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Benjamin Chambers On Supporting SAMHSA in Making Teens a Priority in Block Grants

If you care about adolescent substance abuse treatment (and mental health treatment) this is really important.

As I posted last week, SAMHSA is proposing big changes to its mental health and alcohol and drug treatment block grants. They want your comments by this Friday, June 3, 2011.

Ho-hum, right? Far from it.

First, a little context:

  • The block grants provide a significant proportion of funding for adolescent substance abuse treatment in this country. All that "state" funding that many treatment agencies depend on is actually passed through state agencies from SAMHSA.
  • The guidelines for how the block grants work will set funding -- and service -- priorities for years to come at the national and state level.

The good news is, SAMHSA specifically included youth with substance abuse issues as a priority population when it drafted its proposed changes to the block grants. Here's a direct quote from p. 20,000 of the notice the agency published in The Federal Register seeking comments:

The focus of SAMHSA’s Block Grant programs has not changed significantly over the past 20 years. While many of these populations originally targeted for the Block Grants are still a priority, additional populations have evolving needs that should be addressed. These include military families, youth who need substance use disorder services, individuals who experience trauma, increased numbers of individuals released from correctional facilities, and lesbian, gay, bi-sexual, transgender and questioning (LGBTQ) individuals. The uniform plan required in the Block Grant application must address the statutory populations (as appropriate for each Block Grant) and should address these other populations [emphasis added].

The bad news? Rumor has it that SAMHSA is getting pushback from some states who don't want to prioritize these special populations. We need to make sure that youth who need drug and alcohol services are not removed as a priority population -- we need to speak up, loud and clear, and support SAMHSA's original language.

Comments should be sent to Summer King, SAMHSA Reports Clearance Officer, at summer.king@samhsa.hhs.gov.

The above story appeared in slightly different form on the website of Reclaiming Futures, a national initiative working to improve alcohol and drug treatment outcomes for youth in the juvenile justice system. It has been reprinted with permission.

 

 

Ben Chambers On What Juvenile Courts Should Know about Trauma and Delinquency

It's not a secret that many youth in juvenile court struggle with symptoms related to trauma, but it can be hard to remember in court, when faced with a defiant youth who's been repeatedly delinquent.

So it's great to see a new publication from the National Council of Juvenile and Family Court Judges, 10 Things Every Juvenile Court Judge Should Know about Trauma and Delinquency.(Even though it seems to be aimed only at judges, it's useful for all staff who work with or in juvenile court.)

Scoff at the idea that trauma could be related to breaking the law? Here's a telling observation from the publication:

It does not go unnoticed by youth when their safety and well-being is not addressed but their delinquent behavior is. These kinds of paradoxes and frustrations can increase the likelihood that youth will respond defiantly and with hostility to court and other professionals who are in positions of authority. System professionals would benefit from recognizing that imposing only negative or punitive consequences will likely do little to change the youth’s patterns of aggression, rule breaking, and risky behaviors because such a response does not address the impact of traumatic stress on the child. By recognizing and addressing the role of trauma in the lives of youth, the court and other systems can become more effective in meeting the needs of the justice-involved youth and the needs of the community.

And, just to whet your appetite, here's the first three things on the list:

1. A traumatic experience is an event that threatens someone’s life, safety, or well-being.

2. Child traumatic stress can lead to Post Traumatic Stress Disorder (PTSD).

3. Trauma impacts a child’s development and health throughout his or her life.

4. Complex trauma is associated with risk of delinquency.

For the rest of the list and lots of helpful detail, including the research behind the publication, download the full document and share it with your colleagues. Other resources on childhood traumatic stress are also available from the document's other co-sponsors, The National Child Traumatic Stress Network, and the Office of Juvenile Justice and Delinquency Prevention (OJJDP).

The above story is reprinted with permission from Reclaiming Futures, a national initiative working to improve alcohol and drug treatment outcomes for youth in the juvenile justice system.

 

Benjamin Chambers On Positive Youth Justice

We often assume that teens land in the juvenile justice system because they're "villains" or victims (of trauma, circumstance, or a behavioral health issue like substance abuse).  But what if we used a different lens?

