TREATING TEENS

Introduction and Overview

An untold story of drug and alcohol abuse among the nation's adolescents is the degree to which the juvenile justice system has become the de facto substance abuse treatment provider for young people in trouble with the law. As such, it struggles to reinvent itself to meet a rapidly growing demand for services that effectively help youths to change their lives.

Despite our best efforts to get substance abuse treatment to the youths who need it, the gap remains high between the haves and the have-nots. Estimates suggest that fewer than 10% of youth who appear to need treatment ever get it (Dennis, Dawud-Noursi, Muck and McDermitt, 2001). Our communities pay for this shortage of services in many ways. Compared to their non-drug using peers, those who abuse substances are 3 to 47 times more likely to end up in emergency rooms, do poorly in school, engage in disruptive behavior, find themselves in trouble with the law or be arrested (Dennis & McGeary, 1999). Many of these youths have co-occurring mental health problems, presenting even more challenges (Cocozza and Swowyra, 2000).

Contributing to the troubling equation at the local level are: a high availability of drugs and alcohol, an increasing number of adolescents with little to do, schools and community youth programs facing cutbacks, economic turmoil among families with few resources, and increasingly punitive attitudes towards juveniles. At the national level, the problems of delinquency and substance abuse cost millions of dollars, threaten public safety and disrupt other efforts to build strong communities.

Without intervention and application of an emerging base of evidence-based models, many of these youths will progress towards a more complex and entrenched association with delinquency, later addiction, crime and prison-making our failure to intervene even more costly. Providing substance abuse and related comprehensive services for juvenile offenders is a bargain compared to the long-term costs of the alternative. The lack of appropriate, accessible and effective substance abuse and related integrated services for youths before as well as within a juvenile justice setting should be viewed as one of the most important public health crisis in America.

The Numbers

It has been well established that the substance abuse patterns of youths in the juvenile justice system are dramatically higher than that of the general youth population, and that this relationship is a key precursor to a delinquent career (DiIulio and Baldwin Grossman, 1997). As their substance abuse problems go untreated, increasing numbers of these youths are likely to find themselves in trouble with the law.

In fact, although juvenile delinquency has decreased during recent years, there has been a dramatic increase in the numbers of offender youths entering the juvenile justice system on drug-related charges (U.S. Department of Justice, 1999). Specifically, there has been a 144% increase in juvenile drug abuse violations and a 183% increase in juvenile drug abuse cases that were formally processed among juvenile offenders in the last few years (U.S. Department. of Justice, 1999). One study showed that during the last 10 years there was a 291% increase in the rate at which young people were incarcerated because of drug involvement in general, and the increase in drug-related incarcerations for young black men during that same period was 539% (Schiraldi, Holman & Beatty, 2000). One result of these dramatic increases in justice's focus towards youth and drugs is that the juvenile justice system has found itself as the largest single referral source for youths in publicly funded substance abuse treatment (Dennis & McGeary, 1999). Availability of consistent screening, assessment, and substance abuse treatment (or other services related to the frequent phenomenon of co-occurring disorders) is uneven nationally, further exacerbating a crisis in the capacity to address the problem. Only 36% of juvenile corrections facilities offer any type of substance abuse treatment (SAMHSA, 1997) and juvenile probation departments cite substance abuse treatment as one of their top four program expansion needs (Torbett, 1999).

During the last 15 years, the juvenile justice system has devised a variety of approaches to effectively intervene in this nexus of opportunity between the juvenile justice and public health/substance abuse treatment systems. One result is that an exciting basis of best practices is beginning to emerge to guide the way for future reform-though their adoption has been slow across the U.S. (Nissen, Vanderburg, Embree-Bever & Mankey, 1999; VanderWaal, McBride, Terry-McElrath, VanBuren, 2001). These approaches include such innovations as community assessment centers, juvenile drug courts, and integrated treatment networks, as well as the inclusion of juvenile justice-specific innovation strategies such as balanced and restorative justice, graduated sanctions, systems collaboration, integrated case management, strength-based approaches, and efforts to reduce the disproportionate confinement of youths of color. How can juvenile justice systems best utilize the nine key elements to begin to build a strong response to these trends and seek to build innovative and evidence-based solutions to substance abuse among their young offender populations? The following represents a beginning interpretation of the elements for use in the juvenile justice setting.

Focusing the Nine Key Elements in Juvenile Justice Settings

Assessment and Treatment Matching

In juvenile justice settings, youths enter from a variety of different sources. Juvenile justice professionals need to establish a youth intake process (whether in detention or in other contexts) that screens and assesses for the presence of substance abuse and related problems, no matter how and why they enter the system.

