The prevalence of youth with mental health problems in the justice system is overwhelming, especially when taking into consideration racial disparities in both mental health treatment and juvenile justice system involvement. In social sciences, qualitative research is helpful as a means to gather personal perspectives. In turn, these perspectives are useful in developing relevant recommendations based on the problems observed among respondents, in this case juvenile mental health and juvenile justice professionals. To that end, I interviewed five key stakeholders working in juvenile justice and children’s mental health to assess their perceptions of persistent gaps in the service system for justice-involved youth with mental health problems. These interviews provided me with some insight regarding stakeholder perspectives on systemic gaps across states and child-serving systems. I am going to provide a summary of themes and associated recommendations based on these interviews.

Common Themes
The themes that emerged from the interviews include family support and involvement, childhood trauma, cross-systems navigation and collaboration, racial disparities, and access to services. For this post, I am only going to deep dive into two of the most common themes: family support and involvement and racial disparities.

The theme surrounding family support was most widely represented across the five respondents. For example, one of the respondents described difficulty keeping youth engaged in services due to generational trauma and cultural issues, specific to the families of youth:

“…it’s a double-edged [sic] sword and I think like because there’s like so much trauma we’re already dealing with, we’re working with families with generational trauma and cultural issues, like working with kids who live with grandparents who don’t believe in therapy and don’t want police involved or they don’t want to bring kids to the hospital.”

For youth, especially youth involve in the mental health and justice systems, family support is crucial to their success and the research literature has long established the benefit of keeping youth within the home. However, this becomes difficult when parent involvement and support is not offered.

Another notable theme that was a growing concern among respondents were racial disparities in both the mental health and justice systems, as youth involved in both the behavioral health and justice system are disproportionally youth of color. One respondent described that juvenile justice professionals,

“… know there are differences in who receives diversion. These disparities are evident because we get the kids. They end up with us at [juvenile justice organization] and we have mostly Black and Brown kids with us.”

Multiple respondents identified the need for increased representation of minority groups among providers to better relate to the culture, language, and experiences of youth of color.

Implications for Child & Adolescent Behavioral Health
Youth with mental health problems and juvenile justice system involvement are a very vulnerable population. It is imperative that policymakers address the persistent gaps in the service systems that emerged as common themes through the stakeholder interviews and are also supported by the research literature, specifically the need to reduce the overrepresentation of minority youth in the mental health and justice systems. The first step in addressing these gaps in services is to educate the leadership of organizations and agencies who serve these youth. As described in one of the respondent interviews,

“there are not standards for what it would look like to have true racial equity work.”

We must develop and define the standards to view these systems through a lens of racial equity and this begins at the leadership level. My findings also generated recommendations to address the gaps at the intersection of youth mental health and juvenile justice.

Recommendations
I propose five recommendations based on the common themes identified among stakeholders:

• The American Rescue Plan Act (ARPA) presents eight justice-related goals to be supported by the federal stimulus bill passed in March 2021. Of the eight justice-related goals, a number of them target the needs of the crossover population of youth involved in both the mental health and juvenile justice systems.
  • There is an opportunity for communities planning to pursue funding to prepare impact statements that identify the needs of their community and the target population of justice-involved youth. For instance, state and local communities have the opportunity to pursue over $125 billion in funding to minimize youth involvement in the justice system and reduce recidivism. Alternatively, another justice-related ARPA goal is to invest in community-based health programing to improve healthcare for individuals with behavioral health problems involved in the justice system (Council of State Governments, 2021).
• The Center for Juvenile Justice Reform at Georgetown University (n.d.) developed the Crossover Youth Practice Model, a conceptual framework to pursue the following goals: reduce the number of youth being dually served, reduce the number of youth in out-of-home care, reduce use of congregate care, and reduce racial disparities in the child-serving systems, specifically crossover youth.
  • For communities with existing collaborative relationships, but a need to address the crossover population of youth, it may be helpful to explore the feasibility of implementing the Crossover Youth Practice Model. The model is implemented in phases and promotes alignment of organizations’ core principals to enact organizational change in an effort to pursue systemic change for the target population of youth. Research and evaluations conducted by the Center for Juvenile Justice Reform at Georgetown University, the Annie E. Casey Foundation, and the U.S. Department of Justice, Office of Juvenile Justice and Delinquency Prevention have demonstrated the efficacy of this model in practice (Miller & Pilnik, 2021).
• Parent engagement or lack thereof was widely identified among all respondents. There is no doubt community providers and justice professionals make efforts to engage parents. According to the stakeholders I interviewed, there is a need to develop parent education programs and inform them on the purpose and incentivize treatment for their youth, especially if it is at no inconvenience to the parent. However, I believe the need lies within gaining parent perspectives to facilitate a deeper understanding of the systemic challenges that likely influence their willingness or desires to engage with child-serving systems, rather than a lack of education among parents and caregivers of justice-involved youth with mental health problems. These families have feelings of marginalization, especially families of color who are largely stigmatized within these systems. To that end, I recommend emphasis of parent and guardian perspectives among treatment providers in an effort to shift cultural barriers to treatment engagement (Aratani & Cooper, 2012; White et al., 2019). Moreover, implementation and use of parent peers and boundary spanners should be considered. Parent peers are advocates and provide support for families but may also act as mediators between the families and professionals in the field.
• In general, child-serving systems should adopt a trauma-informed approach to engaging with youth. Through the nature of a youth’s involvement in the mental health or justice system alone, they have likely experience trauma in their lifetime.
  • The Substance Abuse and Mental Health Services Administration (SAMHSA) framework for trauma-informed care support development of trauma-informed approaches among behavioral health organizations to better understand the connection between trauma and behavioral health issues. Moreover, SAMHSA recognizes the high prevalence of trauma in other service systems therefore the framework is generalizable to these systems as well, including child welfare, education, and the justice system. The six principles of a trauma-informed approach are (1) safety, (2) trustworthiness and transparency, (3) peer support, (4) collaboration and mutuality, (5) empowerment, voice and choice, and (6) cultural, historical and gender issues (SAMHSA, 2014).
  • For juvenile justice populations Branson et al. (2017) presented 10 core competences for a trauma-informed juvenile justice system based on a review of the existing trauma-informed care initiatives described in the literature. These core components are categorized into themes and appropriately, these themes are consistent with the themes identified in my stakeholder interviews and throughout this study, including emphasis on cross-systems collaboration, family engagement, access to services, leadership, and cultural competence (Branson et al., 2017).
  • Specifically, states such as Connecticut and California have developed comprehensive approaches and guidance documents to address childhood trauma across child-serving systems. These guidance documents may be helpful to reference in the exploration phase of trauma-informed care approaches for justice-involved youth with behavioral health problems (Child Health and Development Institute of Connecticut, 2019; State of California, 2019).
• Racial equity training and efforts to reduce disparities in both the mental health and juvenile justice systems are central to progress in meeting the needs of underserved minority youth with behavioral health problems that places them at a higher risk of justice involvement. But it is not enough to make the structural change necessary to attain race equity. The pursuit of racial equity at the organizational leadership level may be the appropriate first step for behavioral health organizations. However, representation of people of color in all levels of an organization should be the ultimate goal. System leaders should consider undertaking efforts to address racial equity within these systems through strategies such as employing diverse staff that are culturally representative of the youth they serve and increase advocacy efforts to reduce disparities in the behavioral health and juvenile justice systems.
  • An example of sustainable race equity work is the Annie E. Casey Foundation’s Juvenile Detention Alternatives Initiative (JDAI). The JDAI is designed to enact change within juvenile justice systems in pursuit of improved outcomes for incarcerated youth. JDAI is a data-driven network of juvenile justice and other children’s systems stakeholders that convene to address community challenges, practices, and policies, with technical assistance and training support from the Annie E. Casey Foundation. The JDAI site in Massachusetts is pursuing training initiatives surrounding racial equity to address the overrepresentation of youth of color in the justice system (The Annie E. Casey Foundation, 2021; Bryant-Comstock, 2021).
  • Recognizing structural, institutional, and systemic racial inequalities is central to the mission of JDAI. Within JDAI, the Deep-End Initiative proposes data-drive strategies such as data analysis to identify areas in the system that contribute to inequality in order to pursue targeted interventions at the identified intercepts (The Annie E. Casey Foundation, 2020). For example, research indicates that youth of color are less likely to be diverted from juvenile court than White youth (The Annie E. Casey Foundation, 2020). Thus, targeted strategies at this juncture should be examined such as who makes the decision to divert, when does the diversion occur, and what the eligibility criteria are, along with many other factors. When reviewing these factors, stakeholders must consider any areas in the policies and procedures that are not equitable. Organizations and systems must pursue culturally-grounded practices related to diversion and treatment (The Annie E. Casey Foundation, 2020).

