Blog: Adolescent Mental Health

Juvenile Justice Reform

• Juvenile Justice Reform Bill Passes House (South Dakota Public Broadcasting)
  The state House of Representatives passed a bill revising the juvenile justice system in South Dakota. It focuses on alternatives to incarceration and seeks to keep kids in their communities. Senate Bill 73 comes as a result of a work group that met last year. The group found that South Dakota has one of the highest rates juvenile incarcerations, and the bill aims to reduce those numbers. Representative Brian Gosch is a prime sponsor of the measure. He says it creates a presumption of probation.

• Texas Voters Support Criminal Justice Changes, Survey Shows (JJIE)
  Texas voters support sending nonviolent drug offenders to treatment instead of jail, according to an opinion poll from Right on Crime, a national campaign for criminal justice reform. Voters also support decriminalizing school truancy, according to the poll.

• Positive Youth Justice, Part Four: William F. James Ranch, Santa Clara County, Calif. (The Chronicle of Social Change)
  Last month, The Chronicle of Social Change began “Positive Youth Justice: Curbing Crime, Building Assets,” a series that imagines an entire continuum of juvenile justice services built on the positive youth development (PYD) framework. We accomplish the “creation” of that continuum by profiling successful programs and organizations all over the country. Today, we look at Santa Clara County, Calif., which takes a PYD approach to working with incarcerated juvenile offenders.

• Nevada to close its only max security juvenile detention center (Reno-Gazette Journal)
  Nevada's only maximum security juvenile correction center is closing after the private non-profit contractor hired to run it repeatedly ran afoul of safety and civil rights requirements, state officials said Tuesday.
  

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

• Raising the legal age for sale of tobacco would keep teens from smoking, panel says (The Washington Post)
  Raising the age for sale of tobacco across the United States could prevent substantial numbers of teenagers from beginning a smoking habit, an influential panel of scientists reported Thursday.

• Young Adult And Teen Suicide Rates Nearly Double In Rural Areas Compared To Urban Areas (Medical Daily)
  In the past, rural teens have been more likely to kill themselves as compared to their urban counterparts. Is the same true today, now that technology has woven us together more tightly? Sadly and surprisingly yes: Between the years 1996 and 2010, a new study finds, the rates of suicide among teens and young-adults ranged twice as high in country settings compared to city areas. In fact, the suicide rate in rural areas is nearly double that in cities... and rising.
• Marijuana may smoke your long-term memory (CBS News)
  Teenagers who smoke marijuana daily may have lingering memory problems and structural abnormalities in the brain, even after they stop using the drug, a small study suggests.

• New App Helps Doctors Catch Suicide Risk (NBC News)
  Doctors and other health professionals have a new tool to help fight suicide -- an app that helps them ask the right questions and check the symptoms of someone who might be at risk. Nearly half of people who die from suicide have seen a health professional of some sort in the month before their deaths and there are ways to find out who might be at risk and help them, the Substance Abuse and Mental Health Services Administration (SAMHSA) says.

Last Thursday, WNYC—one of New York’s flagship public radio stations—and Vera Institute of Justice partnered to host the event: The Current State of Institutionalization: Addressing the Mental Health Crisis Behind Bars.

The event was part of WNYC’s current series “Breaking Point: New York’s Mental Health Crisis” which is a four-part series, hosted by WNYC reporter Cindy Rodriguez, examining the connection between poverty, mental health and the criminal justice system.

