IDJJ Mental Health Report Focuses on Staffing, Screening, Solitary

Dr. Louis J. Kraus
Dr. Louis J. Kraus

The report from court-appointed expert Dr. Louis J. Kraus on the mental health services provided in Illinois Department of Juvenile Justice facilities details several areas in need of improvement:

Staffing: The report points to the insufficient number of professionals, lack of a child and adolescent psychiatrist, lack of necessary licensing among mental health staff, inadequate salaries, and insufficient number of security staff.

Kraus suggested hiring a full-time child and adolescent psychiatrist at IYC Kewanee, where most youth with serious mental health diagnoses have been traditionally held. He added that the psychology 2 position, which requires a master’s degree, pays about $35,000 per year. “There was not a single psychology 2 professional who I talked to who thought this was a reasonable salary,” he wrote.

Many professionals in IDJJ lack knowledge of the subtleties of mental health issues, Kraus wrote. “My recommendation is to have a comprehensive review of the definition of what a mental health professional is, as defined by the state,” the report states. “The IDJJ should call mental health professionals what they are.”

MBR“There is a need in some cases for higher levels of training and qualifications, having licenses, having a child and adolescent psychiatrist … who can supervise and assist with the tougher cases,” said Adam Schwartz, ACLU lead counsel. “In some cases, there needs to be potentially enhancements in the salaries.”

Mental health screening and assessment: The report says IDJJ does not adequately identify youth with significant needs, allows excessive idle time, provides inadequate psychiatric review, and does not adequately separate youth of different ages.

[module align="right" width="half" type="pull-quote"]For example, one youth Kraus interviewed at IYC Harrisburg was “overtly psychotic” and was kept “in his fecal smelling room about 22 out of 24 hours a day”[/module]For example, one youth Kraus interviewed at IYC Harrisburg was “overtly psychotic” and was kept “in his fecal smelling room about 22 out of 24 hours a day” and yet was classified mental health level 2 out of 4 (with 4 the most severe), was not on psychotropic medication and did not have a clear diagnosis, the report says.

Kraus praised the department for work on screening and assessment tools, noting that it has made use of the MAYSI-2 rating scale and hired Dr. Tom Grisso, the inventor of that scale. “Other assessment tools such as the GAIN and CANS have also been helpful in assessing the youth,” Kraus wrote. “In my opinion, the IDJJ also has done a reasonable job in assessing suicide risk and doing initial screenings in a time efficient way.”

“Having the tools in place is an important and necessary step, but it’s not a sufficient step,” Schwartz said. “What is necessary is the level of staffing to use those tools and properly diagnose and treat these young men and women.”

Solitary confinement: Kraus wrote that IDJJ should end confinement for punitive reasons, particularly the improper use of specialized treatment units up to 22 hours per day. He cites a 1990 United Nations resolution supported by the United States that specifically prohibits solitary confinement of juvenile offenders, with which the American Academy of Child and Adolescent Psychiatry concurs.

If a youth is “out of control with rage and dangerous right now,” a time out works fine, Schwartz says, “capped at an hour, or less if the young person regains their composure.” If a youth is considered a suicide risk solitary “for their own protection might in some narrow cases be appropriate, but after a short time, measured in days,” he said.

Kraus said IDJJ “has done a reasonable job in differentiating solitary confinement from ‘time outs.’” In addition, he wrote “The facilities in IDJJ have done a good job in having youth that are on confinement for more than 24 hours evaluated by a mental health professional. However, the evaluations that I reviewed have been quite cursory.”

Hospitalization: Certain youths need to be removed from IDJJ and cared for in more appropriate settings, Kraus wrote. Among them are youth who are considered suicide risks for more than a short period, Schwartz said. “The longer a person stays in a psychotic state, the higher the likelihood of long term and irreversible cognitive deficits, among other risks and difficulties,” the report states. “Hospitalization can be avoided if appropriate treatment is put into place.”

Psychotropic medication: The report cites inadequate consent for medication, improper use of stimulants for youths with polysubstance use, and insufficient medication monitoring. “Most information given to the psychiatrist in follow up is from the youth,” Kraus wrote. “Occasionally there is an acute acting out behavior that is shared, but other symptomatology, which might be more subtle, clearly is not.”

Discharge issues: Planning can be inadequate, which means youths are sometimes held beyond their release date due to lack of community placements or strictly so they can complete drug treatment, Kraus wrote. “Continued IDJJ confinement, against their will and after they have been rehabilitated, is simply a violation of their human rights,” he wrote. “To force a youth to enter into a substance abuse program that they are opposed to, and force on them additional set time in IDJJ, violates their rights to refuse treatment.”

Other issues: The report cites insufficient training regarding LGBT youth, lack of specialized treatment in special treatment units, lack of outside accreditation for facilities, inadequate mental health training for security staff, failure to obtain hospital records, inadequate family therapy, and inadequate treatment for juvenile sex offenders.

Kraus’ full report is available here. 


Popular Rapper Chief Keef Sentenced to Juvenile Detention

A popular young rapper will spend the next two months in an Illinois juvenile detention center. Rapper Chief Keef was sentenced Thursday to a 60-day stay in juvie, following a June 26 probation violation.

