Understanding How Adverse Childhood Experiences Affect Teens’ Futures

by Susan Richardson

Have you heard of adverse childhood experiences? Known as simply “ACEs,” this approach is rapidly gaining attention among the medical community and public health professionals alike. The issue is spanning boundaries and becoming increasingly pressing as studies unfold that early adversity—ACEs and toxic stress—dramatically impacts health outcomes.

A recently released TEDMED talk from Pediatrician Nadine Burke Harris explores this issue deeply. Her interest in ACEs began with a study led by Kaiser Permanente and the Centers for Disease Control and Prevention, which evaluated more than 17,000 adult patients. The study appointed each adult an ACEs score—a number that documented how many adverse childhood experiences each person had, such as abuse, neglect, exposure to domestic violence, and parents who were divorced, mentally ill or incarcerated.

The results were striking. The study found that the higher the ACEs score, the more likely adults suffered from dire health outcomes. Specifically:

  • Those who’ve experienced high levels of trauma are at triple the risk for heart disease and lung cancer.
  • Those with four or more adverse childhood experiences are four times more likely to become depressed, and
  • Twelve times more likely to attempt suicide.

Even more, the study revealed that these health outcomes aren’t just a result of high risk behavior, such as alcohol and drug use, that are spurred by toxic stress. These health outcomes result directly from toxic stress. Burke Harris explains that when a young person is exposed to ACEs, his or her stress system is activated over and over, wearing down the system and affecting brain structure and function. Children are particularly sensitive to the impacts of stress activation since they are still developing, and high doses of adversity can also affect developing hormonal systems, immune systems, and the way DNA is read and transcribed.

To tackle this issue, Burke Harris opened the Center for Youth Wellness in California, where her focus is to prevent, screen and treat children with high ACEs scores. The approach is interdisciplinary—a collaboration across health professionals, families and treatment providers—something that we echo here at Reclaiming Futures.

While our focus at Reclaiming Futures is providing substance use and mental health treatment to teens, and mitigating involvement in the juvenile justice system, it’s valuable to understand how ACEs may impact these teens that we work with daily. It’s our approach—the intersection of treatment, family and mentor involvement, and community reintegration—that has the potential to identify those teens who have high ACEs scores, and identify solutions for getting them back on track to bright futures.

Watch Burke Harris’ full TEDMED talk below to hear more on the ACEs impact on futures:

Opportunity Board Roundup: Juvenile Justice Grants, Jobs, Webinars and Events

by Cecilia Bianco

opportunityBelow you’ll find a selection of the latest grants, jobs, webinars and events posted to our Opportunity Board. Please share the Reclaiming Futures Opportunity Board with your colleagues in the juvenile justice, adolescent substance abuse and teen mental health areas. It’s free to browse and post!

Webinars

Events

Diverting Teens from the System: The Toolkit for Status Offense Reform

by Cecilia Bianco

logoThe most recently available national data tells us that more than 116,000 status offense cases were processed in court in 2011, and young people in more than 8,000 of those cases spent time in a detention facility.

While status offenses are non-criminal in nature, they can often jumpstart a cycle in the juvenile justice system that organizations and groups like The Status Offense Reform Center (SORC) believes can be stopped with the right means.

The SORC has a mission to “help policymakers and practitioners create effective, community-based responses for keeping young people who commit status offenses out of the juvenile justice system and safely in their homes and communities.”

In recognizing how challenging transforming a complex and long-lived system can be, the SORC developed a toolkit to help pave a course ahead for those in positions of authority: A Toolkit for Status Offense Reform. The toolkit addresses many common questions state and local officials have when attempting to make changes to this system:

  • Who should be involved?
  • What should our new system look like?
  • How will we know if it’s effective?

Additionally, there are four sections, or “modules,” included in the toolkit that tackle four key areas to help make the positive changes necessary to divert youth from the system:

  1. Structuring System Change

This module describes how to productively engage stakeholders in a system change effort.

  1. Using Local Information to Guide System Change

This module describes how to use data to conduct an assessment of your system.

  1. Planning and Implementing System Change

This module describes how to develop and implement a well-informed plan for system change that can be sustained over the long term.

  1. Monitoring and Sustaining System Change

This module describes how to monitor, assess, and modify your reform plan following its implementation.

For more information, explore the SORC website which includes a library of case studies of successful system reforms in different areas to help determine potential roadblocks and how to overcome them.

