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We Do Need Candidates for Change — in Justice System

TimberlakePresidential politics is in full swing and while the number of candidates is being reduced, those remaining are still in the platitudes stage. You know how it goes: Each speaker states his or her faith in America, the strength and world leadership of the United States, the need to right the wrongs of past politicians, that progress must be made and that only “Change!” can save our future.

Change to what?

We have candidates on both ends of the political spectrum whose prospects seem dim in comparison to decades of experience that tells us that a centrist establishment contender will make it to the White House.

As the primaries whittle away at the number of people on the political stage, those remaining will have taken positions on a variety of policy issues, and some may even explain how they would accomplish their policy goals. This structured progression of politics will be repeated by candidates in state and local elections without as much media coverage but with the same orchestrated familiarity.

Some commentators believe that there is something new in this election cycle. They believe that the popularity of Donald Trump and Bernie Sanders contains a difference from past elections. An inexperienced billionaire and a self-identified socialist are unlikely contestants in a presidential race, but they both champion “change” in a way that is attracting millions of likely voters.

The candidates’ beliefs about what change means are worlds apart, but the phenomenon of voter interest in fundamental change is undeniable. What drives those thousands who gather to hear the words of the change candidates? Perhaps it is the dissatisfaction with lowered real wages after an historic world recession, the enormous educational debt of millennials or the wealth gap in our country. Politicians and parties would do well to recognize the reality of dissatisfaction with the world as it is.

[Related: Juvenile Reforms Included in Senate Criminal Justice Package]

On the off chance that a change in rhetoric becomes a work plan, I hope it means voters will support candidates who argue mass incarceration is not good policy or economics. Reducing jail, detention and prison populations and redirecting the dollars involved is now a point of agreement of policy wonks on the right and the left.

Successful candidates should be able to explain that out-of-home placement of any kind is likely to produce continued problems for those kids in foster care or on probation. Adequate assessment leading to effective case management provides better outcomes for kids, and that produces lifelong savings for taxpayers. We know that appropriate services can intervene in cycles of crime and family failures in ways that punishment and incarceration can never provide.

Juvenile justice reform advocates need a realistic plan to produce officeholders at every level of government who understand the current science of brain development and how to apply that science to practice in publicly funded agencies. We can begin by voting. Also, we must contribute our dollars to those candidates who will commit to change in meaningful ways: adequate funding for community services and probation and enacting budgets to produce positive outcomes for kids in conflict with the law and kids enmeshed in the child welfare system.

We must hold the candidates accountable to the electorate. We can ask questions in public forums and suggest questions to moderators and media commentators. Demand plans, not platitudes.

Even with this kind of specifically targeted inquiry, we all know that money still drives candidates and officeholders alike. Money in politics is not an evil. It is just a fact of how Americans choose their government leaders.

So, we need some money. How about a PAC supporting juvenile justice reform candidates? Let’s call it the “P-soup PAC.” It could support Politicians who commit to adequately fund Probation, provide adequate training to Prosecutors and Public defenders, replace Prisons and Punishment with adequate assessment and community services, restructure Payments to provide Positive outcomes — in other words, real change.

We can use the tried and true method of spending dollars to influence elections, but first we have to acquire some. Start with cooking P-soup.

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New Initiative Will Help Raise the Bar for Serving Youth in Custody

umpierre photo Increasingly, juvenile justice advocates and system partners are calling for the closure of large, prison-like youth facilities. While these reforms are critically important given the research showing the dangers of confinement — particularly for low-risk youth — the practical reality is that reaching such a paradigm shift will not happen overnight.

In any jurisdiction, the effort will require a comprehensive strategy focused relentlessly on achieving public safety and positive youth outcomes. A full continuum of community-based services will need to be developed. Youth will need to be safely transitioned home. Buy-in from communities and stakeholders will need to be attained.

As we engage in these efforts, we must ask ourselves: What happens to the kids left in facilities in the meantime?

According to the Office of Juvenile Justice and Delinquency Prevention, approximately 54,000 youth were placed in residential facilities in 2013, representing a 50 percent decline in the number of youth in placement since 1999. Unfortunately, as the overall numbers of youth in confinement have dropped, challenges at the facility level have seemingly increased.

Anecdotally, juvenile justice administrators and staff across the country report seeing higher percentages of high-risk, high-need youth residents. This includes young people with significant educational, mental health, substance use and gang involvement issues. More than ever, staff operating these facilities seek assistance to better serve these populations.

Fortunately, there is a plethora of research on “what works” for court-involved youth. Two strategies, in particular, are supported by the science on positive youth development: (1) helping youth develop skills and competencies; and (2) supporting meaningful, long-lasting connections to families and pro-social supports. If we can do those two basic things for youth, we stand a better chance of keeping them from further penetrating the justice system and getting them on the path to success.

It is widely recognized that, in general, facilities that are smaller in capacity, maintain homelike environments and are located close to youth’s homes are better suited for therapeutic and family-focused approaches. This is why moving away from the use of big, institutional “youth prisons” is so essential.

But for many jurisdictions, changing facilities’ physical plants or hardware — or replacing facilities altogether with smaller ones based in the community — will simply not be immediately feasible. Until the system is fundamentally realigned, it is incumbent on all system partners to do everything possible with the facilities that currently exist.

[Related:You Don’t Have to Be a Judge to Champion Change for Kids]

And there’s a lot that can be done. Education programs can be transformed into dynamic learning environments that align with guiding principles and equip youth for community success. Cognitive-behavioral interventions, which help kids improve their decision-making and have been proven to reduce recidivism, can be delivered.

Family engagement can be prioritized by including loved ones and supporters in facility programming and encouraging them to visit regularly (which is linked to improved youth behavior and academic performance). The facility’s physical space can be softened with the use of color, artwork and comfortable furniture. These strategies, and many others, can help facilities create healthier environments that foster positive staff-youth relationships, promote youth development and prepare youth for successful community re-entry.

Nevertheless, in my current capacity at the Center for Juvenile Justice Reform (CJJR) at Georgetown University’s McCourt School of Public Policy, and my past experiences as co-coordinator of the National Center for Youth in Custody, I have too often seen well-intentioned facility improvement efforts fall short.

Two pitfalls to achieving sustainable reform are common: (1) initiatives are piecemeal and not intentionally linked to an overarching strategy based on core principles; and (2) administrators do not provide staff with adequate levels of training, tools and support.

Ultimately, transforming the way business is done within facilities is an exercise in culture change. If leadership cannot make the agency’s mission and philosophy permeate  every element of daily practice, and equip and empower staff to carry out the work, any reform effort is doomed to fail.

For all these reasons, we at CJJR have partnered with the Council of Juvenile Correctional Administrators to develop the Youth in Custody Practice Model initiative, an effort designed to assist agencies to deliver high-quality services to youth in residential placement. The model itself is a comprehensive, research-based framework that details the practices agency staff must undertake to achieve positive outcomes for youth, families, staff and communities.