Thursday’s event kicked off with opening remarks from New York City First Lady Chirlane McCray and included a panel of experts to discuss the following key topics:

• Systemic issues driving the over-representation of people with serious mental illness in courts, jails, and prisons in New York and across the nation
• The impact of mental health on public health and safety
• Types of reforms to the mental health and justice systems necessary to address the crisis

The event was livestreamed and is now available to view in full. Watch it now to hear from the panel, moderated by Rodriguez and featuring the following experts:

• Ezekiel Emanuel and Dr. Dominic Sisti, authors of the recent commentary “Bring Back the Asylum” in the Journal of the American Medical Association

• Francis Greenburger, founder and president of the Greenburger Center for Social and Criminal Justice

• Robert Bernstein, director of the Bazelon Center

• David Cloud, leader of Vera’s Justice Reform for Healthy Communities initiative

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:

Juvenile Justice Reform

• Juvenile Justice Reform Bill Moving Forward (Keloland News)
  A plan to change the way South Dakota deals with kids who get in trouble with the law is getting a lot of support in Pierre. The plan, which is similar to the adult justice reform, would keep kids in their own communities rather than sending them to a state facility.

• States see marked drop in juvenile prison populations as reforms take hold (Washington Post)
  A falling crime rate and new reforms to the way juveniles are treated by the criminal justice system have dramatically cut the number of young people in state prisons, according to a new report that highlights the success of some of those reforms.
• Why Keeping Young Offenders Out of Jail Could Reduce Crime (PBS Newshour)
  Juvenile offenders kept under supervision close to home, rather than in secure, state-run facilities, are significantly less likely to be arrested again or commit more serious crimes, according to a new study. Judy Woodruff discusses the findings with Xavier McElrath-Bey of the Campaign for the Fair Sentencing of Youth and Michael Thompson of the Council of State Governments Justice Center.

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

• Income Inequality Hurts Teen Health Around The World As Two Factors Grow Together (Medical Daily)
  A new international study published in The Lancet found that socioeconomic disparities between the richest and the poorest in 34 countries widened over the last decade, and have paralleled a growing inequality gap in health. Overall, poor teenagers were more likely to be less physically active, have higher body mass indexes (BMI), and report more physical and psychological troubles, such as headaches and “feeling low.”

• Dispensing truth and dispelling myths about drugs (MyCentralJersey.com)
  NCADD focused National Drug Facts Week on dispelling common myths related to drugs, drug use and drug abuse for local youth, school groups, clubs and organizations.

• American Academy of Pediatrics Reconsiders Stance on Marijuana (Pierce Pioneer)
  The policy statement describes, “The AAP strongly supports the decriminalization of marijuana use for both minors and young adults and encourages pediatricians to advocate for laws that prevent harsh criminal penalties for possession or use of marijuana. A focus on treatment for adolescents with marijuana use problems should be encouraged, and adolescents with marijuana use problems should be referred to treatment.”

• School-Wide Prevention Program Makes Teens Half As Likely To Feel Suicidal (Huffington Post)
  Suicide is the third leading cause of death between the ages of 10 and 24, according to the U.S. Centers for Disease Control and Prevention (CDC). Suicide attempts are even more common, with some research suggesting that 4 to 8 percent of high school students try to kill themselves each year, the CDC says.

Juvenile Justice Reform

• Program Strives To Keeps Kids Out Of Jail, Link Them To Services Instead (Hartford Courant)
  "The longer a child stays out of the juvenile justice system, the better the outcome is for that child," said Bernadette Conway, who is the state's chief administrative judge for juvenile matters." Avoidable school-based arrests needlessly deprive children of an optimum education and all too often grossly compromise a child's ability to succeed in life."

• Grassley Lists Juvenile Justice As a Top Priority (JJIE)
  U.S. Sen. Charles Grassley, the new chairman of the Senate Judiciary Committee, lists juvenile justice among his top legislative priorities, heartening juvenile justice advocates.

• Rikers to Ban Isolation for Inmates 21 and Younger (New York Times)
  New York City officials agreed on Tuesday to a plan that would eliminate the use of solitary confinement for all inmates 21 and younger, a move that would place the long-troubled Rikers Island complex at the forefront of national jail reform efforts.

• Office of Juvenile Justice and Delinquency Prevention Launches National Mentoring Resource Center (PR NewsWire)
  The Office of Justice Program's Office of Juvenile Justice and Delinquency Prevention (OJJDP) announced today the launch of the National Mentoring Resource Center. OJJDP established the Center to support effective youth mentoring programs and healthy youth development.