Image from SORC website

How Communities are Keeping Kids Out of Crime; News Roundup

by Cecilia Bianco

Juvenile Justice Reform

  • Federal Juvenile Justice Funding Declines Precipitously (JJIE)
    When congressional lawmakers last reauthorized the landmark Juvenile Justice and Delinquency Prevention Act, in fiscal year 2002, they appropriated about $547 million for juvenile justice. Today, federal spending on juvenile justice totals less than half that amount — about $251 million.
  • Positive Youth Justice, Part One: Rosie’s Place, Olympia, Wash. (Chronicle of Social Change)
    Last week, The Chronicle of Social Change introduced “Positive Youth Justice: Curbing Crime, Building Assets.” It is a series that imagines an entire continuum of juvenile justice services built on the positive youth development framework. We accomplish the “creation” of that continuum by profiling successful programs and organizations all over the country. Today, we begin with a program in Washington that aims to redirect youth who are, statistically speaking, hurtling towards involvement with law enforcement and the courts.
  • With ‘Raise the Age,’ Cuomo Continues Push to Reform Juvenile Justice (Gotham Gazette)
    A classic battle between law-and-order Republicans and progressive Democrats is brewing in the state Legislature as Gov. Andrew Cuomo pushes adoption of the recommendations of his Commission on Youth Public Safety and Justice – recommendations that include raising the age at which teens can be tried as adults.
  • How Communities are Keeping Kids Out of Crime (Christian Science Monitor)
    Lucas County, which includes Toledo, is one of the leaders in this movement. Juvenile Court officials here do the “my kid” test with every case. They want to ensure all young people are being treated fairly, and they live by the mantra “The right kid in the right place at the right time” – targeting services to their needs and taking care not to mix children who are unlikely to commit more crimes with high-risk youths.
  • To End Solitary Confinement, Rikers Steps Out Of The Box (NPR)
    New York’s Rikers Island is the second-largest jail in the U.S., and one of the most notorious. But with a single move, Rikers has taken the lead on prison reform on one issue: Last month, the prison banned the use of solitary confinement for inmates under 21 years old.

Jobs, Grants, Events and Webinars

  • Please share the Reclaiming Futures Opportunity Board with your colleagues in the juvenile justice, adolescent substance abuse and teen mental health areas. It’s free to browse and post!

Adolescent Substance Abuse Treatment and Mental Health

  • Rampant medication use found among L.A. County foster, delinquent kids (LA Times)
    Los Angeles County officials are allowing the use of powerful psychiatric drugs on far more children in the juvenile delinquency and foster care systems than they had previously acknowledged, according to data obtained by The Times through a Public Records Act request.
  • Child Experience Study Can Identify Mental Illness Early (TWC News)
    Since the 1990s, doctors have used the Adverse Childhood Experience Study–or ACES–to understand what causes mental health problems in children. That study found that negative experiences in childhood–from abuse to even divorce–can shape the mental health of kids as they grow up.

Webinar Opportunity: Protect the Confidentiality of Juvenile Justice-Involved Youths

by Susan Richardson

On March 4, 2015 at 3 p.m. EST, the National Juvenile Justice Network (NJJN) and the Coalition confidentialfor Juvenile Justice (CJJ) will host a webinar for juvenile justice professionals sharing best practices for protecting youth confidentiality. This includes recommendations for making the process of sealing and expungement accessible to youth. The consequences of poor confidentiality results in obstacles for youth in areas of employment, education and housing.

According to the co-sponsors, you will learn two key takeaways from this webinar:

  • Recommendations to protect your state’s youth, drawn from the Juvenile Law Center‘s recent report – Juvenile Records: A National Review of State Laws on Confidentiality, Sealing and Expungement
  • Examples from the work that Delaware Center for Justice (a NJJN member) has been doing to improve expungement laws in their state, and how they are addressing challenges and obstacles.

In order to best protect juvenile justice-involved youths and improve outcomes for them in the future, it’s necessary to take these extra steps and follow best practices for confidentiality.

Webinar Details

  • Protecting the Confidentiality of Juvenile Justice-Involved Youth: Access to Records, Expungement, and Sealing
  • When: Wednesday, March 4th, 2015 at 3 PM EST
  • Presenters:
    • Riya Saha Shah – Staff Attorney at Juvenile Law Center.
    • Kirstin Cornnell – Director of Operations at the Delaware Center for Justice.
  • Register here

Opportunity Board Roundup: Juvenile Justice Grants, Jobs, Webinars and Events

by Cecilia Bianco

opportunityBelow you’ll find a selection of the latest grants, jobs, webinars and events posted to our Opportunity Board. Please share the Reclaiming Futures Opportunity Board with your colleagues in the juvenile justice, adolescent substance abuse and teen mental health areas. It’s free to browse and post!