As part of the initiative, a team of field experts will provide up to three state or county juvenile correctional agencies (selected after a competitive application process) with 18 months of intensive training and technical assistance, including on-site and distance support, to develop and begin to implement strategic action plans in targeted facilities. It is our hope that through this process we can help agencies enhance the “footprint” of their existing facilities — working to align cultures and practices with what the research shows works.

Juvenile justice reform is multifaceted and can be achieved using different, but complementary, strategies. While moving away from the use of large institutions is important, it is equally imperative that we serve those youth remaining in custody as effectively as possible.
Michael Umpierre is a senior research fellow at the Center for Juvenile Justice Reform at Georgetown University’s McCourt School of Public Policy. A graduate of Stanford University and Yale Law School, Michael's experience includes co-coordinating the National Center for Youth in Custody, serving as the chief of staff for the District of Columbia's Department of Youth Rehabilitation Services and representing youth and adults as a trial attorney at the Public Defender Service for the District of Columbia.

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You Don’t Have to Be a Judge to Champion Change for Kids

Judge Steven TeskeThe art of leadership, some say, is not in finding followers, but in creating more leaders.

Something I wish I had thought about when I first developed the school-justice partnership.

I was only four years into judging, and probably still suffering from “robeitis” — a disease unique to judges who let the robe they wear go to their head. Symptoms may include inflated opinions of one’s self, expressions of invulnerability and bouts of singing Carly Simon’s “Nobody Does It Better.”

Maybe this disease contributed to my biased attitude that only judges can be champion conveners to initiate local school-justice reform. I would later realize — while doing replication work around the country (which would bring me into contact with some unique leaders in education and law enforcement) — that my opinion of the judicial role was inflated.

There is no doubt that judges possess the best vantage point to champion change for kids. You are sitting as a traffic cop in a courtroom that is the intersection of juvenile justice and its multiple stakeholders. However, too many judges say they won’t or can’t be that champion.

A collaborative model that requires a champion to convene others to begin change is most effective when “champion” is broadly defined. It should accommodate any stakeholder leader willing to exert their influence to convene other stakeholder leaders.

This is especially true in a system like juvenile justice that requires multiple parts, including mental health, social services, schools, law enforcement and the courts, to work in tandem if juvenile delinquency is to be significantly reduced. A community will never realize its true potential to improve public safety unless a leader somewhere in this system convenes others to start talking to integrate a fractured system so it can accommodate best practices.

A juvenile justice system without a champion is like a ship without a sail drifting aimlessly, its passengers hoping for land like a community wishing for fewer crimes. Without that champion to convene the different parts, the system will remain fractured. Its parts will work independently and never realize their common goal because a champion to lead them to do something uncommon is missing.

The art of reducing recidivism requires integrating a system of multiple parts, each acting as independent variables influencing the dependent variable (recidivism). As multiple regression analysis shows, the trick is to identify all the independent variables influencing a reduction in recidivism, then to create a system that best allows the variables to mesh at the right moment with the right kid to increase the effectiveness of treatment.

[Related: Convicted on Drug Charges, Georgia Youth Faces Life After Rehab]

We know that family dysfunction, lack of school-connectedness, antisocial peers, substance abuse, cognition (attitudes, values and beliefs) and weak problem-solving skills are risk factors for delinquency. We also know that the services provided to minimize these risk factors fall within different parts of the system — a system with parts that do not lend themselves to working together, and oftentimes working against each other.

The school-justice partnership model devised in 2003 requires a local champion to encourage the system parts to calibrate themselves to work simultaneously. The goal is to increase graduation rates by reducing suspensions, expulsions and arrests and treating chronically disruptive kids with modalities that target the cause of the behavior.

As goes graduation, so goes crime. The more kids we graduate, the fewer adults committing crimes — a principle that can resonate with law enforcement.

And these statistics have begun to move as we begin to see law enforcement leaders filling the void created by those who can’t or won’t act to convene.

I was first introduced to Kevin Bethel, deputy commissioner of the Philadelphia Police Department, several years ago at a meeting of multidisciplinary stakeholders by the MacArthur Foundation in Chicago meant to develop insight into the problem of zero tolerance and solutions. He would return to Philadelphia inspired by what some informally refer to as the “Clayton Model” and others the “Teske Model” and convene stakeholders to create a program that diverts students from arrest on minor offenses to avoid a criminal record.

Bethel’s champion role led to a partnership that diverts students to programs sponsored by the Philadelphia Department of Human Services and supported by the District Attorney, Public Defender and the Juvenile Court. The diversion program began in May 2014. It has shown success, with student arrests dropping 54 percent in its first year with 1,000 fewer behavior incidents in the schools. These are outcomes that explain why researchers have declared the Teske Model “an ideal solution to reducing suspension and expulsion (and arrests).”

Bethel may give me credit for inspiring him to do something, but his deviation from my model’s emphasis on judicial leadership inspired me to expand the definition of a champion to include any stakeholder leader inspired to convene others.

Bethel’s academic understanding of zero tolerance and practical application of collaborative solutions recently earned him the honor of being named a Diana A. Millner Youth Justice Fellow by the Stoneleigh Foundation at Drexel University, where he will spend the next three years addressing Philadelphia’s school-to-prison pipeline. Through the university’s Juvenile Justice Research and Reform Lab, he will be seeking to “expand the diversionary program beyond students and include other youths who are first-time offenders for small crimes, like theft.”

Bethel exemplifies the art of leadership by his dedication to a model that creates more leaders.

Steven Teske is chief judge of the Juvenile Court of Clayton County, Ga., and vice chairman of the Governor's Office For Children and Families. He is a past president of the Council of Juvenile Court Judges and has been appointed by the governor to the Children & Youth Coordinating Council, DJJ Judicial Advisory Council, Commission on Family Violence, and the Governor's Office for Children and Families.

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My Truth

This letter is written to anyone who needs or wants a change in life. I hope that my experience can keep you from walking the same path as me.

I'm 20 years old serving a 50 years to life sentence, which means I won't be eligible for parole until I serve 50 years, and even then my parole isn't promised.

I was 17 years old when I got arrested, and to be honest, each year that passes I regret my mistakes more and more. It sucks to spend any birthday in prison but that's my reality.

I began my downhill spiral at the age of 12 when I started doing drugs and joined a gang. It was like a rite of passage for me, a way to prove to everyone that I wasn't a little boy anymore. That was one of the worst mistakes of my life.

I grew into this lifestyle not knowing any better. All around me gangs plagued my neighborhood for generations. The false belief that I had was that I was protecting my block, making sure no outsiders messed with my friends and family. But in reality all we do is lie, cheat and steal from each other and in most cases kill one another.

I know because I'm serving a life sentence due to a gang-related murder. And you know what's a trip? Out of all those who claimed to be my homies, not one remembers I exist. I no longer am relevant to them. Just another dummy doing time.

The only real support I have is my whole family, who has been there for me since day one. Without them who knows where I'd be right now.

I understand that some have no family and that's why they join a gang. But real family encourages you to become something in life; they don't turn their backs on you when you choose to do good. In my case I followed in many of my older family members’ footsteps. I tried to become just like them, from how they dressed to how they talked. I needed their approval. I could have chosen a different life for myself but I was too young to understand what life was.