The 17-year-old Chicagoan—whose real name is Keith Cozart—was serving 18 month’s probation for allegedly pointing a firearm at several police officers when he fired a rifle at an indoor gun range while filming a video in New York, violating his parole. As a result, not only was Cozart’s probation revoked Thursday, but he was also made a ward of the state for what a judge considered “blatant violations” of court orders.

Cozart became an overnight rap sensation last year, based on the strength of singles popularized on YouTube like “Love Sosa” and “I Don’t Like.” His major label debut on Interscope Records, “Finally Rich,” was released December 2012 and has sold nearly 100,000 copies.

Over the past two years, Cozart has been involved in several incidents with the police. In 2011, he was found delinquent and placed under house arrest on charges of manufacturing and distributing heroin. Later that same year, he received multiple charges of aggravated assault and resisting arrest, a misdemeanor.

The Illinois Department of Juvenile Justice will hold Cozart, and his next hearing currently is scheduled for March 14.

Photo courtesy of jletitiamo.

To Keep Kids Out of the System, We Need Community Involvement

Most of the teenagers walking into my courtroom were 1st or 2nd time visitors.  They didn’t want to return, and we worked with them and their parents to make that first visit their last one.

However, some kids need more support and intervention to change their life trajectories from negative to positive.

After seeing the same teens in court year after year, judges wonder what it will take to change the behaviors that keep bringing them back into court. Short of sending a youth off to a state prison, the options usually available to juvenile court judges include stern lectures and warnings, mandated community service, assessment and rehabilitative services, and electronic monitoring.

Sometimes judges reach a point where everything has been tried at least once, and yet the youth is again back in court with a new offense.  When that happens, will the judge leave the youth with his or her family and try for rehabilitation again? Or will the judge think “been there, done that” and send the youth to incarceration far from home?

Sending any young person to prison can’t be equated with sending your troubles away forever. They always return. And when they do, they go right back into the same home environment, same community, and same group of friends or gang.

A few months or even years in a juvenile prison rarely improve behaviors. Unless something has changed at home, chances are that juvenile will be back in court or will age into the adult courts.

Incarceration is an option whenever the teen poses a threat to public safety or his own safety. Otherwise, rehabilitative services are worth repeated attempts. They are far less expensive than prison and are more effective.

While every situation is different, families always are key to keeping sons and daughters out of trouble.

The youth brought repeatedly to juvenile court often have parents who had been in either the juvenile or adult system – or both. Judges, especially in rural areas like my own, come across generations of families in courtrooms. One or more family members appear in child welfare cases, domestic violence situations, small claims court and every nook and cranny of the courthouse.

Because these families are involved in both the child welfare system and the justice system, we should involve both systems in solutions. Bringing community-based services to an entire family, can help parents communicate with their children to resolve arguments and use appropriate discipline to address behavior problems. When social services involve the youth’s entire family, other children in the home benefit as well, and we sometimes can prevent siblings from following the same path into the juvenile justice system.

Early investment in prevention and assistance, such as mental health counseling and treatment for drug addictions, can pay dividends for many years into the future. Breaking a family’s cycle of juvenile and adult crime is an obvious benefit to public safety, but it also means those youth become productive citizens less likely to need other assistance or return again and again to expensive adult prisons.

In Illinois, we’re beginning to apply those same lessons to the most challenging kids and families, through Redeploy Illinois, which keeps kids out of state prisons, and through innovative aftercare programming for youth who do pass through those youth prisons.

In 2011, the Illinois Department of Juvenile Justice (IDJJ) piloted an aftercare program for youth entering prison from Cook County, our state’s largest county. By assigning specially trained aftercare specialists to work directly with youth and their families from the day they first enter prison until they leave and the months beyond, we can better prepare those youth to follow the law and continue in school.

This promising approach works with kids and families to plan for a safe and successful return home and to build support and strengths to keep kids in the community and out of costly and ineffective prisons. It's showing positive impact and is rightly being expanded across the state.

To complement IDJJ’s aftercare specialists, the Illinois Juvenile Justice Commission (IJJC) funded a youth aftercare series pilot project partnering with well established non-profit family service agencies to give added services to youth returning to some of the state’s toughest neighborhoods in Chicago and the East St. Louis region –communities sending the largest number of youth to the state’s juvenile prisons.

Using $1.5 million in federal funds, the Commission’s aftercare projects test the impact of intense, family-focused community services and support in keeping kids at home and out of prison.

Together, these projects are developing replicable models for working with young people at the “deep end” of the justice system.

These responses are even more successful when others in the community work with the juvenile justice system to reach teens in trouble. When service providers, including those outside the justice system, like faith-based organizations and schools, are trying to help the same family and can collaborate, they can create an integrated and powerful response. Communities must come together to save our children.

Whether in prison or not, we can’t give up on any young people. With the right supervision, support and services, all are capable of change and growth.