Further, in order to make a good referral "match" to treatment, a continuum of available treatment slots must be developed to meet the unique needs of youth offenders and their families. Some of the services must be available in detention and other locked settings, as well as among community providers who are specially knowledgeable about the drugs/delinquency cycle.

Comprehensive, Integrated Treatment Approach

In short, the needs of these youths are complex and defy a solution by any one agency or professional-no matter how capable. Community services tend to occur within what have become known most commonly as funding and professional "silos." In order to meet the needs of youths and their families, the state-of-the art in treatment approaches in any youth-service endeavor generally involves learning to work across and between these systems, as well as within them. A comprehensive and integrated approach minimizes artificial barriers between systems and services, and provides services that will meet the needs of the people, not the systems involved. It also requires that dynamic case management will most likely be needed to support youths and their families through the particular legal complexities of juvenile justice, substance abuse treatment and other services.

Family Involvement in Treatment

Successful engagement of the family is often the key to the long-term success of youths in any type of formal service system. A juvenile justice contact represents a crisis for most families in which they are often simultaneously frustrated, bewildered at the complexity of the system, and anxious regarding the fate of their child. It can be even more complex and challenging if substance abuse is part of their youth's and/or their family's situation. The stigma associated with the combination of issues can be even more burdensome. Families served in the juvenile justice system may be financially challenged and may have limited linguistic and/or geographic access to people making decisions regarding their child's case. They may have substance abuse and/or other health problems themselves. Likely they have other children, jobs, or situations that require their attention and may not be able to focus on dealing with multiple systems. Great care, planning and attention should be paid to providing adequate outreach, support, education, information and hope to families in this situation. They should be given the opportunity to be involved in their child's case, as well as treatment, as full partners, and consistently given the message that although they are facing challenges-they can rise to the occasion and build a new start as a family together.

Developmentally Appropriate Program

Every service offered to youths in the juvenile justice system should reflect their unique strengths, orientations, and perspectives. They have a developmental need to be involved as partners in their treatment planning - and often provide powerful insights into their situation that professionals might miss. Because a youth has made some bad decisions- it doesn't mean that he or she is incapable of learning and modeling better community norms given an inviting opportunity. Youths not only need developmentally appropriate treatment services, but a wide range of opportunities to extend beyond the traditional rehabilitative menu; these might include such things as civic engagement, youth leadership and service learning (Bazemore & Nissen, 2000). The ability of youths to learn, grow and experiment is their most important developmental strength-even in the juvenile justice setting. Be especially wary of treatment/intervention models that have only been used with adults. Until adapted for youth specifically, they can be of little value and even create additional problems.

Engage and Retain Teens in Treatment

A judge ordering treatment does not guarantee that a youth will become engaged and complete the treatment process. Especially if a youth has had multiple previous contacts with the system, special efforts must be made to overcome cynicism and skepticism about the potential of any professional helper to tell him/her anything he or she hasn't heard before. Though it may seem obvious, it is important to approach system-experienced youth with a healthy respect. Their experiences of disappointment, ineffective or self-perceived injurious encounters with the juvenile justice system should be acknowledged rather than minimized. The most innovative programs serving youthful offenders get clients involved in dramatic ways, encourage leadership and ownership of the process, build on their strengths, challenge their behavior patterns that have proven ineffective to long-term success, and invite their ideas about how to improve their own lives and the lives of their families and community members.

Qualified Staff

Many staff enter the profession without adequate knowledge of current best practices, so staff training must reflect the rapidly emerging knowledge base across the various domains described. Without quality and regular infusions of training on new approaches, administrators and staff will likely devolve into use of outdated models that attempt to "scare" youth "straight," push them to adopt a disease model that doesn't reflect their unique perspectives, or inadequately addresses their needs for prosocial skill building and substance-free identity development. Structuring ways to become regular consumers of the research in both substance abuse treatment and juvenile justice innovations is critical to staying effective.

Gender and Cultural Competence

The data are staggering when noting the increase of youth of color involved in juvenile justice systems due to an alcohol/drug-related charge. Failing to acknowledge the unique challenges and opportunities to building more culturally responsive service options and capacities is essential to helping such youth get out of the system for good. To do this, not only should the best training and infusion of culturally-relevant best practices be adopted in substance abuse programs serving youth of color and their families, but communities of color should invited to dialogue about ways to combat the current trends and participate in efforts to decrease/eliminate disproportionate representation of youth of color in the juvenile justice system.