My mom and dad did their best to keep me away from gangs, but destiny always brought me back to the same neighborhood. Twice my dad moved us away to keep us from growing up in a tough neighborhood, and twice he lost a house. So back we went to live in my aunt's garage. I was in seventh grade when my dad lost the last house.

When I came back things were different with my old friends: They suddenly did drugs and shaved their heads and talked different. They no longer desired to play kid games, so I made the decision to be like them. It was the only way for me to keep my so-called friends.

I was really young, didn't even realize what I was doing. I joined a gang. Since then I've lost two close family members to gang violence and many friends to gangs. This life is hard and don't let anyone convince you otherwise. You either end up dead or in prison, no other way around it.

All the fame and respect you think you get as a gangster is a huge lie. No matter what I did for my neighborhood, I no longer exist. I lost relevance. The new generations took my place, not realizing they will end up just like me or worse.

If only I could go back and stay in school and do the complete opposite of what I've done, I would probably be in college or something even better. Who knows where I would be?

But for you it's still possible to get it together: It's never too late. I myself continue to change the fact that I messed up big time.

Nothing is impossible, even in prison. With a little help it's all possible. All you have to do is look for help and put in effort. So I encourage you to do something with your life. All you have to do is try.

Jesus Trujillo, 22, is serving his time in the California State Prison Los Angeles in Lancaster, California.

This column appeared in The Beat Within, a publication of writing and art from incarcerated youth. David Inocencio founded The Beat Within in San Francisco in 1996. Weekly writing and conversation workshops are held in California, six other states and Washington, D.C. Submissions and new partners are welcomed. Write to him at dinocencio@thebeatwithin.org.

March Until ‘Shoot First, Ask Questions Later’ by Police Stops

Timberlake-headshot-2015-bThanksgiving has passed, leaving pleasant memories of good food with reconnected families and recollections of conversations among people who may seldom have the opportunity to speak together. The chats often begin with safe topics like the weather and current events.

As I was lifting the worst turkey I ever cooked out of the oven, one of our guests asked me what I thought of the protest marches in Chicago. The exact question was: “What do those people think blocking streets will accomplish?”

Because I had to attend to the emergency of a half-baked bird while the rest of the dinner was on the table, my response was truncated. I said that the Vietnam War was ended by people in the streets; that gay people had demonstrated to gain acceptance as members of society; and that people with disabilities marched to create a world in which they could be mobile — maybe people in the streets could move racism into history. Like the roasting of the bird, that conversation ended too early.

[Related: Time to Take Closer Look at Race in Juvenile Justice System]

Protests in Chicago, New York and around the country followed the release of the police cam video of Chicago Police Officer Jason Van Dyke shooting Laquan McDonald 16 times from maybe a 20-foot distance as the 17-year-old was walking away from police cars. The boy was reportedly high on PCP, was brandishing a knife and had been harassing some pedestrians. And he was black — Officer Van Dyke is white.

The protests in Chicago were nonviolent but very direct: Marchers stretched across a very busy interstate highway and stopped traffic. Angry participants blocked store entrances and interrupted shoppers trying to enter. No shots were fired, no blows were thrown, but a great commotion was created.

hub_graphic_racialdisp-01I did not have the opportunity to re-engage our dinner companions about their thoughts, but my guess is that the well-mannered middle-class small-town people at our dinner table were put off by the commotion: The shooting was a tragedy but it happens often in our country and what good would protesting do?

Our guests and family members are educated, accomplished and successful members of white society who would benefit from hearing the rest of the story. The video was released 400 days after the event and was forced into the public’s consciousness by a Freedom of Information Act request.

It was kept secret as other police shootings around the country prompted protests in other cities; as Chicago paid out tens of millions of taxpayer dollars to settle other lawsuits against its police; as city politics passed through primaries and a general election. The protesters want a federal investigation and the resignation of the Cook County state’s attorney, the police superintendent and Mayor Rahm Emanuel. (The mayor fired the superintendent Tuesday.)

Whether those actions would change things is unknown, but the marchers have a right to be angry.

What does this Thanksgiving conversation have to do with juvenile justice?

First, the victim was a juvenile — a 17-year-old boy with all the same characteristics we have come to understand about youth brain development. We should use scientific research to change the system, including law enforcement,  the first place in the system where a decision is made about a child’s future.

Reform work is done by cops with the support of the International Association of Chiefs of Police and Fight Crime/Invest in Kids, but the topic of alternatives in police practice usually stops at diversion. We need more — alternatives to excessive force, to deadly force.

Of course, alternatives to death on the street already exist. If force is needed, Tasers can incapacitate a person. Pepper spray can, too. “Quarantining” a kid like Laquan is a realistic policy — surround and follow — step in with force only if he does not tire out or come down from a drug-induced state or becomes a genuine threat to others.

More and better alternatives to any use of force can surely be developed but “Shoot first and ask questions later” is a practice that ignores a risk-based approach to policing and creates outrage by the targeted population — black male teenagers and their community members.

In Chicago, marchers were reacting to this child’s death but also to a system that allows secrecy to protect bad cops and those who conceal them through silence; to those who manage information in order to protect themselves from political reprisals; to those who accept voters’ confidence and then break the promise of a democratic system. We cannot accept this without protest.

So ... keep marching. Civil disobedience has led to justice in this country and can do so again. March until we get it right. Change the system.

Judge George W. Timberlake, Ret., is chair of the Illinois Juvenile Justice Commission, and an alternate member of Federal Advisory Committee on Juvenile Justice. He was a trial court judge for 23 years before retiring as chief judge of Illinois' 2nd Circuit. He is a member of the Illinois Models for Change Coordinating Council, the Illinois Juvenile Justice Leadership Council, the Redeploy Illinois Oversight Board and the board of the state Juvenile Justice Initiative.

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We All Have Responsibility to End Institutionalized Racism in Juvenile Justice Systems

Why Gang Life Is Not What It Is Cracked Up To Be

When I first joined my gang, I was 12. I believed that I wanted to be from my gang. Most of my family I grew up with was from the hood; it seems that I was destined to be too.

Everybody would tell me that I was going to be from the hood when I grew up, so it seemed like the right thing to do.

I was already sneaking out at night, watching the older homies partying at the child care center, drinking, etc. When they saw me, some would say, “Boy, take your butt back in the house,” while others would offer me a sip of their beer or a hit of the weed.

I wouldn’t realize until today that the ones that tried to ruin me were actually trying to save me from that life. Like I said, I was 12 when I joined. I fought three dudes separately because it is easy for dudes to jump you. In my hood, we want to see if you could hold your own.

Anyways, I got put on and I did what was expected of me, putting in work, harming the enemy and selling drugs. While doing all of these things, I was constantly putting my life in danger and being loyal to a group of dudes who would abandon me in my darkest hours.

It’s easy to think that the homies are going to be there for you at first because you’re always around each other, getting in trouble together, messing with females and all the so-called “perks” that come along with the gang life. In actuality, none of those so-called perks will matter in the end because you’re hurting and doing people wrong to attain what you may consider riches.

Trust me when I tell you, in the process of attaining these riches, you will be incarcerated. And when that time comes, you will start to see who your true homies are. Depending on how much time you get is when the real and fake ones start to separate.