What if we assumed that teens commit crimes to meet needs typical of of all adolescents? After all, during this phase of development, teens want excitement, power, status, and a sense of belonging. (Plus, they're not strong on empathy, paving the way for criminal behavior.)

Using this lens instead of a villain/victim lens means changing what we do. It means working with communities to help teens meet their developmental needs in more positive, constructive ways, so they can live crime-free lives.

While this "positive youth development" approach is not blind to the fact that teens' delinquent behavior has real consequences and real victims, or to the fact that young people in the justice system also need behavioral health care, physical health care, and other services, it makes use of a largely-untapped source of positive change. Rather than focus on fixing their deficits, it helps youth identify and grow their assets and strengths.

You'll find all this in a great report from the Coalition of Juvenile Justice, titled, "Positive Youth Justice: Framing Justice Interventions Using the Concepts of Positive Youth Development," authored by Jeffrey Butts, Gordon Bazemore, and Aundra Saa Meroe.

In it, the authors propose that positive youth development can be used as a framework for designing general interventions with young people in the juvenile justice system. (See above for their matrix, taken from page 31 of the document.) As they explain it:

"The Positive Youth Justice Model ... includes 12 key components depicted as a 2 by 6 matrix. Each cell in the matrix represents the interaction of two key assets needed by all youth: (1) learning/doing, and (2) attaching/belonging. Each asset should be developed within the context of six separate life domains (work, education, relationships, community, health, and creativity)."

Of course, the matrix is only a guide. (And bear in mind that the activities listed in the matrix are only examples. In theory, a fully-developed approach would include more than one activity in each of the six domains, and they would be tailored to youth interests and what was available in the community.)

But the matrix could be powerfully transformative for juvenile justice systems as well as youth. In fact, it suggests new ways to measure youth success:

The Positive Youth Justice Model also encourages practitioners to rely on the two assets and six domains as they design measurement strategies for evaluation and performance monitoring. In the health domain, for example, the [m]odel reminds practitioners that they need to measure whether youth are gaining the knowledge and experience to live healthy lives, but they also need to track whether youth form stronger attachments as they apply knowledge and gain experience. Thus, measurement strategies must do more than track a youth's participation in vigorous exercise and any improvements in stamina and fitness. Practitioners need to measure a youth's sense of belonging and group attachment as it relates to physical activity. Using subjective measures such as interviews and questionnaires, a practitioner might ask youth to describe their feelings about group membership. Do their feelings grow more positive over time in relation to their participation in fitness activity? Using objective measures such as behavioral observation, do youth collaborate effectively in team sports and does their level of collaboration improve over time?

One can immediately see the power of this approach, especially with youth in recovery from alcohol and drug treatment -- their developmental needs are identical to youth who are not in recovery, and they, too, need help learning to have fun and contribute to their communities in positive ways.

The above story is reprinted with permission from Reclaiming Futures, a national initiative working to improve alcohol and drug treatment outcomes for youth in the juvenile justice system.

Benjamin Chambers on Some Surprising Findings About Youth Attitudes Toward Crime

Do delinquent teens see criminal activity as something positive?

Many adults assume that they do. However, research by Rachel Swaner and Elise White, published in 2010 by the Center for Court Innovation, suggests that for some youth at least, their attitudes and values are not anti-social at all. Though the youth outcomes in their study were not terribly positive, it underscores the need to provide youth with opportunities to do positive activities that reinforce their positive values.

The study, titled, "Drifting Between Worlds: Delinquency and Positive Engagement among Red Hook Youth,"  involved a small sample of 44 youth in a housing project in Red Hook, Brooklyn. About half participated in Youth ECHO, a positive youth development program that enlisted the youth themselves in choosing community problems to tackle, and creating guerrilla marketing campaigns to address them.

A few highlights from the study:

  • Youth participating in the program thought they were doing important, useful work that "mattered to other young people." They also "expressed a desire for more opportunities for positive engagement, specifically for programming that was youth-led."
  • The youth wanted to be seen as successful and wanted to obtain skills that would help them find work. Also, they "did not value 'easy money' or express a desire to get by without working."
  • The young people tended to define "crime" as violent. They did not see low-level delinquent behavior -- such as fighting, doing alcohol or drugs, or truancy -- as criminal.  "Moreover, the youths identified basic reasons for committing these petty crimes, saying that 'there's nothing else to do' and that they need the money gained through their petty crimes to live." (Bear in mind, however, that these youth were engaged mostly in low-level delinquency, and were not, for example, involved in serious gang activity.)

