifiably hesitant t o talk to the social worker and psychia- trist, neither of whom can promise confi- dentiality. Nor can court personnel devel- o p a sufficient relationship with the individuals to gain real insight into their personality in a few hurried interviews. A juvenile who is disrespectful, evasive or uncooperative makes it more difficult for the social workers and the psychiatrists to offer assistance. They will tend to help only those who are receptive and cooperative. Consequently, the juvenile’s attitude can have a crucial effect on their recommenda- tions to the court.

The delinquent’s reaction to his referral to the clinic may contribute to this confirma- tion of his discredited character and thus further his own incarceration. The delin- quent may define the clinic as part of the authoritarian court setting and respond evasively or hostilely to the clinic’s efforts t o “help” him. I f he maintains this stance, the clinic will evaluate him as unfeeling, secretive, and anti-social. Moreover, clinic personnel will ascertain neither his inner feelings nor his subjective accounts for his behavior. This ruins the psychiatric as-

February, I9801 Juvenile & Family Court Journal 3 1

EDWARD PABON

sessment of his character and leads to un- favorable recommendations to the court. In this way, the suspicious and uncoopera- tive delinquent helps destroy his “last chance” to escape incarceration and hence possible permanent stigmatization a t the hands of the court.ls

Therefore, the major reasons for refer- ring a case to a clinic for evaluation may have less t o d o with the ideal of individual- ized juvenile court treatment and more to d o with the imperatives of the system’s handicaps. First, many cases are difficult to classify within the system’s personality categorizations; they fall across categories or are unclearly defined. The referral t o the clinic is made.for assistance in determining the proper categorization of the case. Sec- ond, referrals are made in the hope that the clinic will come up with a last chance alter- native to placement. Third, the court clin- ic, as well as other diagnostic and social service institutions, provides a political tool for the court. Obviously, the judge can use a n unfavorable report from the court clinic to justify institutionalization to the juvenile, his parents, his attorney, and to the appellate courts. Inversely:

The judge can use psychiatric diagnoses and findings to justify lenient handling of the delinquent with a prior record of nu- merous or serious offenses. Hence, he can use the psychiatrist’s report t o placate po- lice, parole, or school officials, pressing for what he feels is premature or inappropriate commitment. The judge can also turn to the psychiatric report and its evidence where a decision not to commit backfires and comes to public attention. This report provides a professionally competent opin- ion to point t o in justification of a decision under political or public criticism.Ih

In large court systems, judges will use the court clinic to ( I ) insure that a problem- atic case did not return to an already crowded court calendar on the same day; and (2) allow the perplexed and overbur- dened judge the means of shifting the un- comfortable role of Solomon to highly credentialed professionals who represent a

statutorily sanctioned and ethically proper way of temporarily disposing of a case.”

Finally, many judges may refer cases to the court clinic after they have made a decision solely to insure that there is noth- ing in the history or background of that juvenile which has not been discovered. They feel that is about all they can expect from the clinic.

In addition to the pretension and abuses of mental health diagnostic and treatment services in the juvenile court, many profes- sionals questioned the effectiveness of such services in guiding the dispositional alter- natives of the court, especially as to danger- ousness. If we cannot reliably predict vio- lent behavior, how can we justify our continued incarceration ofjuveniles evalu- ated as violent? Schlesinger investigates the application of predictor variables iden- tified by nine previous studies and by staff members of a family court and its psychiat- ric clinic to clinical predictions of danger- ousness.18 The records of 122 juveniles evaluated by the clinic during a six month period were studied for the presence or absence of the variables. N o significant re- lationships were found in comparisons among predicator variables, clinic recom- mendations to the court, and subsequent dangerous behaviors. Can the use of un- substantiated and demonstrably unreliable techniques be professionally and ethically justified? And how shall we balance the rights of individuals to remain free from the control of others and society’s need to protect itself from those few who will be- come violent? The fairness of the present policies is dubious.

IN CONCLUSION

It is possible to regard the introduction of a mental health clinic into a juvenile court system from the point of view of two systems. The juvenile court is the estab- lished system with its own mode of opera- tions and traditions. The clinic is the in- coming system with its own methodology and traditions rooted in medicine and the

32 Juvenile & Family Court Journal/ February, 1980

social sciences. But since the clinic enters with the tacit knowledge that its function is subordinate to the needs and requirements of the juvenile court, it must structure its methodology and traditions to the de- mands of the juvenile court setting.

