By Judge Linda Teodosio*
The close of many state run residential mental health facilities for youth has not eliminated the need for mental health services. Instead, it has transferred the responsibility for caring for these youth to families and local communities. Not surprisingly, many of these youth end up involved with the juvenile justice system.
According to the National Center for Mental Health and Juvenile Justice, over seventy percent of youth involved in the juvenile justice system are experiencing mental health disorders. More than one-half met criteria for at least two diagnoses and over sixty percent of those with a mental disorder also had a substance abuse disorder. Nearly twenty-seven percent of justice-involved youth have disorders serious enough to require immediate and significant treatment.
Thus, the impact of mental health and the co-occurring disorders of mental illness and substance abuse upon the cases coming before juvenile courts is clear. What is even more evident is that if we wish to rehabilitate and prevent continued involvement with the juvenile justice system, the referral of youth and families to viable treatment alternatives must be a part of the dispositional orders of the court.
In 2003, Summit County, Ohio, embarked on a process to create a means to deal with the many court-involved youth experiencing the co-occurring disorders of mental illness and substance dependence. The collaborative effort included forty-two individuals from diverse fields involving service to children, including the Summit County Juvenile Court, the Alcohol, Drug Addiction and Mental Health Service Board, Children's Hospital Medical Center of Akron, The University of Akron, Children Services Board and Child Guidance and Family Solutions, to name but a few. Additionally, representatives of the schools, legal defender's office, prosecutor's office, law enforcement, mental health treatment agencies, substance abuse treatment agencies, and interested parents and family advocacy groups took active roles.
The result of the collaboration was the Crossroads program - a voluntary, intensive probation program that enables youth ages 12 to 17 and their families to achieve wellness, and that provides them with the tools necessary to maintain that wellness long after probation has ended.
Many courts nationwide have utilized either drug courts or mental health courts. Crossroads is unique in that it tackles both substance abuse and mental health problems simultaneously using a similar specialized docket model. Because the community worked as a team to develop the program, it is funded by a re-allocation of existing resources and by the use of services that would be available to families regardless of court involvement.
A child must be adjudicated as delinquent before her or she can participate in Crossroads. A parent, prosecutor, defense counsel, or court intake officer, community treatment provider or traditional probation officer are among those who frequently request that a child be considered for the Crossroads Program. A suitability team reviews each referral to assure that there is a qualifying diagnosis and that the program will meet the dispositional needs of the child. The program is reviewed with the family and if they and the judicial officer are in agreement, the dispositional orders issued by the judge or magistrate and will include the completion of Crossroads. If the family or the court is not in agreement, a traditional juvenile disposition, which will also have a treatment component, will be ordered.
The probation officer assigned to the youth acts as a case manager and assists the family in developing a case plan to address individual needs. The program has a capacity of 60 and each probation officer is responsible for approximately 15 clients. Families are referred to their choice of existing treatment providers. The court assists the family in working with their insurance carrier and in making the financial arrangements for treatment.
Youth are required to follow through with both the recommendations of their treatment provider, including medication compliance. Weekly court reviews before a judge or magistrate monitor the youth's progress and provide encouragement, incentives, direction and sanctions as necessary.
Signs of Progress
As the child progresses through the year-long program, contact with the court decreases from reviews every two weeks, to three then four weeks. Youth are required to go to school and obtain employment, if age appropriate. The probation officers make most of their contacts with the youth in the community so that they can provide assistance with issues that may present themselves in school or in the home. If the youth is substance dependent or has used in the past, periodic random urine drug screens are required.
A key component to this program is Intensive Co-occurring Treatment (ICT) developed by Dr. Helen Cleminshaw and Dr. Richard Shepler of the University of Akron and provided in the community by Child Guidance and Family Solutions. ICT provides intensive short term intervention by a counselor licensed to provide both mental heath and substance abuse treatment. The assigned counselor provides in-home services and is on-call 24/7 for crisis intervention. ICT is utilized as early as possible in Crossroads for cases in which there is a dual diagnosis of substance dependence and metal illness.
Once the goals, as established with the family, are met and the youth is stabilized, the ICT counselor transitions the family to existing agencies for on-going treatment in the community which is monitored then by the court and probation officer.
Additionally, as the child proceeds through the program, service providers from the community meet on a bi-monthly basis as a Treatment Team to discuss the progress and to suggest treatment alternatives that might better assist them if the youth is not progressing. Recommendations may include short-term residential treatment for purposes of stabilization, additional assessments, or additional community supports.
Upon successful completion of Crossroads, the youth is recognized at a graduation ceremony; he or she gives a speech and receives a diploma. Their accomplishments are outlined as reinforcement for their continued success and to provide incentive to other youth in the program. Most importantly, upon completion, the presenting charge and any probation violations are dismissed and the youth's record is expunged.
Youth in the Crossroads program report an increase in self-esteem and demonstrate a marked improvement in grades. Age appropriate youth are employed. A significant history of sobriety has been achieved and a relapsed prevention has been developed. Families report an improvement in the parent-child relationship and often credit Crossroads with giving them "their child back." Participation as a member of the judiciary in Crossroads is also rewarding. It gives the judge an opportunity to be a witness to a metamorphosis of the participant and enjoy their success.
Summit County, by its commitment to the Crossroads Program, recognizes the best way to deter juvenile crime that is based on mental illness or substance abuse is to provide treatment. Treat the illness, and lawful and productive behavior will result.
*Judge Linda Tucci Teodosio was elected to the Cuyahoga Falls Municipal Court in 1997 and to the Summit County Court of Common Pleas Juvenile Division in 2002. She is a graduate of The University of Akron with a B.S. in Education Summa Cum Laude. She received her Juris Doctor from the University of Akron School of Law in 1982.