Here's what I found most interesting:

  • "Despite their desire to effect positive change in their community, Youth ECHO participants struggled with consistently avoiding the activities they were supposed to be condemning, as well as other delinquent activities. For example, a couple of participants reported continuing to sell drugs. During the course of their participation in the program, the numbers of all participants having been arrested and having used alcohol, cigarettes, or marijuana in the past 30 days significantly increased from 43 percent, 19 percent, and 29 percent, to 52 percent, 33 percent and 38 percent, respectively. These increases were potentially due to one of the cohorts ending their program in the summer, when they had more free time to be engaged in those activities. Other survey data showed that greater civic engagement was correlated with feelings that delinquent behaviors (e.g., skipping class without an excuse, petty theft, smoking and selling marijuana) were not wrong."

The authors concluded that youth attitudes toward crime and pro-social activities are more complex than we give them credit for. Their description of youth "drifting between worlds" of criminality and productive work seems perfectly consistent with what we know about adolescent development: teens are still malleable. Sure, they'll commit a crime because they're bored or need money, but the next day, they'll turn around and make a positive contribution to their community because caring adults took the time to engage them and focus their energies.

The question is, are we providing them with enough "windows of opportunity" to contribute to our communities?

The above story is reprinted with permission from Reclaiming Futures, a national initiative working to improve alcohol and drug treatment outcomes for youth in the juvenile justice system.

 

 

Benjamin Chambers: Juvenile Drug Courts – There ARE Practice Guidelines

Some of you may have heard this disturbing account of a drug court in Glynn County, Georiga, aired recently on "This American Life."

Usually, a drug court may take a year, possible two years, to complete.  For 24-year-old Lindsey Dills, who was 18 when she entered the Glynn County juvenile drug court, she won't be done with it until 10-1/2 years later, counting time behind bars and probation.

Now, the show makes it clear that this particular Georgia drug court is commonly thought to be run counter to generally-accepted principles of drug court.

But I thought it would be a good time to mention the so-called : "16 strategies" for juvenile drug courts.  (Follow the link for a monograph from the Department of Justice, explaining the details.)

Here they are:

  • Strategy 1: Collaborative Planning
  • Strategy 2: Teamwork
  • Strategy 3: Clearly Defined Target Population and Eligibility Criteria
  • Strategy 4: Judicial Involvement and Supervision
  • Strategy 5: Monitoring and Evaluation
  • Strategy 6: Community Partnerships
  • Strategy 7: Comprehensive Treatment Planning
  • Strategy 8: Developmentally Appropriate Services
  • Strategy 9: Gender-Appropriate Services
  • Strategy 10: Cultural Competence
  • Strategy 11: Focus on Strengths
  • Strategy 12: Family Engagement Strategy 13: Educational Linkages
  • Strategy 14: Drug Testing
  • Strategy 15: Goal-Oriented Incentives and Sanctions
  • Strategy 16: Confidentiality

 

The above story is reprinted with permission from Reclaiming Futures, a national initiative working to improve alcohol and drug treatment outcomes for youth in the juvenile justice system.

 

Benjamin Chambers: Evidence-Based Practices for Children Exposed to Violence: A Selection from Federal Databases – and More

Seems like youth violence -- and ways to address it -- is all over the news right now.

1.  Research: Children Exposed to or Victims of Violence More Likely to Become Violent.

A study of 800 children between ages 8 and 12 showed that kids exposed to violence think it’s normal and are more likely to become aggressive.

2.  Evidence-Based Practices for Children Exposed to Violence: A Selection from Federal Databases.

This publication from the U.S. Departments of Justice and Health and Human Services "summarizes findings from federal reviews of research studies and program evaluations to help communities improve outcomes for children exposed to violence. It cites evidence-based practices that practitioners and policymakers can use to implement prevention services and activities for these children." (H/t to www.findyouthinfo.gov.)

