Before sharing our accomplishments and expansion efforts, let’s take a moment to acknowledge numerous people and organizations that we have had the privilege of working with over the past few years to implement Reclaiming Futures’ version of Screening, Brief Intervention, and Referral to Treatment (RF-SBIRT).
First, we must acknowledge the youth and families who have agreed to participate and engage in a process of considering how substance use and mental health concerns might be affecting their goals. This may not have been easy and we appreciate their willingness.
Second, the SBIRT coordinators, project directors and other project staff have collaborated to provide us with critical feedback, offered in the kindest way, on aspects that needed improvement. Project staff also shared examples of how RF-SBIRT is empowering young people and their families to decide to work towards their goals keeping health and wellness in mind. Repeatedly, we hear the strength-based screening helps engage youth and families. The screening combines a series of strength-based questions and the Global Appraisal of Individual Needs Short Screener. It screens for a young person’s self-identified strengths and symptoms related to mental health and substance use. The information is used to start a conversation with a young person to affirm their strengths and determine if they would benefit from the brief intervention and/or referral to other services and supports.… Read More »
Since the release of the OJJDP-funded national evaluation of Reclaiming Futures, we have made a significant effort to study the findings in order to understand which elements of our approach may be producing better outcomes for young people and which elements need improvement. One thing that stands out when you look at the Reclaiming Futures evaluation report is that both the Reclaiming Futures cohort of sites and the comparison cohort – which was a very well-funded group of Juvenile Drug Treatment Courts – were very similar in that both consistently used evidence-based treatment practices.
When Reclaiming Futures launched more than 15 years ago, it was considered innovative and forward-thinking that one of our key principles of practice was to support and cajole the local jurisdictions to adopt and sustain evidence-based treatment approaches. Now juvenile justice and other youth-serving systems widely accept the importance of evidence-based treatment approaches as a standard of practice in the field. In spite of the consensus around using evidence-based practices, the expansion of treatment-focused diversion programs, and alternatives to incarceration, significant racial and ethnic disparities in youth outcomes continue to plague our system.
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Reclaiming Futures has been promoting the use of evidence-based practices (EBPs) since its inception. Yet, over time, it may have become unclear as to exactly what this means. As such, in this blog post we re-visit the topic. To start, it’s important to acknowledge Reclaiming Futures itself is an EBP used to screen, assess, and coordinate services for young people and their families who have behavioral health concerns. It also uses national standards to ensure access and engagement in services in a timely fashion. Studies have found it to be an effective model.
There are varying degrees of evidence used to determine if a process, intervention, or approach is evidence-based. The strength of evidence can range from expert opinions to systematic reviews. Types of interventions can fall into categories that aim to improve systems, organizations, communities, specific populations, individuals, and/or families. National repositories such as the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Registry of Evidence Based Programs and Practices (NREPP) and the Office of Juvenile Justice and Delinquency Prevention’s (OJJDP) Model Programs Guide offers a list of EBPs, how they were assessed, and various ratings.
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Discrimination Against Patients With Substance Use Disorders Remains Prevalent and Harmful: The Case for 42 CFR Part 2
April 13, 2017
The authors of a recent Health Affairs Blog post argue that 42 CFR Part 2, the law designed to protect confidentiality of patients with substance use disorders, is outdated and unnecessary. We could not disagree more. 42 CFR Part 2 provides bedrock protections for people with substance use disorders that are as critical now as they were in the 1970s when the law was first enacted. The purpose of the confidentiality law is to ensure that a person with a substance use disorder is not made more vulnerable to discriminatory practices and legal consequences as a result of seeking treatment. Unfortunately, patients with substance use disorders still face enormous consequences associated with disclosure, including loss of employment, loss of housing, loss of child custody, loss of benefits, discrimination by medical professionals, and even arrest, prosecution, and incarceration. As our country faces an unprecedented epidemic of opioid addiction and overdose, we must ensure that fear of discrimination does not deter people from seeking treatment.