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

• This Is What Happens When We Lock Children in Solitary Confinement (Mother Jones)
  While in isolation, Kenny—who was diagnosed with attention-deficit/hyperactivity disorder prior to the sixth grade—wrote to his mother, Melissa Bucher, begging her to make the two-hour drive to visit him. "I don't feel like I'm going to make it anymore," he wrote. "I'm in seclusion so I can't call and I'm prolly going to be in here for a while. My mind is just getting to me in here."

• Teens Influenced by Misconceptions of Their Peers (Medical News Today)
  Research published in Developmental Psychology suggests that teenagers tend to overestimate the amount of drugs and alcohol that their peers use, as well as underestimating the amount of studying and exercise they do.

• Eight Local Health Providers, UWM Respond to Gun Violence at Schools (BizTimes.com)
  Through a federal grant created to help communities respond to gun violence at schools, eight regional behavioral health providers and the University of Wisconsin-Milwaukee are working to strengthen trauma and substance abuse counseling services for youth.

• Heroin-Linked Deaths Surge 39 Percent, CDC Finds (Huffington Post)
  Overdose deaths linked to heroin jumped 39 percent in 2013 from the year before, according to data released Monday by the Centers for Disease Control and Prevention.

Thirteen percent of children, as young as age six, have diagnosable mental illness. About half of adults with mental illness had problems starting at a young age, and three-quarters of adults with mental illness experienced symptoms by age 22. The recent story of Joshua Plunkett in the The Denver Post, who has struggled with mental illness since the age of three, called attention to the growing need for early treatment for children dealing with mental illness.

Joshua’s story was likely shared in light of the estimated 89,000 children and teens in Colorado dealing with serious emotional disturbances, some of them severe enough that they cannot live with their families.

The emergency room at Children’s Hospital Colorado reported 3,100 kids experiencing a mental health crisis, which has contributed to the 10 to 30 percent average increase each year. The hospital is on track to see more than 3,800 children in mental health crisis at the emergency department this year—many of which are described as suicidal or aggressive and threatening to hurt someone else.

“We are really in a behavioral health crisis in our state,” said Dr. Douglas Novins, chair of the department of psychiatry and behavioral sciences at Children’s. “The number of children who are coming here in behavioral health crisis has really increased enormously.”

Recent studies have demonstrated that early treatment is key to improving mental illness; however, kids younger than six are the least likely to receive mental health care if they need it.

Because a huge portion of brain development happens in the first three years of life, treatment at that time can have a lifelong impact, Dr. Shannon Bekman, program manager for the infant mental health program at the Mental Health Center of Denver, said.

The Mental Health Center of Denver provides therapists in several Denver schools and public health clinics to allow kids to get psychiatric care at the same place they see pediatricians. More than 1,500 Denver students received 12,000 mental health therapy sessions last year.

Denver Public Schools has also implemented plans to help combat this growing issue: Every school in the district has either a psychologist, social worker or both, and mental health staff has increased 30 percent in five years.

“If we don’t look at it through the mental health lens, it may be seen as a discipline problem,” Eldridge Greer, director of social emotional learning for Denver schools, said. “If we don’t address mental health, we are not going to get the results we want in academics.”

Read the full story on The Denver Post for more details.

Due to the connection between ACEs (adverse childhood experiences) and juvenile justice system involvement, it has become increasingly important that the system become more trauma-informed in its processes.

The term ACEs refers to childhood abuse, neglect, and general household dysfunction that negatively affects a child’s development. To improve the treatment of young people impacted by ACEs in the juvenile justice system, there is an ongoing effort to increase knowledge of trauma-informed care and how it can improve systems in health, justice and education.

Communities like ACEs Connection, which work to prevent Adverse Childhood Experiences (ACEs) and to change systems to stop traumatizing already traumatized people, are already paving the way to combat this problem in the future.