3.  National Summit on Gender-Based Violence Among Young People: Reading Materials

"On April 6th and 7th, The Department of Education hosted The National Summit on Gender-Based Violence Among Young People. The summit brought together more than 150 major organizational, federal and academic leaders to discuss how to translate research into practice, highlight promising practices, and provide the field with the tools they need to serve our nation's students. The purpose was to engage federal partners and the broader field in developing a comprehensive federal strategy to address the issue of Gender-Based Violence among young people. Topics discussed included: domestic violence, teen dating violence, sexual harassment and sexual assault." (Hat tip to www.findyouthinfo.gov.)

4.  Summit on Youth Violence

The Department of Justice hosted this summit on April 4, 2011.  (You can read Attorney General Eric Holder's speech) here; and event coverage from The Crime Report here.)  Mayors and other officials from six cities -- Boston, Chicago, Detroit, Memphis, Salinas (CA), and San Jose -- presented comprehensive plans to prevent youth violence in their communities. The Departments of Justice, Education, Health and Human Services, Housing and Urban Development, Labor and the White House Office of National Drug Control Policy are collaborating to provide technical assistance to the participating cities.

According to JUVJUST , the cities' comprehensive plans to prevent youth violence are available at www.findyouthinfo.gov, but I wasn't able to find them. However, you can find a lot of related resources on youth violence prevention on that site.


The above story is reprinted with permission from Reclaiming Futures, a national initiative working to improve alcohol and drug treatment outcomes for youth in the juvenile justice system.

 

Benjamin Chambers: What Works with Serious Juvenile Offenders – Pathways to Desistance Study

Does the juvenile justice system really work?

Reading comments from readers on news stories about youth in trouble, you'd think the juvenile justice sysem was a system designed to mollycoddle dangerous kids, turning them into super-predators.

Nothing could be further from the truth.

Among other reasons, we know this because of "Pathways to Desistance," a research study led by Edward P. Mulvey, Director of the Law and Psychiatry Program at Western Psychiatric Institute and Clinic at the University of Pittsburgh School of Medicine. (Dr. Mulvey and Carol Schubert contributed a post to us on their findings in April 2010.)

The "Pathways to Desistance" research study is a unique study of what works in the juvenile justice system. This large, multi-site research project followed 1,354 serious juvenile offenders for seven years. An informative brief on the study findings was released in 2009 by the MacArthur Foundation; now, the Office of Juvenile Justice and Delinquency Prevention (OJJDP) has released another fact sheet, titled, "Highlights From Pathways to Desistance: A Longitudinal Study of Serious Adolescent Offenders."

Here's what the study found:

  • Most youth quit or reduce their offending over time.  Only 8.5 percent of the youth in the study persisted at high levels of offending. As Dr. Mulvey explains in the OJJDP fact sheet,

"Two factors that appear to distinguish high-end desisters from persisters are lower levels of substance use and greater stability in their daily routines, as measured by stability in living arrangements and work and school attendance."

  • Providing services and sanctions based on individual need -- factors including substance abuse, mental health needs, family background -- could be more effective than providing them based on severity of the crime and prior convictions. Surprisingly, the researchers found that the youth who persisted in offending and those who reduced their offending behavior got about the same kind and intensity of services.
  • In a related finding, the study found that incarceration did not reduce offending. In fact, for the subgroup of serious juvenile offenders who greatly reduced their offending after contact with the justice system -- who spent about 30 percent of the study followup period in institutional care -- incarceration actually increased their offending to a small, but statistically signifcant degree.

If locking them up didn't help, what did? Community-based services and probation supervision. As Dr. Mulvey writes,

"Youth who received community-based supervision and aftercare services were more likely to attend school, go to work, and avoid further offending during the 6 months after release, and longer supervision periods increased these benefits."

  • For many of these youth -- those meeting their definition of "serious juvenile offenders" -- substance abuse treatment is key, as the MacArthur Foundation brief makes clear:

"Levels of substance use and associated problems are very high in these young offenders. More than one-third qualify for a diagnosis of substance use disorder in the year prior to the baseline interview, and over 80 percent report having used drugs or alcohol during the previous six months. Moreover, the level of substance use walks in lockstep with illegal activity over the follow-up period: more substance use, more criminal offending."