Speaking for myself. I was in and out of juvie so I did not see it at first. I thought it was cool to be praised for going to jail, “being fresh out” and telling stories of the enemies I saw and fought! Again, I didn’t see what the future had waiting for me.

So I continued living the life of a gang member. By 14 I was incarcerated several times. Most of my cases had me taking the rap for an older homie because I would get less time than him. Constantly building a rap sheet thinking I was cool.

So fast-forward three more years to the age of 17 where I was in the car riding with some homies one night when the police pulled us over and searched the car where they found a gun. Being once again the only juvenile in the car, I took the rap for the gun, not knowing that a murder was committed with this gun I claimed was mine. About two years after that, I was arrested and convicted and sentenced to life without parole.

Now at this time, I had homies in my car telling me to tell on the homie that actually did it and how they wouldn’t go down for something they didn’t do. But who was I to go against the code I took? To never tell on your homies! So as I sat in the holding tank or shall I say attorney booth, looking my mother in her eyes as she begged me to tell and not to go down for anybody; that was the most broken-hearted decision that I ever made in my life. Having to tell my mother that I would not tell and was willing to throw my life away for the gang.

Now you want to imagine having to tell the woman that gave birth to you, fed you, raised you, took care of you, that you were throwing your life away for the gang!!! And at the age of 17, my life hadn’t even started, and I was here giving it up for what? Again, some homies were telling me that I was a real homie or a stand-up guy and how they admired me for keeping it real. But at what cost?

So fast-forward what would be now 17 years later. Guess how many of your homies have written you? Or sent you pictures, money, help, or a package or even a visit? All those years you were gone and all your homies are gone. Trust me, this gang life ain’t no joke.

In the end, only a few homies are probably going to be in your life, but mainly it is going to be your family that is in your corner. And eventually you will see what I am saying. I just hope that you won’t figure this out while sitting in a cell. This is just a small testimony to my story and one of the many reasons as to why the gang life ain’t what it’s cracked up to be.

McDuffy wrote this from the California State Prison Los Angeles in Lancaster, California. He is serving a sentence of life without parole.

This column appeared in The Beat Within, a publication of writing and art from incarcerated youth. David Inocencio founded The Beat Within in San Francisco in 1996. Weekly writing and conversation workshops are held in California, six other states and Washington, D.C. Submissions and new partners are welcomed. Write to him at dinocencio@thebeatwithin.org.

Our Justice System Stuck in the Past, As in Scottsboro Boys’ Case

Elizabeth ClarkeIn the 1930s, nine black boys were arrested for a fight on a train in rural Alabama. The assault charges turned into rape when it turned out that two of the hobos were white women who were also riding the rails.

Despite their young age, all were speedily convicted in adult court trials and placed on death row. The speed of the prosecution and their ages brought their case into the national spotlight.

Eventually, their cases were championed by two national organizations, the NAACP and the International Labor Defense, with criminal defense attorney Samuel Leibowitz from New York stepping in to represent the boys on appeal.

Numerous retrials resulted. Despite factual inconsistencies and the withdrawal of one rape complaint, the Northern lawyer had a difficult time convincing Southern juries of the boys’ innocence. Eventually, after lengthy litigation including two U.S. Supreme Court opinions, most of the boys were exonerated or freed.

It’s impossible to imagine that this case could be turned into a musical — but that is just what Mark Stein and Harley White Jr. managed to do brilliantly in “Direct from Death Row.” The musical, directed by Michael Menendian, closed Nov. 14 in Chicago. Performances were followed by a thoughtful discussion of the, sadly, still relevant topics of race and injustice in America.

How is it possible that injustice on the scale depicted in the Scottsboro Boys’ case could still be relevant? We pride ourselves on being part of an interconnected world, yet as a nation we remain “exceptional,” with a system of policing and mass incarceration unparalleled in the modern world.

The U.S. is the only nation with laws allowing life sentences for juveniles. We are the only developed nation to sanction widespread trial of children in the adult court. Racial disparities are so entrenched that Chicago’s juvenile detention center is 98 percent black and brown children. And, with just 5 percent of the world’s population, we incarcerate 25 percent of the world’s prisoners.

As the National Academy of Sciences recently concluded, our heavy reliance on incarceration is costly and has profound negative consequences — without any demonstrable evidence that it keeps us safer. The NAS report urged the U.S. to dismantle mass incarceration as quickly as possible, especially eliminating mandatory minimum sentences and extended sentences.

There is some positive movement. Black Lives Matter is shining a light on racial disparities in our justice system. Bipartisan coalitions are forming in Congress and in the states to dismantle some of the most egregiously harsh sentences for low-level drug and nonviolent offenses.

But the most hopeful sign of change is the new book by Supreme Court Justice Stephen Breyer, “The Court and the World.” Breyer makes the case that the judicial isolationism of the Supreme Court (and all the lower-level federal and state courts, I might add) threatens our rule of law and our civil society.

[Related: Schools Need Restorative Justice to Keep Kids Safe, Out of Trouble]

Breyer’s concern stems in part from a juvenile case. In overturning the juvenile death penalty, Justice Anthony Kennedy dared to point out that the death penalty was prohibited under international human rights treaties, citing the Convention on the Rights of the Child (CRC).

As Kennedy noted, most of the rest of the world had ratified the CRC and had abolished the juvenile death penalty. Kennedy merely urged the court to take note of this worldwide consensus against the use of the death penalty in juvenile cases, but his comments were widely criticized by conservatives in the judiciary and in the political world.

The criticism did not deter Kennedy: He reiterated the need to look to international standard, practice and laws in a subsequent decision involving juvenile life without parole.

The criticism is unfounded, Breyer argues. In fact, he makes the case that to ignore international consensus on issues involving crime and punishment will push the U.S. further out of the international community and will put at risk our goal of spreading the rule of law and civil society, as well as jeopardizing rule of law within our nation.

The rapid growth of human rights standards and laws was the international response to the magnitude and horror of World War II. The U.S. was deeply involved in the development of a worldwide consensus of the fundamental value and dignity of every human — the right of every human to certain liberties and treatment. We expect the human rights of free speech and assembly to be respected both within and outside the U.S. But we are less eager to champion the human right of every child to trial in juvenile court in our own nation, and to deprivation of liberty as a last resort for as short a time as possible.

The Scottsboro Boys’ case reminds us that we have been stubbornly resistant to change in the juvenile justice arena for more than 80 years. Our neighbors to the north (Canada) and south (Mexico) have developed national laws incorporating the basic international standards that prohibit trial of children in adult court, that prohibit excessive sentences including life and that limit incarceration to a last resort for as short a time as possible.

It’s time to bring our state and national laws in line with our neighbors and with the rest of the developed world. As Justice Breyer so eloquently notes, failure to do so will jeopardize our own freedoms.

Elizabeth Clarke of Evanston, Ill., is founder and president of the Juvenile Justice Initiative, a coalition working to transform the juvenile justice system in Illinois.