Events

Reducing Negative Stigma Around Girls in the Juvenile Justice System

by Cecilia Bianco

NCFA recent article on JJIE, written by The National Crittenton Foundation’s President Jeannette Pai-Espinosa, examines how the juvenile justice system impacts girls who have committed status offenses, as well as the stigma that surrounds them.

Pai-Espinosa first calls out three grim facts about girls in the juvenile justice system:

  • “The percentage of girls in the juvenile justice system has steadily increased over the decades, rising from 17 percent in 1980 to 29 percent in 2011.”
  • “Girls are more likely than boys to be arrested for status offenses — behaviors that would not be considered offenses at the age of majority — and often receive more severe punishment than boys.”
  • “Victimization of girls typically precedes their involvement with the system.”

As it’s often hard to understand the impact of these facts, Pai-Espinosa shares the story of Tanya, a girl who suffered trauma starting at a young age and continually ran away from home to escape the cycle of abuse she was trapped in. Her time homeless on the streets led her to a juvenile detention facility—something that the author says is not uncommon: “Simply put, behaviors such as running away, breaking curfew, skipping school and possession or use of alcohol places girls at increased risk of entering the juvenile justice system.”

Once in the juvenile justice system, many girls are marked by society as a “bad girl” for not meeting gender role expectations to be, as the author says, “sugar and spice and everything nice.” This “bad girl” image can prevent young girls from seeking the help they need and cause them to continue on a troublesome path, in and out of the system for minor offenses that Pai-Espinosa refers to as cries for help, not criminal behaviors.

These cries for help that result in crime are commonly a means to escape abuse and other traumatic experiences. According to the Survey of Youth in Residential Placement, 42 percent of girls in custody reported past physical abuse, 44 percent reported past suicide attempts and 35 percent reported past sexual abuse.

Pai-Espinosa describes how the juvenile justice system can be a harmful intervention, causing more trauma for Tanya and the many other girls like her who need a safe place to recover and heal.

The author believes there are several necessary steps that have the power to eliminate the “bad girl” stigma and shift the treatment of these girls to instead recognize their strength and resiliency and help them get the support they need, including the following:

  • “Promote universal assessment for girls and boys involved in the juvenile justice system to better understand their exposure to violence, abuse and neglect.”
  • “Advocate that girls in or at risk of entering the juvenile justice system receive gender and culturally responsive, trauma-informed, developmentally appropriate services to heal from the violence and abuse they have experienced.”
  • “Push for the reauthorization of the Juvenile Justice Delinquency Prevention Act, with a focus on preventing detention for status offenses and the importance of gender-responsive and trauma-informed services.”
  • “Endorse and advance the important work of organizations like the Coalition for Juvenile Justice and the National Standards for the Care of Youth Charged with Status Offenses.”

Pai-Espinosa concludes with a quote from Tanya describing how the support she eventually received was a bridge to a different kind of life for her:

“I had no way of knowing at the time, that self-love would be something that I would have to first learn that I was missing, and then fight like heck to reclaim it in order to be happy … I have come to learn that life and its successes unfold incrementally, so that in each moment we can see some measure of success. Some days this may simply mean that I decide to keep moving forward, on other days, I may have honored my personal truth a little more. Healing does not EVER happen overnight, but incremental success does.”

For more information, read the full story on JJIE.org.

Restorative Justice has Unanticipated Results; News Roundup

by Cecilia Bianco

Juvenile Justice Reform

  • This Is How Black Girls End Up in the School-To-Prison Pipeline (The Nation)
    According to a report released Wednesday, incidents such as these in which black girls are subject to harsh, apparently unwarranted school discipline and end up in the juvenile justice system are much more likely than the existing research and public conversation about the school-to-prison pipeline suggest.
  • State decreases seclusion in youth prisons (The Columbus Dispatch)
    After settling a federal lawsuit, the Ohio Department of Youth Services reduced seclusion of juvenile offenders by more than two-thirds last year, a state report shows.
  • Federal Juvenile Justice Funding Declines Precipitously (JJIE.org)
    When congressional lawmakers last reauthorized the landmark Juvenile Justice and Delinquency Prevention Act, in fiscal year 2002, they appropriated about $547 million for juvenile justice. Today, federal spending on juvenile justice totals less than half that amount — about $251 million.
  • Christine Wolf: Restorative justice has unanticipated results (Chicago Tribune)
    Our meeting consisted of 15 participants arranged in what was described as a peace circle: A trained facilitator from the police department’s youth services division; two 14-year-old offenders who’d been arrested by (and admitted their guilt to) juvenile detectives; the offenders’ parents; four community volunteers; and four members of the condominium’s board. As we began, the kids looked scared and the board members looked irate. It wasn’t hard to guess where things might go, but all my suspicions were incorrect.