Treating youth for at least 90 days, with their family members involved, cut both their substance abuse and their offending, at least during the six months after treatment.  (Tellingly, the sub-study this conclusion was based on, "Substance use treatment outcomes in a sample of male serious juvenile offenders," which appeared in 2009 in the Journal of Substance Abuse Treatment, found that only 25% of the serious juvenile offenders in its sample received treatment that included family members. The study authors speculated that this might be partly because these offenders were being treated in secure institutional environments, rather than the community.)

In an age when every state is trying to find money to fund juvenile justice services, policy makers should be turning to this research to help them guide funding to what works in juvenile justice.

The above story is reprinted with permission from Reclaiming Futures, a national initiative working to improve alcohol and drug treatment outcomes for youth in the juvenile justice system.

Benjamin Chambers on Reducing School Violence and Suspensions with Restorative Justice

The bad news: recent research indicates that schools suspend far more kids than they need to, and youth – especially youth of color, though not always -- suffer unfairly for it.

The good news? Sure, zero-tolerance school discipline policies need revision. But there's another solution to the problem: changing school culture by implementing mediation and "restorative justice" techniques in schools.

First, the background. "Suspended Education: Urban Middle Schools in Crisis," by Daniel J. Losen and Russell J. Skiba, published by the Southern Poverty Law Center, makes for fascinating and depressing reading. After reviewing more than 30 years of data from nearly 10,000 middle schools nationwide, it concludes that suspension is over-used as a disciplinary tool, and that youth of color -- black males especially -- are suspended far out of proportion to their numbers.

The authors looked specifically at types of suspensions where school staff could exercise discretion -- incidents of fighting, disruptive behavior and so on. They analyzed how many youth were suspended and broke down differences by race/ethnicity, and gender.

What they learned was appalling: suspension rates have nearly doubled for students of all races/ethnicities since 1973; African American, Latino, and American Indian youth were suspended at higher rates than white youth; 6 percent of all black students were suspended in 1973, compared with 15 percent in 2006; and a breathtaking 28.3 percent of black males were suspended in 2006, compared with 10 percent of white males.

When researchers looked at the 18 largest urban school districts, they found that most "had several schools that suspended more than 50 percent of a given racial/gender group." They even found schools that suspended more than half of their white and Hispanic female students.

Seriously. 50 percent.

Worse, the authors point out that the federal data they used only counts students who've been suspended at least once -- it doesn't actually count the number of suspensions. So their conclusions probably underestimate the frequency of suspensions, and the impact on these students' classroom time (which is linked to their likelihood of dropping out and, of course, their chances of ending up in the juvenile justice system).

You might be shrugging your shoulders and saying, "Well, if it makes the school safer and helps other students learn better ..." Here's what the authors have to say about that:

[D]espite nearly two decades of implementation of zero tolerance disciplinary policies and their application to mundane and non-violent misbehavior, there is no evidence that frequent reliance on removing misbehaving students improves school safety or student behavior.

In fact, frequent use of suspension and expulsion as disciplinary tools doesn't seem to help other students do better:

[E]merging data indicate that schools with higher rates of school suspension and expulsion have poorer outcomes on standardized achievement tests, regardless of the economic level or demographics of their students. It is difficult to argue that disciplinary removals result in improvements to the school learning climate when schools with higher suspension and expulsion rates average lower test scores than do schools with lower suspension and expulsion rates.

Since research suggests that instructional time is strongly related to achievement outcomes, a policy shift is necessary:

It is critical to note that schools with very high suspension rates (e.g., suspending one-third or more of the student body at least once) are not receiving the kind of public attention or regular exposure that schools with low test scores receive.

The disparate impact on youth of color, and black youth in particular, makes this a civil rights issue, the authors say. Here's why:

Research on student behavior, race, and discipline has found no evidence that African-American over-representation in school suspension is due to higher rates of misbehavior (McCarthy and Hoge, 1987; McFadden et al., 1992; Shaw & Braden, 1990; Wu et al., 1982). Skiba et al. (2002) reviewed racial and gender disparities in school punishments in an urban setting, and found that white students were referred to the office significantly more frequently for offenses that appear more capable of objective documentation (e.g., smoking, vandalism, leaving without permission and obscene language). African-American students, however, were referred more often for disrespect, excessive noise, threat, and loitering -- behaviors that would seem to require more subjective judgment on the part of the referring agent. In short, there is no evidence that racial disparities in school discipline can be explained through higher rates of disruption among African-American students.