The latest resource to support these efforts is a new tool created by JBS International and Georgetown University National Technical Assistance Center for Children’s Mental Health. These two organizations came together to build a free online tool called “Trauma Informed Care: Perspectives and Resources” that provides insights and resources for those who want to be more trauma-informed.

The tool includes the following to allow users to take advantage of existing research, knowledge, practices, and approaches that have already shown to be effective in addressing trauma:

• Video interviews of national, state, tribal, and local leaders in many child-serving systems; developers of evidence-based treatments and practices; physicians; researchers; administrators of provider organizations; clinicians; youth and young adults; families; and advocates who share lessons learned and identify remaining gaps.
• Issue briefs that provide an introduction and overview for each of the tool’s eight modules.
• Comprehensive resource lists to support users in understanding how to build trauma-informed systems and organizations.

Explore the eight modules of the tool on the site, which is now live!

For past reporting on ACEs in the juvenile justice system, see the following:

• Study Reveals Stronger Link Between Childhood Trauma and Juvenile Offenders in Florida
• Healing From Trauma: Girls in Juvenile Justice; News Roundup
• End the Culture of Violence and Trauma: The Robert Wood Johnson Foundation Wants Your Ideas

Two years ago Hurricane Sandy struck the northeastern coast of the U.S., killing dozens, destroying thousands of homes and affecting the mental health of individuals and communities as a result.

New York State Office of Mental Health (OMH) received a grant from the Federal Emergency Management Agency to deliver counseling services to those affected, but as OMH Medical Director Lloyd I. Sederer addresses, were these services enough?

Sederer explains in his Huffington Post article that the grants provided to communities delivered three services: outreach to impacted communities, education on common disaster reactions and coping skills, and brief crisis counseling. What’s missing from this bundle of services provided is mental health treatment, despite a 50 percent participation rate in existing crisis counseling services provided.

The most intriguing part of the article is Sederer’s proposed solutions, some of which fall right in line with what Reclaiming Futures champions for mental health and substance abuse treatment. Particularly, Sederer recommends Screening, Brief Intervention and Referral for Treatment (SBIRT) as a valuable addition to traditional counseling services, and specifies, “SBIRT has been used in primary care and emergency settings with notable results.”

Reclaiming Futures is designing and piloting a new version of SBIRT for court-involved adolescents in five sites across the country, offering a promising start to the expanded and more robust mental health treatment programs that Sederer refers to—and for a population who, like those impacted by tragedies like Sandy, are vulnerable to the impact of trauma and loss. Evan Elkin, who is developing the Reclaiming Futures SBIRT model, says:  “Court-involved adolescents show high rates of trauma and often show mental health symptoms that fly under the radar until they get much worse. We view SBIRT as a very nimble and effective way to intervene early with large numbers of vulnerable young people who arrive at the doorstep of the juvenile justice system.”

“Nearly two-thirds of adolescents who have had a major depressive episode don't get treatment, according to the Substance Abuse and Mental Health Services Administration.”

A new study, Collaborative Care for Adolescents With Depression in Primary Care, examined the impact of a concerted treatment effort among parents and a depression care manager. NPR reports on the study:

“In a clinical trial, researchers from the University of Washington and Seattle Children's Hospital split a group of 100 teens who screened positive for depression into two categories. Half were referred to mental health specialists and had their screening results mailed to their parents.

The rest were treated with what doctors call a collaborative care model. These kids were paired with a depression care manager (a specially trained nurse, social worker or therapist) who worked with them and their parents to choose a therapist and make decisions about whether a psychiatric medication might help. The care manager also followed up with the teens every week or two, and called their parents every month.

After a year, only 27 percent of the teens who didn't get that extra coaching had enlisted in the recommended treatment, while 86 percent of the collaborative care group got treatment.”

The study not only explores the general lack of long-term support for teens with depression, it reiterates the need for collaborative parental, medical and community involvement in mental health treatment. That’s our goal at Reclaiming Futures. Providing a strong united support system to kids with mental health issues can prevent substance abuse and crime, helping kids avoid the juvenile justice system altogether.