Jobs, Grants, Events and Webinars

  • Please share the Reclaiming Futures Opportunity Board with your colleagues in the juvenile justice, adolescent substance abuse and teen mental health areas. It’s free to browse and post!

Adolescent Substance Abuse Treatment and Mental Health

  • Addressing the Mental Health Crisis: What Really Matters (Mad in America Blog)
    Evidence increasingly suggests that psychological difficulties are on the rise. The Global Disease Burden Study, published in August of 2013, declared that “mental and substance use disorders are the leading cause of nonfatal illness worldwide, with a global disease burden that trumps that of HIV/Aids, tuberculosis, diabetes, or transport illnesses.” Depression is the number one cause of illness and disability in 10-19 year-olds worldwide.
  • Jackson: Heroin’s hold grips region (East Valley Tribune)
    Here at ICAN we focus on education. Our youth attend daily evidenced-based programs that include “Too Good for Drugs” where we provide age-appropriate information about the negative consequences of drug use and the benefits of a non-violent, drug-free lifestyle. Youth also participate in “Steps to Respect,” which promotes healthy decision-making skills to prevent negative behaviors.
  • State Data Isn’t Specific About Legal Marijuana’s Impact on School Students (Rocky Mountain PBS News)
    “Alcohol is by far and away the most used substance by middle schoolers, then it goes down for marijuana and tobacco is just below that,” said Dr. Christian Thurstone, attending physician for the Denver Health Adolescent Substance Abuse Treatment program. “Prescription drug use is number four, and it’s increasing, so that’s been an alarming increase, as well, that we need to pay attention to.”

Michael P. Botticelli is Appointed Director of the Office of National Drug Control Policy

by Susan Richardson

Last week, the Senate voted unanimously to appoint Michael P. Botticelli as Director of The Office of National Drug Control Policy (ONDCP).Michael_Botticelli

This is a significant step toward advancing sustainable systems change, as Boticelli has a focus on substance use treatment. His two decades of experience working in this field, including as Director of the Bureau of Substance Abuse Services at the Massachusetts Department of Public Health, equips him with the skills to implement evidence-based programs and span boundaries among partnerships with law enforcement agencies, health and human service agencies and stakeholder groups. Boticelli also has experience establishing a treatment and prevention systems for adolescents.

Read Boticelli’s introductory remarks as Director on the ONDCP blog and below, and join me in welcoming him to office:

Many great movements to change public perception and policy around a public health issue have been fueled by people with a disease speaking out publicly.  What is seen as someone else’s problem—someone else’s disease – takes on a new dimension when people speak up about it.  

Such was the case when Betty Ford revealed her breast cancer diagnosis and her substance use disorder. Such was the case when Magic Johnson’s revealed that he was HIV positive, spurring action to stem the AIDS epidemic.

Yet, despite the fact that nearly every family and community in America is affected by a substance use disorder, those fighting to overcome this disease are too often hidden in the shadows of shame and denial.  It is whispered about. It is met with derision and scorn.

According to the National Survey on Drug Use and Health, only 1 in 9 people with a diagnosable substance use disorder gets treatment.  Compare this to the treatment rate for diabetes, for which 72% of people with the disease receive care.

When treatment is provided for substance use disorders, it too often comes at the most acute stages of the disease when effective treatment is far more challenging and costly than in the early stages. Because substance use disorders have historically gone unidentified for far too long, and timely access to treatment has been far too difficult to come by, a person is expected to hit “rock bottom” before seeking help for a substance use disorder.

Standard medical care does not allow a diabetic to enter kidney failure before offering insulin.  Yet untreated substance use disorders routinely proceed unchecked until they have reached such levels of emergency.  In addition to the unnecessary suffering for patients and their families, our current approach costs the United States hundreds of billions a year in increased health care costs, crime and lost productivity– over $223 billion related to alcohol and $193 billion related to illicit drugs.

Decades of scientific research have proven that substance use disorders are a health issue:  chronic medical conditions with genetic, biological and environmental risk factors.  Effective substance use disorders requires a comprehensive, public health approach involving evidence-based prevention, early intervention, treatment and recovery support services.  The National Drug Control Strategy, the Obama Administration’s template for drug policy, outlines more than 100 action items across federal government to prevent drug use and its consequences.