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Nearly two decades ago, our nation’s juvenile justice system began to slowly shift the way we think about young people. The prevailing punitive and heavily racialized narrative about justice-involved youth that produced the infamous term “super-predator” has gradually given way to a new, more humanistic narrative. While we still have a long way to go, the field now looks at delinquent behavior through a more developmentally informed lens, is more willing to look at the root causes of racial disparities in the system, and understands that many youth arrive at the doorstep of the justice system with a history of significant trauma. Many jurisdictions now actively look for opportunities to divert low-risk youth from court and employ an array of treatment-oriented alternatives to incarceration for youth who need a therapeutic intervention.
Reclaiming Futures is proud to have played a lead role over the past 17 years in sensitizing juvenile justice jurisdictions to the importance of evidence-based and developmentally appropriate responses to substance use and behavioral health concerns, which do not widen the net and pull youth further into the justice system. Along the way, we’ve helped jurisdictions around the country to better engage families and mobilize community supports for youth. In recent years, we amplified our focus on addressing racial and ethnic disparities, in terms of both health and justice outcomes in the jurisdictions where we work. We are also piloting a cutting edge new framework to help juvenile treatment courts address disparities.… Read More »
As many of you know, in 2016 the Office of Juvenile Justice and Delinquency Prevention (OJJDP) released the Juvenile Drug Treatment Court Guidelines (JDTC). The purpose for developing the Guidelines was to organize the most effective JDTC implementation components based on the best available research. Building on the 2003 Juvenile Drug Courts: Strategies in Practice (JDC: SIP), this systematic and thorough review developed seven objectives, each with corresponding guidelines statements, and supporting information.
Before going forward, it’s appropriate to look back. Reclaiming Futures and JDC: SIP have co-existed in many juvenile justice jurisdictions. OJJDP funded a number of grants to implement both Reclaiming Futures and JDC: SIP. Subsequently, they funded a cross-site evaluation that examined the implementation process, youth changes over time, and costs of Reclaiming Futures and the combined Reclaiming Futures and JDC: SIP approach. Findings from this study were used to support the empirical basis for some of the JDTC objectives.
Of relevance, Greene and colleagues (2016) developed a logic model blending Reclaiming Futures and JDC: SIP. The authors indicated the two approaches are complimentary and aim to achieve the same goals: reduce/eliminate substance use and future crime. They indicated Reclaiming Futures and JDCs both emphasize (1) developing team collaboration (2) expanding the network of services through community partnerships, (3) focusing on youth strengths, (4) involving and engaging the family, and (5) monitoring and evaluation. Greene and colleagues also noted some differences. As compared to JDCs, Reclaiming Futures is a broader approach, recommends a greater number of individuals involved in collaboration process, works towards system change rather than implementing programmatic activities, and places a greater emphasis on community directed engagement following services and supports.… Read More »
In this month’s Reclaiming Futures newsletter, we turn our attention to one of the most important threads in the juvenile justice reform narrative of the past 15 years: the debate regarding the age of adult responsibility in the criminal justice system. In the past decade, we have gained an increasingly sophisticated understanding of the neuroscience of adolescent behavior; this has transformed the way juvenile justice stakeholders view a delinquent youth’s culpability and has guided the field to question the efficacy of traditional juvenile justice responses to delinquency. Furthermore, a recent report by the Justice Policy Institute points out that cost-benefit studies have consistently contradicted the common anxiety that raising the age will flood the juvenile system with cases and generate unmanageable costs. Finally, there has been an increasing openness over the years to view court-involved youth in a less punitive, more humanistic and developmentally appropriate light that also accounts for the ways that adverse childhood experiences, and mental health and substance use problems, can drive the behaviors that get youth in trouble with the law. However, none of these shifts have moved the needle on the persistent racial and ethnic disparities that plague both the juvenile and adult justice systems. The executive director of the Justice Policy Institute, Marc Schindler, interviewed for a recent NPR piece on the role of race in the raise-the-age policy discussion and reminds us that the policies driving more youth into the adult criminal justice system have a disproportionate impact on youth of color.… Read More »
Research shows that adolescents have a high propensity for engaging in risk taking activities given the significant changes in neurology, biology, and other developmental issues (e.g., social; cultural; familial) they experience. Specifically related to decision-making, science shows the pre-frontal cortex region of the brain is underdeveloped until a young person is well into their 20’s. With these findings in mind, how should this influence the way we think about key juvenile justice policies and practices like the age of juvenile jurisdiction?