Additionally, girls represent the fastest growing sub-population of youth in the juvenile justice system today. Many of these clients have serious substance abuse problems for which extremely limited substance abuse and related treatment services exist. Building options for girls that are anchored in the special strengths and perspectives of this group must be an area of focus.

Continuing Care

Substance abuse treatment works best when it extends beyond a brief active intervention phase and continues to support a youth once he/she begins to put new alcohol and drug-free identity building skills to work following the treatment process. This can be challenging once a youth leaves a locked setting or the periodic monitoring of a probation officer. Careful attention should be paid to helping such a youth find adequate and effective supports that assist his/her newly-forming delinquency and drug-free identity.

Treatment Outcomes

What does it mean to successfully address substance abuse and delinquency- A first challenge is to reframe the question. Advocates need to help communities understand that punishment alone is not a solution to a public health need. Successful outcomes must be expanded and couched in youth who are redirected, rehabilitated and reclaimed - not merely sanctioned. Programs need to listen to the public safety concerns of the communities in which they live-and rise to the occasion to demonstrate how investments in treatment add a measurable value in terms of more effective services and increases in public safety. Now more than ever, the emphasis on evidence-based practice should be clear and substantial. Youth and family successes should be illuminated based on use of state-of-the-art approaches. Mechanisms for tracking financial and public safety incentives should be encouraged.

Changing Systems

To accomplish what is outlined above, most juvenile justice settings will need to push for changes systemically both within their own organizational boundaries as well as across the rest of the youth services (education, mental health, substance abuse treatment, child welfare, etc.) continuum. They will need to address such barriers as scarcity of resources for needed services and service development, "turf battles," confidentiality issues, lack of linkages and coordination between agencies, slow infusion of best practices and youth/family centered approaches. They will need to involve the community differently to reflect the needs of these youths as a community challenge - not merely a justice problem.

Strategic and Shared Leadership

To change systems, leaders must mobilize. Since the challenge is greater than any one system's ability to correct the problems singlehandedly, strategic and shared leadership must address the gaps and barriers on a community-wide basis, and find the community assets that provide the necessary change. This type of leadership includes developing a community-wide vision of success for youths and their families with dual challenges of substance abuse and delinquency, and attainable action steps to change systems to support and encourage this success. Identified leadership alliances should include not only the most obvious-such as juvenile court judges and treatment providers-but should extend to all relevant stakeholder groups representing both formal and informal stakeholders in a community. A well-developed leadership team stands ready to identify, advocate and move community energy and attention to investment in redemptive policies and approaches rather than punitive.

Reclaiming Futures

In March of 2002, The Robert Wood Johnson Foundation officially funded 11 communities nationally to begin a new generation of community demonstration projects addressing the need to build community solutions to substance abuse and delinquency. Putting the above described principles to work across a variety of communities in the U.S., this five-year demonstration initiative offers an important opportunity for systems to reinvent their approaches, contribute to the development of best practices for the youth in the juvenile justice system and build sustainable systems changes and community leadership for long-term success. To learn more about these approaches, the communities, and other resources, please visit the Reclaiming Futures website at www.reclaimingfutures.org

References

Bazemore, G. & L. Nissen (2000). "Mobilizing social support and building relationships: Broadening correctional and rehabilitative agendas." Corrections Management Quarterly, 4 (4), 10-21.

Cocozza, J.J. & K.R. Skowyra (2000). "Youth with mental health disorders: Issues and emerging responses." Juvenile Justice 7 (1), 6-16.

Dennis, M.L., Dawud-Noursi, S., Muck, R.D., McDermitt, M. (In press). "The need for developing and evaluating adolescent treatment models." In S.J. Stevens & A.R. Morral (Eds.) Adolescent substance abuse treatment in the United States: Exemplary models from a national evaluation study. Binghamton, NY: Haworth Press.

Dennis, M.L. & McGeary, K.A. (1999). "Adolescent alcohol and marijuana treatment: Kids need it now." TIE Communique (pp. 10-12). Rockville, MD: Substance Abuse and Mental Health Service Administration, Center for Substance Abuse Treatment.

DiIulio, J.J. & J. Baldwin Grossman (1997). "Youth crime and substance abuse: Act-now strategies for saving at-risk children." Philadelphia, PA: Public/Private Ventures.

Nissen, L.B., J. Vanderburg, J.Embree-Bever, J. Mankey (1999). " Strategies for integrating substance abuse treatment in the juvenile justice system: A practice guide." Washington, DC: Center for Substance Abuse Treatment.

Schiraldi, V., B. Holman and P. Beatty (2000). "Poor prescription: The costs of imprisoning drug offenders in the United States." Washington, DC: Justice Policy Institute.