References/Resources

Aratani, Y., & Cooper, J. (2012). Racial and ethnic disparities in the continuation of community-based children’s mental health services. Journal of Behavioral Health Services & Research, 39(2), 116–129. https://doi-org.ezproxy.lib.usf.edu/10.1007/s11414-011-9261-z

Branson, C. E., Baetz, C. L., Horwitz, S. M., & Hoagwood, K. E. (2017). Trauma-informed juvenile justice systems: A systematic review of definitions and core components. Psychological Trauma: Theory, Research, Practice, and Policy, 9(6), 635–646. https://doi.org/10.1037/tra0000255

The Annie E. Casey Foundation. (2021). Juvenile Detention Alternatives Initiative. https://www.aecf.org/work/juvenile-justice/jdai

The Annie E. Casey Foundation. (2020). Leading with race: To reimagine youth justice. Retrieved from https://assets.aecf.org/m/resourcedoc/aecf-leadingwithracetoreimagine-2020.pdf

Center for Juvenile Justice Reform (n.d.) Crossover Youth Practice Model. https://cjjr.georgetown.edu/our-work/crossover-youth-practice-model/

Child Health and Development Institute of Connecticut. (2019). Helping young children exposed to trauma: A systems approach to implementing trauma-informed care. https://www.cmhnetwork.org/wp-content/uploads/2019/06/CHDI_Early-Childhood-Trauma_IMPACT_2019-06-03_Final-DL-Pgs.pdf

Bryant-Comstock, Scott, B. (Host). (2021, January 27). Achieving Racial Equity in Massachusetts: The Dynamic Duo is on a Mission! [Audio podcast episode]. In The Optimistic Advocate. https://theoptimisticadvocate.com/episodes/achieving-racial-equity-in-massachusetts-the-dynamic-duo-is-on-a-mission/

The Council of State Governments. (2021, June 17). American Rescue Plan Act of 2021: Guide to advancing justice-related goals. https://csgjusticecenter.org/publications/american-rescue-plan/?mc_cid=fd4ba0c946&mc_eid=163f0c6e84

Miller, A. & Pilnik, L. (2021). Never too early: Moving upstream to prevent juvenile justice, child welfare, and dual system involvement. Georgetown University, McCourt School for Public Policy, Center for Juvenile Justice Reform. Retrieved from https://georgetown.app.box.com/s/u8lznq3kuyw4kpjqzqpdl2ar7wuma701

Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach. HHS Publication No. (SMA) 14-4884. Rockville, MD. https://www.cmhnetwork.org/wp-content/uploads/2021/08/SAMHSA_Trauma.pdf

State of California. (2019). Memorandum of understanding implementation guide: State of California trauma-informed system of care for children and youth. https://www.cmhnetwork.org/wp-content/uploads/2020/01/CHHS-Trauma-Informed-System-of-Care-MOU-Guidance-FINAL-1.pdf

White, L., Aalsma, M., Salyers, M., Hershberger, A., Anderson, V., Schwartz, K., Dir, A., & Mcgrew, J. (2019). Behavioral health service utilization among detained adolescents: A meta-analysis of prevalence and potential moderators. Journal of Adolescent Health, 64. doi: 10.1016/j.jadohealth.2019.02.01