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American Friends Calls for Private Prison Company Divestment

Sheriff's_Prisoner_Transport_Bus

The American Friends Service Committee is the latest group to call for investors to move their money away from private prison companies, saying it’s unethical to profit from prisoners.

As part of a new campaign, the AFSC tracks dozens of companies that run facilities or provide services and supplies to such facilities, including private juvenile detention centers. The group recommends divestment from six: Avalon Correction Services, Corrections Corporation of America, G4S PLC, Providence Services Corporation, Sodexo SA and the GEO Group.

Baum
Dalit Baum, director of economic activism at AFSC

Dalit Baum, director of economic activism at AFSC, said the Quaker organization researched the industry broadly because it feels the problem goes beyond one or two high-profile names.

“The problem is not just one corporation. The problem is an entire industry,” she said. Private prisons held 8 percent of the total U.S. prison population in 2013, according to the federal Department of Justice.

Their website lists reports of abuse and mistreatment by companies, as well as discusses the ethical concerns about a for-profit prison model. They based recommendations for divestment on three criteria: if a company owns  for-profit prison facilities, has private prisons as their primary business or has proven to be unresponsive to public or investor pressure.

[Related: New Jersey Laws Could Pave Way for More Reforms]

For companies not on that divestment list, investors may be able to pressure them to change their practices, Baum said. She urged other faith and community groups to consider similar criteria to guide their efforts.

hub_arrow_2-01Other groups have been vocal critics of the for-profit prison industry as well. The United Methodist Church divested from certain private prison companies starting in 2012. After pressure from students, Columbia University decided in the summer to divest from private prison companies.

Steven Owen, a spokesman for CCA, blasted divestment campaigns in a statement, saying they are less about affecting companies’ bottom lines and more about creating publicity for activists.

“Frankly, we’re delighted to have a greater share of investors who are thoughtful about our business, can tell the difference between rhetoric and reality, and agree that the free market is a great creator of innovation and economic opportunity,” he said.

Sonia Kowal, President of Zevin Asset Management
Sonia Kowal, president of Zevin Asset Management

The president of Zevin Asset Management, Sonia Kowal, calls the AFSC website tool a boon to investor advocacy. The tool allows investors to enter lists of companies to determine if any appear on AFSC’s divestment lists.

“It’s a lot of work to figure out who’s profiting from criminalization,” she said. “I think it will be a seminal tool.”

Kowal said greater attention to the causes and effects of mass incarceration — and how investment can play a role — is necessary.

“We need a bigger groundswell and that will only happen if clients ask for it,” she said. Zevin encourages and helps clients divest from companies that contribute to mass incarceration, including for-profit companies.

Successful divestment campaigns usually are more about the debate they cause than the financial repercussions they have on a company, said David Meyer, a professor of sociology and political science at the University of California-Irvine who studies social movements.

“Divestment is a tactic that opens a space for debate and conversation,” he said.

The conversation can be particularly powerful when it takes place in a public space, such as a university’s board of trustees or a city council, rather than only on an individual level, he said.

Divestment campaigns should be wary of how the debate unfolds because a call to action can be lost among financial jargon, Meyer said.

“If the conversation shifts to investment and investment returns, you lose. If the conversation stays on the morality of private prisons, then you win,” he said.

The AFSC online guide looks at areas including facility management, youth detention and treatment, medical and mental health, community corrections, supervisions and surveillance equipment, transportation, phones, food and commissary, video visitation and probation. The group plans additional research on prisoner banking, facility construction, information technology and prison labor.

AFSC has a history of economic activism connected to civil rights, anti-apartheid and farm worker movements. The group also supports boycott, sanctions and divestment work focused on Israel and Palestine, specifically companies they say profit from the Israeli occupation of Palestinian territories.

(This article has been updated.)

More related articles:

Advocates, Analysts See Pivotal Moment in Push for Reforms

OP-ED: When Reform Fails on the State Level, Turn to Local Advocates

Texas Voters Support Criminal Justice Changes, Survey Shows

3 Steps to Reform Our Juvenile and Criminal Justice Systems

 

Where’s the Oversight of Psychiatric Meds for Pennsylvania Youth Offenders?

Troubled kids, powerful drugs

[See Part 1: Pennsylvania Juvenile Offenders Given Psychiatric Drugs at High Rates]

Pennsylvania is lagging when it comes to tracking the powerful psychiatric medications kids get in the state’s youth correctional facilities.

While other states have reformed the way they control and track such medications so that it is done systemwide, the Pennsylvania Department of Human Services follows only the total amount paid for the drugs prescribed in its six facilities on a systemic basis.

Everything else is looked at on an individual resident and facility basis. Experts and officials in other states say the fragmented approach reduces the department’s ability to see patterns and to plan effective programs.

PublicSource-logo-REDA PublicSource investigation found that psychiatric medications are being given at alarmingly high rates to the confined youth. The most powerful and risk-laden class of psychiatric drugs, the antipsychotics, was ordered in amounts that could treat an average of one-third of those in the state facilities at any given time over the seven years studied.

Among concerns about the levels of prescriptions is that the drugs can have serious side effects and may be used to keep kids in line.

The rate of antipsychotics prescribed in the state’s youth development centers and forestry camps is higher than that found for juveniles in foster care in Pennsylvania, where 22 percent were given antipsychotics in 2012, according to a study commissioned by the Department of Human Services (DHS).

The state and much of the nation is focused on stemming the high levels of psychiatric medications, also called psychotropic medications, used in foster care.

But other states have realized kids in the delinquency system often come from foster care or similar backgrounds. They have begun scrutinizing medications prescribed to both populations through the courts and the departments that oversee the facilities. In addition to tracking the meds, they have also established controls on prescribing.

hub_arrow_2-01Experts see this as a crucial health matter for kids who are already slipping through the cracks.

Robert Schwartz, co-founder of the Juvenile Law Center in Philadelphia, said the state needs a way to track variations in prescribing by doctors and facilities, the degree to which parents are involved in making decisions about treatment and the impact on kids, both foster and delinquent.

“It’s pretty clear that we do not have that system today,” he said of the state’s methods.

Review

The high-security juvenile system has been shrinking in recent years as the state moves away from placing kids in the rural facilities and invests in more community-based services.

The five youth development centers and forestry camps still open have 370 beds, but only about 270 kids were residing in the centers or camps as of Oct. 14. The sixth included in PublicSource’s analysis — the 52-bed Cresson Secure Treatment Unit in Cambria County — closed Sept. 30.

Thousands of young people, ages 12 to 20, spent time in the state facilities from 2007 through 2013. There were 606 beds in fiscal year 2007-08.

The department wrote that information on medications is maintained in individual juvenile files and monthly invoices.

“We physically do not have the system to pull this,” DHS spokeswoman Kait Gillis told PublicSource in a May 2014 phone call about the records requested. “The only aggregates we keep is the amount of money spent that has to go into the budget for how much money we spend on prescriptions.”

In a Sept. 26, 2015 email, Gillis wrote that “a review of medications and costs is conducted monthly by each health services site to monitor costs and quantity.”

She wrote that the reviews entail someone at each facility looking at costs as well as the medications and quantities given to each individual for “treatment plan management.”