Substance Abuse and Mental Health Services Administration (1997). " Substance Abuse Treatment in Adult and Juvenile Correctional Facilities." Findings from the Uniform Facility Data Set, 1997 Survey of Correctional Facilities. Washington, DC: SAMSHA.

Torbet, P. (1999). "Holding juvenile offenders accountable: Programming needs of juvenile probation departments." Pittsburgh, PA: National Center for Juvenile Justice.

U.S. Dept. of Justice, Office of Juvenile Justice and Delinquency Prevention (1999). "Juvenile offenders and victims: 1999 national report." Washington, DC: U.S. Department of Justice.

VanderWaal, C.J., McBride, D.C., Terry-McElrath, Y.M., VanBuren, H. (2001). "Breaking the juvenile drug-crime cycle: A guide for practitioners and policymakers." Washington, DC: National Institute of Justice.

Key Policy Recommendations Regarding Substance Abuse in the
Juvenile Justice System

1. Federal and state governments, foundations and other organizations with national influence should increase their leadership roles in educating the public and policymakers about the relationship between substance abuse and juvenile delinquency, as well as evidence-based methods of interrupting this destructive cycle. Advocates should continue efforts to redirect trends from primarily punitive strategies to more redemptive approaches that include family, cultural and community-based orientations.

2. While increases in evidence would be desirable, the recent "renaissance" in research regarding effective substance abuse treatment is sufficient to reinforce and retool existing service delivery systems and raise the standard of care for youths with substance abuse problems in the juvenile justice system.

3. The shortage of substance abuse treatment for this group should be discussed as a public health crisis in which known services that can increase both public health and public safety are not being deployed adequately.

4. Improvements and dissemination of clinical advances should be balanced with evidence that retooling systems of care to increase their coordination, cross-system communication and integrated care plans is equally essential to improving youth and family outcomes.

5. More opportunities for synergy should be encouraged between advances in efforts to address substance abuse in the juvenile justice system with other juvenile justice reforms such as disproportionate minority confinement reduction, detention reform, attention to co-occurring mental health disorders, and creation of balanced and restorative justice models.

6. Attention to the substance abuse treatment needs of youths not yet in the juvenile justice system should continue to remain a priority-and treatment on demand should remain a goal for this group among others. To do otherwise is to indirectly contribute to the practice of net-widening in which youths (especially those in the public sector) end up in the juvenile justice system to access a treatment resource better deployed outside of a confined setting.

Strength-Based Bill of Rights for Youth in the Juvenile Justice System

1. I have the right to be viewed as a person capable of changing, growing and becoming positively connected to my community no matter what types of delinquent behavior I have committed.
2. I have a right to participation in the selection of services that build on my strengths.
3. I have a right to contribute things I am good at and other strengths in all assessment and diagnostic processes.
4. I have a right to have my resistance viewed as a message that the wrong approach may be being used with me.
5. I have the right to learn from my mistakes and to have support to learn that mistakes don't mean failure. I have the right to view past maladaptive or antisocial behaviors as a lack of skills that I can acquire to change my life for the better.
6. I have the right to experience success and to have support connecting previous successes to future goals.
7. I have the right to have my culture included as a strength and services which honor and respect my cultural beliefs.
8. I have the right to have my gender issues recognized as a source of strength in my identity.
9. I have the right to be assured that all written and oral, formal and informal communications about me include my strengths as well as needs.
10. I have a right to surpass any treatment goals which have been set too low for me, or to have treatment goals which are different than those generally applied to all youth in the juvenile justice system.
11. I have a right to be served by professionals who view youth positively, and understand that motivating me is related to successfully accessing my strengths.
12. I have a right to have my family involved in my experience in the juvenile justice system in a way that acknowledges and supports our strengths as well as needs.
I have a right to stay connected to my family no matter what types of challenges we face.
13. I have the right to be viewed and treated as more than a statistic, stereotype, risk score, diagnosis, label or pathology unit.
14. I have a right to a future free of institutional or systems involvement and to services which most centrally and positively focus on my successful transition from institutions.
15. I have the right to service providers who coordinate their efforts and who share a united philosophy that the key to my success is through my strengths.
16. I have the right to exercise my developmental tasks as an adolescent; to try out new identities; to learn to be accountable and say I'm sorry for the harm I've caused others - all of which is made even more difficult if I'm labeled a "bad kid."
17. I have the right to be viewed and treated as a redeemable resource and a potential leader and success of the future.

Developed by Laura Burney Nissen, Ph.D., MSW, CAC III, 1998