Foundation Honors Champions of Juvenile Justice Reform

Starcia Ague

WASHINGTON, D.C. -- Arrested and convicted as a teenager, Starcia Marie Ague made a decision to escape her present and her troubled past by focusing on her education. She finished high school and began taking college courses while still incarcerated. Upon her release, she completed an associate’s degree at a community college in Spokane, Wash., and went on to graduate from Washington State University with a bachelor’s degree in criminal justice in 2010.

This afternoon, Ague, who once spent six years in secure juvenile facilities, became the youngest person honored as a Champion for Change by the John T. and Catherine D. MacArthur Foundation, an award reserved for people who have demonstrated a commitment to improving the way things work in the juvenile justice system and who have creatively used the resources provided by the MacArthur Foundation’s Models for Change initiative to push for system reform.

Six other people received the awards, announced today at the 7th annual Models for Change national conference in Washington, D.C. They are Lisa M. Garry of the Maryland Department of Juvenile Services; Laura Cohen of the Rutgers School of Law-Newark; Gene Griffin of the Northwestern University Feinberg School of Medicine; Arthur D. Bishop of the Illinois Department of Juvenile Justice; Sharon Guy Hornsby of Northshore Technical Community College, Florida Parishes Campus; and George D. Mosee Jr. of the Philadelphia District Attorney’s Office, Juvenile Division.

While still an undergraduate student, Ague began to work on improving protocols for keeping records in schools and courts, and for interviewing children and their guardians. She now works for the University of Washington, offering her expertise on matters of juvenile indigent defense and working to reform the way juvenile offender records are accessed by the public.

Ague choked up when describing why she continues to represent the interests of at-risk youth in her state.

“I have chosen to do youth advocacy work both to help myself overcome my past and also to help others in comparable situations who are striving to overcome” obstacles, Ague said while accepting her award.

Through her tears, she called upon conference attendees to face “the tragedy of redeemable lives that are lost in our punitive juvenile justice system.”

“Kids who made bad mistakes should not have to pay the price for those mistakes repeatedly,” Ague said.

The High Cost of Ineffective Juvenile Justice Policy

John Last 1Anyone who has been involved with governmental agencies can probably attest to their generally poor quality of service and high level of ineptitude. Bureaucracies by their nature are designed to remove decision making power from those best able to make the decisions. They attempt to automize decision making, and the results are often predictably absurd. Juvenile justice systems are usually no exception.

A recent study of the Illinois Department of Juvenile Justice (DJJ) found it to be ineffective and costly according to a December 13th story in the Chicago Tribune. The study, conducted by the Illinois Juvenile Justice Commission, concluded that more than half of the kids who were incarcerated by the DJJ returned to the system, and that the juvenile facilities were in effect a “feeder system” for adult incarceration.

In an interview with the Tribune, George W. Timberlake, the Chairman of the Commission and a retired judge, said, "we actually saw a system that doesn't work so well, if we gauge the worth of the system in increasing public safety, doing so at the least possible cost and improving the outcomes of kids who otherwise might be part of future criminal activity.”

He contrasted the $86,000 price tag of keeping a kid in detention with the $3,000 - $5,000 cost of more effective community-based supervision programs. Also, as many as 40 percent of the kids in detention are there for conditional violations, such as missing curfew and skipping school.

According to Kathryn Baer, a public policy expert who runs the website Poverty and Policy, recidivism rates for kids in detention are 50 to 80 percent. It doesn’t take a mathematician to figure out that the current practices of locking up kids who are not dangerous, and in fact have often violated laws that are only crimes because of their age, isn’t a smart approach.

The commission also reviewed the procedure used to decide whether or not kids would be sent back to prison. In Illinois these decisions are made by prison review boards, often after the kids are cited for violations by their parole officers. The officers oversee a mix of adults and kids, usually about 100, and receive no special training for dealing with juveniles.

Although every state has its own procedures, the bureaucracy of most juvenile systems seems to lead to more failure than necessary. The woman in Tennessee who I recently wrote about sent me an email telling me a little more about her son. He was on probation, and had completed the drug treatment program, but this wasn’t reported to the proper authorities. Now he is subject to indefinite detention until he is an adult.

The failure of government agencies to do a good job is hardly surprising, but during difficult economic times it seems more galling. Continually we see evidence that prove not only that diversionary and community-based programs are more effective in deterring crime, they are also flat out more cost effective.

In Poverty and Policy Baer writes about the District of Columbia’s Youth Court. D.C.’s Youth Court is one of the largest and most successful of its kind in the country. It is an alternative sentencing program for first-time offenders that uses peer juries to make determinations of sentence. Since 1996, 11 percent of the kids who have been through the court have been rearrested. This, at a cost of about $713 per youth, seems to be an idea that is actually working. Around the country other programs are working too, but most of them face an uphill battle when it comes to getting funding. State agencies are famously adept at maintaining themselves in budgetary battles, and will often go to great lengths to discredit innovative methods that might reduce their piece of the pie.

It is my hope that policy makers will take advantage of the lean economic times to implement programs that actually work and get rid of those that are based on outmoded ideas of toughness and bureaucratic inertia. There are enough problems with the economy without spending money on things that not only don’t work, but will cost society more in the long run.