The doctors and other health staff regularly monitor individual residents for how well medications are working and side effects, Gillis wrote.

Kid by kid

Melissa Sickmund, director of the Pittsburgh-based National Center for Juvenile Justice, leads several national data collection efforts on juvenile justice issues. Her job exists to collect and analyze data that can be used to make policy on state and federal levels.

Sickmund said the state could use aggregate data on prescribing to establish goals for the health care of all the kids they serve rather than only looking at each kid’s health issue in a silo.

“If you’re looking at one kid and one kid and one kid, you won’t even notice that you had that big jump, so you’re not ever going to ask yourself, ‘Why?’” she said.

The state would not discuss whether it has policies for prescribing psychotropics (a technical term for psychiatric medications).

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PolicyLab, a research arm of the Children’s Hospital of Philadelphia, released the DHS-commissioned study on prescribing to the state’s foster kids in June. There are many more children in foster care than in the youth correctional facilities. PolicyLab identified 18,400 youth who were in foster care at some point in 2012.

The department responded to that study by saying it would create an “electronic dashboard” to monitor the use of antipsychotics in foster youth.

Also in response to the study of foster children, DHS said it would create a consultation hotline for physicians who prescribe psychotropics to children, improve assessment tools and revise guidelines on treating children when parents cannot be reached in a timely manner to give consent.

Schwartz, of the Juvenile Law Center, said data collection of all kinds has put a strain on Pennsylvania state agencies, and it results in a lot of data not being collected at all.

“It’s not that it’s not doable, but it may be expensive,” he said. “It hasn’t been a priority, but many of us who work with kids think it should be.”

It has been a priority in other states, whose decisions could show the way to improve  prescription monitoring for Pennsylvania juveniles.

In Colorado, a 2014 legislative audit of youth correctional facilities found high levels of psychiatric medication prescribed.

This July, Colorado’s Department of Human Services hired a medical director to oversee the use of psychiatric medications for both foster and delinquent youth.

The Colorado General Assembly dedicated nearly $745,000 to medical management oversight for this population, according to an email from Alicia Caldwell, the department’s spokeswoman.

Other groups and institutions that provide health care to children say that monitoring and data collection are crucial to running effective programs.

Hospitals use aggregate data to see what their clinicians are doing and to understand the population they’re serving, said Kathleen Noonan, founding co-director of PolicyLab.

“It helps you forecast where you’re going, and do you want to change?” she said.

Policies

In May 2011, the Palm Beach Post reported that Florida’s Department of Juvenile Justice didn’t track prescriptions or know why doctors were prescribing certain medications.

Around the same time, the department began considering a number of juvenile justice reforms, including prescribing practices. It has since become a leader in tracking and putting controls on medications in its juvenile justice facilities.

The state has electronic medical records in its detention centers that flag the use of psychotropic medications and allows health services to track and analyze them systemwide. The department is also implementing electronic medical records in its secure residential and correctional facilities, said Laura Moneyham, assistant secretary for residential services.

Since 2012, the department has conducted regular evaluations of psychiatric medication use. The Florida department shared with PublicSource its January 2014 findings broken down by program, region, drug type and other indicators. It showed 29 percent of the youth in the state’s various juvenile justice programs were on a psychiatric medication.

Moneyham said the department has not seen a “substantive change” in the percentage of kids on psychiatric medications since they began tracking.

Florida also codified existing policies in an administrative rule in June 2014, requiring prescribers to provide clinical justification in writing for the use of more than one psychiatric medication at a time and to obtain parental consent, verbal and written, every time a new psychiatric medication is prescribed, discontinued or changed.

The rule prohibits using psychotropic meds in an emergency to control behavior. It also says they can’t be used “as punishment, for staff convenience, discipline, coercion or retaliation.”

Texas has a similar policy in place, in which an independent review is triggered any time the medications are used in emergencies.

Judges’ roles

When Allegheny County Court of Common Pleas Judge Kathryn M. Hens-Greco began to hear juvenile dependency and delinquency cases years ago, she noticed kids showing up in her courtroom in what appeared to be a drugged haze.

Her concerns, which she raised at roundtable sessions of the Pennsylvania Supreme Court’s Office of Children and Families in the Courts, resulted in a working group. From 2011 to 2014, they evaluated the use of psychiatric medications among foster children.

Pennsylvania is more easily able to analyze prescribing for foster children because they are on Medicaid. Medicaid benefits are terminated or suspended when a youth is sent to a state facility.

“Without oversight, it’s a really bad problem for our kids,” said Hens-Greco. “With oversight, what we’re really asking is for people not to make the prescription pad the first choice of treatment.”

[Video: A judge’s expectations]

When a young person is sent to a correctional facility, it is not a sentence like you see in adult court; they are called commitments and the person’s time in the facility is up to interpretation, based on progress noted by caseworkers and judges at periodic review hearings.

The state working group developed a card for judges that provides questions for them to ask to help understand and regulate medication use among foster children and youth offenders.

Two years ago, the National Council of Juvenile and Family Court Judges, a Reno, Nevada-based nonprofit with a mission to improve the family court system, adopted a resolution creating protocols for judicial oversight of these medications.

According to the resolution, judges are expected to seek out what is being prescribed and why, alternatives that have been tried and the effects of the medication. It also calls on judges to ensure that there is monitoring and that parents and children have been fully informed about the medications.

In California, the Welfare and Institutions Code requires court authorization for psychiatric medications. A physician must submit a request with the reason for the medication, the child’s diagnosis, the goals of using the medication and a description of potential side effects.

The state’s governor this month signed into law even stronger protections for kids seen in juvenile court by requiring more information on medications be submitted to courts and by training court officials to recognize overprescribing.

The policy is decidedly more generic in Pennsylvania, where judges are required to see that juveniles are receiving “necessary treatment and services,” according to Keith Snyder, executive director of the Juvenile Court Judges’ Commission (JCJC), a state agency that advises juvenile courts.

JCJC is providing judges with education on mental health treatment to better determine what is necessary in the treatment of mental health issues, Snyder said. Mental health was part of a weekend training for juvenile court judges in October, he added.

“We are going to be encouraging the judges to get more hands-on and not just trusting the treatment provider to do what we think is right,” he said.

“We send kids to treatment programs, we expect them to get appropriate treatment, and now we need, I think, to pay closer attention to what's going on in these facilities and ask pointed questions to make sure these kids aren't being overprescribed.”

Coming Sunday: State won’t disclose names of doctors prescribing in youth corrections.

A George Polk Grant for Investigative Reporting and a grant from The Fund for Investigative Journalism helped fund this PublicSource project.

Reach Halle Stockton at 412-315-0263 or hstockton@publicsource.org. Follow her on Twitter at @HalleStockton.

Data work by Alexandra Kanik, Eric Holmberg and Stockton.

 

Pennsylvania Juvenile Offenders Given Psychiatric Drugs at High Rates

This story was reported and written by Halle Stockton for PublicSource.

It’s the end of the line for these Pennsylvania kids. They’ve fallen through every safety net, and they keep making the same mistakes or more violent ones.