Clearly, the history of the juvenile court, the evidence of misdiagnoses, mistreat- ment, and abuses to which children have been subjected, and the lack of evidence of effectiveness tells us that rethinking of the role of mental health services in the juve- nile court is a necessity. This is not to say that mental health services have no role in the juvenile justice system. But, maybe, its role has to be re-assessed in terms of cur- rent knowledge of human behavior, the effectiveness of known treatment tech- niques, and the importance of safeguards for the legal rights of children and parents.

The proponents of a court based mental health service hold that a child or parent should be treated under the auspices of the authoritarian agency responsible for the client. Such a client should know that non- participation or failure may have certain consequences. But this type of logic would lead to the creation of clinics in all courts and protective agencies, as well as in schools - hardly the efficient way of or- ganizing community resources.

A community would be wiser to develop a community-wide public clinical service t o which courts, schools, and other child welfare agencies would have easy access in making referrals for clinical assessment and treatment. Given the present tenden- cies to request psychiatric studies in too routine a fashion, guides for referral would have to be developed between the juvenile court and the clinical service. Studies should be requested when ( I ) where the child’s and parent’s conduct in family cases appear to reflect serious emotional distur- bance, so that diagnostic guidance is neces- sary; (2) where a child or a parent shows a history of serious mental illness or psycho- pathology; (3) where an institution re- quires a psychiatric report before consider-

ingadmission of a child; and (4) where help is needed in evolving an appropriate placement plan. In delinquency cases, psy- chiatric studies should be limited to cases in which there is substantial evidence of mental illness. Studies should not be re- quested to assist in fact-finding at the ad- judication level, and they should not be used to justify incarceration as a disposi- tion. Dispositions should be based on the offense only, and not on the evaluation of the youngster. The rights of children in situations where the legal and mental health professions often confront one another should be of increasing social importance.

FOOTNOTES ‘Halleck, S., “American Psychiatry and the crimi-

nal,” American Journal of Psychiatry, 12 I , Suppl: i-xxi, 1965.

*Sarri, Rosemary, Brought to Justice? Juveniles, the Courts and the Law, Ann Arbor: University of Michigan, National Assessment of Juvenile Cor- rections, 1976, p. 231.

3Platt, Anthony, The Child Savers, Chicago: Univer- sity of Chicago Press, 1969, p. 138.

4Mead, George H., “The Psychology of punitive jus- tice,” American JournalofSoriology, 23, 19 18, pp.

‘New York Family Court Act, Art. I , sec. I15 (1976). 6Commonwealth v. Fisher, 213 Pa. 48.62 Atl. I . 198.

1905. ’Ketcham, Orman, “The Unfilled Promise of the

American Juvenile Court,” in Margaret Rosen- heim fed.), Jusficefor the Child, New York: The Free Press, 1962, pp. 22-43.

Veele, James and Sol Levine, “The Acceptance of Emotionally Disturbed Children by Psychiatric Agencies,” in Stanton Wheeler (ed.), Controlling Delinquenfs, New York: John Wiley& Sons, 1967, pp. 103-126.

vNew York Family Court Act. Art. 2, sec. 251 (1976) IOKahn, Alfred, Planning Community Services f o r

Children in Trouble, New York: Columbia Univer- sity Press, 1963, pp. 266-270.

“Fishman, Melvin and Paul Holtz, “A Plan for the Reorganization and Enlargement of Mental Health Services to the Family Court of the State of New York in the City of New York,” February 1970.

I2Spanier, Donald and Associates, “A Study of the Services and Organization of the Mental Health Clinic, Family Court, City of New York,” De- cember 1973.

‘3Resource Group Inc., “Evaluation Study of the Rapid Intervention Project,” March, 1975.

5 77 -60 2.

MENTAL HEALTH SERVICES I N THE JUVENILE COURT: AN OVERVIEW

February, 19801 Juvenile & Family Court Journal 33

EDWARD PABON

‘4Emerson, Robert, Judging Drlinquenrs. Chicago: ”Resource Group, Inc., “Evaluation Study of the Rapid Intervention Project,” March, 1975, p. 160.

‘KSchlesinger, Stephen, “The Prediction of Danger- ous in Juveniles,” CrirneandDelinquency, January

Aldine Publishing Co. , 1969, p. 266.

“Ibid., p. 266. IhIbid., p. 249. 1978, pp. 40-48.

34 Juvenile & Family Court Journal/ February, 1980