Earlier this month, President Obama in his 2016 Budget requested historic levels of funding –including $133 million in new funds– to address the opioid misuse epidemic in the U.S. Using a public health framework as its foundation, our strategy also acknowledges the vital role that federal state and local law enforcement play in reducing the availability of drugs—another risk factor for drug use.  It underscores the vital importance of primary prevention in stopping drug use before it ever begins by funding prevention efforts across the country. It sets forth an agenda aimed at stripping away the systemic challenges that have accumulated like plaque over the decades: over-criminalization, lack of integration with mainstream medical care, insurance coverage and the legal barriers that make it difficult for people once involved with the criminal justice system to rebuild their lives.

The implementation of the Affordable Care Act will dramatically increase coverage for treatment and ensures that services are comparable to other chronic conditions for more than 60 million Americans. This is the biggest expansion of substance use disorder treatment in a generation, and it will transform millions of lives.

All of these advancements, however, are not enough unless we fundamentally change the way we think about people with addiction.  There are millions of people in recovery in the United States leading meaningful, productive lives full of joy and love and laughter – and I am one of them.

Tonight, the United States Senate voted to confirm my nomination as Director of National Drug Control Policy. This is an honor I never dreamed of 26 years ago, when my substance use disorder had become so acute that I was handcuffed to a hospital bed. I accept this challenge with the humility and tenacity of someone in long term recovery.

I am open about my recovery not to be self-congratulatory, I am open about my recovery to change public policy. I have dedicated my life to treating drug use as a public health issue, and that’s how I approach this new role, as well.  I hope that many more of the millions of Americans in recovery like me will also choose to “come out” and to fight to be treated like anyone else with a chronic disease. By putting faces and voices to the disease of addiction and the promise of recovery, we can lift the curtain of conventional wisdom that continues to keep too many of us hidden and without access to lifesaving treatment.

It is time to make a simple, yet courageous decision to be counted, to be seen and to be heard.

Share your story with us today.

Data Collection & Evaluation Leads to Juvenile Treatment Court Program Improvements in Lucas County, OH

by Tonia Pace

gainAs the Grant Data Manager for Reclaiming Futures Lucas County, it is important for me to recognize and implement necessary changes to increase the success of our model and its impact on teens in the Juvenile Treatment Court (JTC).

Over the past 24 months at the Lucas County JTC, we have strived to determine how best to use the data collected through GAIN assessments—which stands for Global Appraisal of Individual Needs, a biopsychosocial assessment created by Chestnut Health Systems.

GAIN assessments of JTC clients (our treatment court youth) take place at baseline or initial assessment, three months, six months and 12 months in the program—GAIN I are the initial interviews and GAIN-M90 are the three-month follow up interviews. Questions asked in the interviews address youth perception of the treatment process and program. GAIN Site Profiles of clients include answers and feedback given during the assessments and are kept confidential beyond the use of the treatment team to evaluate the program.

What the data revealed informed significant programmatic changes, in order to meet the needs of Lucas County Juvenile Treatment Court clients. The GAIN Site Profiles validated that a large percentage of youth were engaging in high health risk behaviors, especially regarding sexual behavior. This information flagged for our team that there were gaps of service in our program that needed to be addressed to enhance our impact.

The GAIN data allowed us to determine the specific areas of discussion and education that were lacking in our program—in this case, the need for more education around high health risk behaviors that can lead to unplanned teen pregnancy and sexually transmitted infections.

As a result, our program has started implementing the PREP (Personal Responsibility Education Program) curriculum—created by the Ohio Department of Health—that helps educate staff to become trainers in evidence-based prevention programming. This curriculum is disseminated to staff during regular, existing meetings, where we share data, discuss needs, and establish next steps. The staff then uses the curriculum to educate our youth, which has been successful and engaging.

LaTonya Harris, Project Director at Reclaiming Futures Lucas County, is a strong advocate of the PREP curriculum:

“The Ohio Personal Responsibility Education Program (PREP) has allowed us to educate youth and dispel some myths about abstinence and sex decisions.
The youth in the group seem to be enjoying the structure of the group and they appear to feel comfortable asking questions without fear of judgment. It’s been a nice addition to our program.”

As the Grant Data Manager, I conduct the GAIN-M90 interviews and am able to report what I learn from our clients in regularly scheduled meetings with our treatment team, which will allow us to continually make program improvements. We utilize our meetings as time for me to report what’s working and what’s not, and to discuss how to fill any clear gaps in service.

While I cannot determine any major changes in high-risk health behaviors among our program youth, as we are currently halfway through the assessment cycle, I can share from my latest GAIN interviews that clients have reported receiving appropriate classes and education on these behaviors, demonstrating the improvements we have been able to make.

Image from GAIN website