The kids — nearly all black or white teenage boys — are sent hours away from their families to youth correctional facilities, sterile lock-downs surrounded by barbed wire or cabins so far out in the wilderness they’re considered secure even without a fence.

They are the toughest kids in the juvenile justice system. And, in some ways, the most vulnerable.

In the months they spend at correctional facilities, they receive mood-altering psychiatric medications at strikingly high rates, particularly antipsychotic drugs that expose them to significant health risks.

Psychiatric medications are prescribed to manage mental health and behavioral symptoms; antipsychotics are a type of psychiatric medicine approved to treat schizophrenia, bipolar disorder and irritability with autism.

Kids are more vulnerable to the severe side effects of antipsychotics — rapid weight gain and diabetes among them — yet doctors and juvenile justice experts told PublicSource they’re confident the drugs are being used off-label in the state facilities to induce sleep or to reduce anxiety or aggression.

Some child advocates refer to this use as “chemical restraint.”

[Video: Julie Donohue: "Off-label prescribing is...]

Over a seven-year period, enough antipsychotics were ordered to treat one-third of the confined youth, on average, at any given time, according to a PublicSource analysis of drug purchasing information obtained from the Pennsylvania Department of Human Services, which operates the youth correctional facilities.

Only 1 to 2 percent of kids in the U.S. take antipsychotics.

Most “antipsychotic use is likely for sedation and behavioral control” in Pennsylvania’s youth correctional facilities, said Dr. Mark Olfson of the Columbia University Medical Center. Olfson is a leading research psychiatrist who reviewed the data PublicSource provided. “The new findings will hopefully spur much-needed institutional reforms.”

Thousands of at-risk kids lived in six state-operated youth development centers and forestry camps from 2007 through 2013. Within the razor wire — or dense tree lines in forestry camps — psychiatric medications are still flowing, despite the potential consequences to the developing brains and bodies of kids.

A recent study showed about one-fifth of foster care youth in Pennsylvania were taking antipsychotics in 2012 — a finding that sounded alarm bells for the Department of Human Services (DHS), which commissioned the report.

juvieRx-P1-class-cardsThe secretary of the department called the rates among foster children “disturbing” and “unacceptable.”

PublicSource’s look at the issue for the state’s most troubled delinquent young people showed even more widespread prescribing, yet Human Services officials said they aren’t encountering the same issues in the juvenile justice system.

The agency communicated with PublicSource almost entirely through email with responses approved by its legal department.

The department had weeks, and sometimes months, to respond to questions. Requests to interview DHS officials went unanswered for six weeks; an interview with Secretary Ted Dallas was scheduled and then abruptly cancelled. PublicSource shared its findings with the agency on Oct. 6.

The state also would not release the names of the doctors who are contracted to care for and prescribe to the youth, saying that it would compromise the safety of doctors if the facility residents had personal information on them.

A greater mental health need

Most of the kids are sent to the facilities after they’ve committed assaults, thefts and burglaries, or crimes related to guns and drugs. It is common for them to come from unstable homes or to roam with other kids who have had brushes with the law.

hub_arrow_2-01At its root, it is often a traumatic experience, one witnessed or committed, that drives their actions and can mimic mental illness.

PublicSource was not granted access to the facilities — one of which closed on Sept. 30. The centers are described by those who have visited as plain, with more the feeling of a hospital than a jail, but still with a maze of locked doors.

The state juvenile justice system takes youth ages 10 to 21; the state facilities saw youth 12 and 20 in the seven years studied.

For an average of seven to eight months, they’re kept on a strict schedule for meals with schooling on the premises and some socializing in common areas with TVs and computers.

PublicSource-logo-REDDHS spokeswoman Kait Gillis wrote in an email that the department provides individualized health care to the juveniles with a multidisciplinary team that regularly monitors the effects of psychiatric medications, also called psychotropics.

She wrote that 44 percent of 266 residents in the facilities on Sept. 30 had a psychotropic medication prescribed by a psychiatrist. The department conducted a manual calculation on that day shortly after receiving additional questions from PublicSource on the matter.

Many enter the facilities with a psychotropic prescription, Gillis added, and some can be weaned off as they make progress with other nondrug therapies.

“The protocols we have in place actually lead to a reduction or termination of medication when possible,” she wrote. However, the state did not share whether it has any policies or controls on prescribing.

The department could not say how many enter with such a prescription, and the invoices provided by the department did not link the medications to specific cases or diagnoses because of privacy concerns.

PublicSource consulted several health care professionals and researchers to review the data, which took two years to obtain and turn into a usable database.

While the experts did see red flags pointing to potentially excessive or inappropriate prescribing in the state facilities, justice-involved youth are known to have a greater mental health need than the general population. Studies and experts estimate that between 50 percent and 75 percent have a diagnosable psychiatric disorder.

However, not every disorder calls for a medication and certainly not an antipsychotic.

Psychiatric medications can quickly improve an adolescent's quality of life by alleviating depression or creating a clear mind. But many believe some prescribers overuse psychotropics, deploying them as a “silver bullet,” rather than addressing underlying issues.

juvieRx-P1-race-age“The great concern among children’s advocates is that ... too often the medications are used to the benefit of the institution to control behavior in ways that are not appropriate,” said Robert Schwartz, co-founder and recently retired executive director of the Juvenile Law Center, a national public-interest law firm based in Philadelphia that brought the notorious “Kids for Cash” scandal to light in 2008.

The scandal netted two judges guilty of taking $2.6 million in kickbacks to send youth to private for-profit centers and created demand for reforms to policies affecting youth in the state’s juvenile courts. Tools were adopted in many counties to assess mental health upon arrival at juvenile justice facilities, and the state began unshackling kids in courtrooms.

Quick fix

Antipsychotics, the most used of the psychotropics in the state facilities, are extremely powerful and effective.

That’s why they’re used so often in crisis.

The drugs are tranquilizing, instilling a quick calm. Some equate that calm to a stupor.

Dr. Terry Lee, a child and adolescent psychiatrist who treats residents of a Washington state-run secure juvenile correctional facility, said most antipsychotics used in correctional facilities are given to control disruptive behavior, like outbursts, aggression and breaking the rules.

“There aren’t that many kids in juvenile justice facilities who are psychotic,” he said.

Judge Kathryn M. Hens-Greco, who has heard delinquency cases for five years in the Allegheny County Court of Common Pleas, said she can’t remember ever sending a kid diagnosed with schizophrenia or autism to one of the state facilities.

Some youth with behavioral health disorders, Olfson said, are likely receiving antipsychotics inappropriately.

“If they have schizophrenia or bipolar, hopefully they are not here but in psychiatric hospitals getting rehabilitated,” he said. “I think their need for antipsychotics should make them ineligible for these facilities.”

The American Psychiatric Association says poor and minority kids are more likely to receive antipsychotics for off-label reasons. The PolicyLab, a research entity of the Children’s Hospital of Philadelphia, found 5 percent of Medicaid-enrolled children in Pennsylvania were taking antipsychotics in 2012.

It was prescribing among the state’s Medicaid-enrolled foster children driving that rate.