What can be done?

One solution: mediation. And here's evidence from two Connecticut schools that mediation lowers suspension and expulsion rates.

For stronger evidence, check out this international report, "Improving School Climate: Findings from Schools Implementing Restorative Justice," showing that restorative justice and mediation in the schools has a significant positive impact on student behavior. (Restorative justice focuses on repairing the harm done to the victim, and is usually accomplished in a cooperative process with all relevant stakeholders.)

When these techniques were implemented in 10 schools in the U.S. and Canada, large drops occurred in suspensions and "behavioral incidents." Results varied by school, but reviewing the data and the comments from school teachers and administrators is inspiring.

Given the data uncovered by the Southern Poverty Law Center, it's obvious that school administrators are reaching for the suspension hammer too often. In most cases, it's safe to assume that they probably didn't feel that they had another option.

Now, they do. It's time to start using them.

The above story is reprinted with permission from Reclaiming Futures, a national initiative working to improve alcohol and drug treatment outcomes for youth in the juvenile justice system.

What do Teens in Prison Need to be Successful?

Click to view full video

Imagine being ripped from your safe, normal professional life and thrust into federal prison for a year, for something stupid you did when you were a teenager, or even a young adult.

Piper Kerman doesn't have to imagine it, because that's exactly what happened to her. She was locked up in a federal prison at age 34 for a drug crime she committed in her early 20s.

Because Kerman spent a year living in close quarters with many women, including 18- and 19-year-old girls, she has an unusual, nearly first-hand perspective on what teens in prison need to be successful.

Here's her suggestions about what they need:

  1. Positive attention. Kerman found the teens in particular were incredibly responsive to positive attention, creating significant opportunities for change -- opportunities that were often missed.
  2. Continued connection to their families and their own children.
  3. Alcohol and drug treatment and mental health services.

But you should really hear it from her own lips: check out the video above.

What impact did the experience have on Kerman?  It moved her to produce an acclaimed memoir of her experience, Orange is the New Black: My Year in a Women's Prison – a memoir, she says, which even her former cellmates are pleased about.

More importantly, perhaps, the experience turned Kerman into an advocate for criminal and juvenile justice reform, and for addressing disproportionate minority contact in the adult and juvenile justice systems.

The above story and video are reprinted with permission from Reclaiming Futures, a national initiative working to improve alcohol and drug treatment outcomes for youth in the juvenile justice system.

Illinois to Cut All Alcohol and Drug Treatment Spending – Will Other States Follow?

Blogger Benjamin Chambers brings up the subject of debilitating state budget cuts, pointing out the depressing news that the state of Illinois plans to zero-out its budget for alcohol and drug prevention and treatment programs and asks, just how bad can it get?

As of March 15, the state of Illinois is cutting its $54 million budget for alcohol and drug treatment and prevention services to zero (full disclosure: I wrote the news summary linked to here).

That's right: zero.

According to providers, that means many of them will shut down.

What's left, without state money? According to provider representatives, about 80 percent of their clients (or about 55,000 people) get treatment funded by the state, leaving 20 percent of their clients who are covered by Medicaid -- -- women only, though. The state will reportedly be cutting the amounts it reimburses for Medicaid services by six percent.

What's not precisely clear from news reports is the impact on youth treatment. Prevention services serving about 230,000 youth a year are definitely gone, but children's treatment can be covered by Medicaid - I'm not sure how that's handled in Illinois. However, in my experience, most treatment agencies rely on the volume of their adult treatment programs to support their youth treatment programs. Without the mix, I would guess that many youth programs -- even those billing Medicaid -- might not survive.

Will other states follow?

The above story is reprinted with permission from Reclaiming Futures, a national initiative working to improve alcohol and drug treatment outcomes for youth in the juvenile justice system.