While developmental science has guided juvenile justice policies, it cannot be the only factor in determining the age at which young people are transferred to adult courts. Yet, the Supreme Court has used developmental science to guide its opinions in cases (e.g., Miller v. Alabama). Moreover, the committee that prepared the Reforming Juvenile Justice A Developmental Approach report argues for two guiding principles related to age of transfer policies including: proportionality and individualization (p. 134). They also argue for the importance of keeping the jurisdictions goals of crime prevention in the forefront. More specifically:
- Proportionality is the notion that a lower threshold for punishment for adolescents should be considered as compared to adults and young people should be offered alternatives to confinement
- Individualization suggests that decisions about transferring youth to adult courts should be made based on multiple factors and not just arbitrary age limits. This may include type and severity of the law violation and other contextual factors
- Crime prevention strategies should examine the policies and programs that support their goals. Studies have shown that confining young people does not prevent future re-offending, and in fact, can be counterproductive to crime prevention efforts. This is particularly true regarding confining young people in adult facilities given the opposing aspects for healthy adolescent development (e.g., isolation; possible victimization; potentially greater access to negative role models/adults; delays in academic progress)
There are so many noteworthy aspects to the “first ever” Surgeon General’s Report on Alcohol, Drugs, and Health. For example, it is grounded in the best evidence available to date and it examines issues of neurobiology, prevention, treatment, recovery, and health care systems. It also has educational and promotional materials such as fact sheets and social media ideas and resources. If you have not reviewed it – now is the time. It’s my understanding that additional fact sheets are forthcoming including one on criminal/juvenile justice populations. As such, keep visiting the website for updates and let’s keep talking about this report and its importance to individuals, families, and communities impacted by substance misuse and/or disorders.
I want to take a moment to discuss the chapter on prevention. The efforts we make each day with youth and families to provide education; supports, and services are likely preventing further consequences of substance use and involvement with juvenile/criminal justice systems. The Surgeon General’s report indicates that the “vast majority of people who misuse substances in the United States do not have a substance use disorder” (p. 3-4). This suggests that prevention efforts to educate and intervene about the potential harmful effects of substance misuse while offering healthy behavioral options might be sufficient for the majority of people. This is not to suggest that treatment options should be ignored; but rather, taking the time to respond to a young person’s needs using a continuum of services and supports is likely to be most effective.… Read More »
In this month’s Reclaiming Futures newsletter, we focus our attention on the question that has preoccupied many of us in recent months: What will be the impact of the new presidential administration on juvenile justice policy? In this uncertain time, the field of juvenile justice should certainly be concerned about funding, but many of us are more concerned about protecting the significant progress we’ve made as a field to humanize and improve juvenile justice policy and practice over the last two decades.
In the twenty years that I’ve worked in juvenile justice and behavioral health, we’ve seen a revolution in the use of juvenile detention thanks to the Annie E. Casey Foundation’s Juvenile Detention Alternatives Initiative. We’ve also seen a major shift in the way we view adolescent misbehavior; and with research advances and greater integration of knowledge from the fields of developmental psychology and brain science, we’ve managed to dig ourselves out the dark ages and stop viewing young people as super-predators. Finally, we have begun to see an increased willingness to seek honest, practical and data-driven solutions to the chronic racial and ethnic disparities that continue to plague our juvenile justice system. Owing in part to the hard work we’ve done here at Reclaiming Futures over the past 15 years, there is now and accepted blueprint that allows the field to prioritize treatment and community alternatives over punishment for youth who enter the system with substance use and mental health problems. Will the field be able to maintain this hard-won progress?… Read More »