Antipsychotics are quick to stabilize, but can also cause rapid weight gain that can lead to diabetes, metabolic syndrome and cardiovascular problems. It may lead to brain shrinkage and a shorter lifespan.

Even the U.S. Supreme Court recognized that the brains of youth offenders are still developing when it took life sentences without parole off the table; so too, experts say, should state officials and doctors recognize they are taking a young person’s future into their hands when they prescribe psychotropics — for better or worse.

Dr. Christoph Correll, a psychiatrist and scientist, published a study in 2009 linking antipsychotic use and weight gain in youth. The kids studied gained 10 to 20 pounds in fewer than three months, he said. “Children and adolescents seem to be more vulnerable to these side effects,” he said. “We need to improve the behaviors of the mentally ill with education and healthy lifestyle and go to low-risk interventions first.

Gillis, the DHS spokeswoman, wrote that all residents of Pennsylvania youth correctional facilities get a mental-health screening within one hour of arrival. The kids are further assessed by social workers, nurses, physicians, psychological services associates, counselors and psychiatrists, she wrote.

Other therapies offered include cognitive behavioral therapy, individual and group counseling and programs for anger management and substance abuse issues, she wrote.

“There are unique challenges as many of the residents have not had consistent access to preventive care or to a medical provider,” Gillis wrote.

In the state facilities, the youth are provided a bill of rights, 22 liberties that include the rights to receive appropriate behavioral health care and to be free from excessive medication. The state contracts with the Mental Health Association in Pennsylvania to send in youth advocates. If medication questions come up, advocates refer them to a nurse.

Gillis wrote that kids prescribed certain psychiatric medications are monitored regularly through therapy, blood work and physical exams, and monthly updates are provided to the psychiatrist.

At the Washington state facility in which Lee works, he developed and implemented psychiatric practice guidelines. The guidelines include requirements to generally limit antipsychotic prescriptions to youth with psychotic and bipolar disorders; to prioritize skills training and nondrug therapy for disruptive behavior; and, when prescribing for sleep, to first use medications with more benign side effects, like melatonin or diphenhydramine (Benadryl).

Lee published a study on Oct. 1 in the journal Psychiatric Services that compared psychiatric medication costs and aggression levels at three secure juvenile facilities, including where he works.

The study, spanning 2003 to 2012, shows that Lee’s facility, with psychiatric practice guidelines, reduced its costs of psychotropic drugs by 26 percent, and incidents of aggression remained level. Costs for facilities without the guidelines doubled, and aggression levels increased, Lee said.

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Psychotropic drugs dominated the medication budgets at the Pennsylvania youth centers, accounting for more than $3.4 million of the $5.5 million spent over seven years, according to the PublicSource analysis.

The state and counties pay for medications prescribed to residents of youth correctional facilities because Medicaid benefits are terminated or suspended when a juvenile is sent to one.

Seroquel (quetiapine) and Abilify (aripiprazole) — both antipsychotics — were two of the most ordered medications. About $2.2 million was spent on these two drugs alone.

(This interactive drug app will allow you to explore the data we received from the state.)

Rx pad

There has been no thorough examination in the state or nation on the prescribing of psychiatric medications to delinquent youth — an irony considering the momentous trend of jails and prisons, both adult and juvenile, filling the role of psychiatric facility.

With fewer resources and less training to cope with aggression, the mental health system over time has lost its ability to handle youthful offenders, and correctional facilities have become the default, said Ned Loughran, executive director of the Council of Juvenile Correctional Administrators.

“The Catch-22 is the more the youth correctional facilities respond to that and develop specialized programs because they have to deal with the youth, the more the courts are going to use them,” he said.

The majority of youth offenders in Pennsylvania are in private facilities. They are for the teens with lesser crimes, fewer problems and shorter stays. The chronic or violent offenders go to the youth development centers and forestry camps.

The facilities have adapted, contracting with medical professionals who know how to treat depression, anxiety and attention deficit hyperactivity disorder (ADHD) with medications that also fall under the umbrella of psychotropics.

In addition to antipsychotic use in the six state facilities:

  •      The antidepressants ordered were sufficient to treat more than 20 percent of the confined youth, on average, at any given time over the seven years studied. That includes the drugs Prozac and Paxil, which have been shown to increase suicidal behaviors in adolescents.
  •      Mood stabilizers, like lithium, which is generally used to treat manic episodes and bipolar disorder, were the next most used of the five drug classes analyzed. The prescriptions were sufficient to treat an average of 14 percent of residents at any given time.
  •      The four child and adolescent psychiatrists who advised PublicSource were surprised by the levels of anti-ADHD medications, which were ordered about one-third as often as antipsychotics. ADHD is likely one of the most prevalent disorders in the facilities, experts said. The orders were sufficient to treat an average of 9 percent of the youth at any given time.
  •      Medications to combat anxiety were the least ordered of all the psychotropic classes, sufficient to treat an average of 6 percent of the juveniles at any given time.

It is also possible that some juveniles receive more than one psychiatric medication. It’s called polypharmacy.

If one drug starts losing its power, the meds are often layered with others.

The American Academy of Child and Adolescent Psychiatry says polypharmacy should be generally avoided.

Once a medication is on the market, a doctor has free rein to prescribe it for all kinds of symptoms. Sometimes the evidence supports its use, and sometimes not.

Correll, a professor at Hofstra University’s School of Medicine, advises using interventions with fewer side effects and rarely, if ever, trying antipsychotics off-label for sleeplessness, anxiety or ADHD. Alternatives can include anything from changing diet and sleep habits, to counseling, to other medication with fewer risks.

Finding clarity

Jennifer Drake is the national director of behavioral health services for Youth Advocate Programs (YAP), a Harrisburg, Pennsylvania-based nonprofit that provides community-based services to youth in 18 states and Washington, D.C., many of whom have been placed in corrections or foster care.

YAP has programs in 31 Pennsylvania counties and the city of Philadelphia.

Drake remembered a teenage boy who had experienced multiple placements, with medications layered at every stop.

When he returned home, YAP’s psychiatrist diagnosed him with depression. The boy was taken off antipsychotics and anti-ADHD drugs in favor of a mild antidepressant and counseling.

First, his headaches went away and he began to lose weight, she said. Then he started to break out of his shell and have conversations.

“I think all of us believe medication should only be one part of a child’s treatment,” Drake said. “They are certainly lifesaving and life-changing and many kids need them, but they shouldn't be the first line of treatment or the only treatment.”

(Read sidebar on how PublicSource got this story: Search for Data Began 2 Years Ago)

Coming Wednesday: Oversight of psychiatric meds for youth offenders lacking.

A George Polk Grant for Investigative Reporting and a grant from The Fund for Investigative Journalism helped to fund this PublicSource project.

PublicSource is a leading investigative news organization, providing Pennsylvania citizens with in-depth information. Reach Halle Stockton at 412-315-0263 or hstockton@publicsource.org. Follow her on Twitter at @HalleStockton.

Data work by Alexandra Kanik, Eric Holmberg and Stockton. App development by Kanik with help from the Institute for Nonprofit News. Graphics and charts by Kanik. Videos by Ryan Loew. Illustrations by Anita DuFalla.