Transcript Strengthening Communities – Youth (SCY)

Strengthening
Communities-Youth
(SCY)
Presented by
Dr. David Hussey
Institute for the Study and Prevention of Violence at
Kent State University
Strengthening Communities –
Youth (SCY)

Cuyahoga County SCY project (2002-2007) targeted
resources on two child serving systems -- the alcohol and
drug addiction services system through the Alcohol and Drug
Addiction Services (ADAS) Board, and the juvenile justice
system through the Cuyahoga County Juvenile Court. SCY
project goals specifically attempted to: improve coordinated
system of care infrastructure, facilitate earlier identification of
juvenile justice youth with drug and alcohol problems, improve
access to needed services, expand service capacity, and
address comorbidity issues including the relationship between
substance abuse and violence. The project was designed to
strengthen and improve the overall system of care, and
collaborate with the mental health system of care for juvenile
justice youth that present mental health problems.
Strengthening Communities – Youth
(SCY)





CSAT developed the Discretionary grant program to
respond to the growing demands for substance abuse
treatment and to address gaps in the substance abuse
treatment delivery system
The SCY project (2002-2007, 3.75 million dollars) serves
youth between the ages of 12 and 17 who arrive at the
Cuyahoga County Detention Center as a result of a new
arrest
Youth are screened for substance use by a representative
from the Public Defender’s office/Juvenile Division and
referred to Catholic Counseling Services for further
assessment using the Global Appraisal of Individual Needs
(GAIN)
Clinical recommendations will be presented to court prior to
disposition
Once assessed, youth are referred to an appropriate level of
care for substance abuse treatment and followed at 3, 6,
and 12 months (84% 12 month follow-up rate for study)
Detention Center Demographics

Based on the Cuyahoga County Court of
Common Pleas – Juvenile Court Division 2005
Annual Report, there were a total of 3,102 youth
held in the detention center (excludes youth on
home detention and in Shelter Care) in 2005

Of these 3,102, 76% were male and 75% were
African-American, 21% were Caucasian, 4%
were Hispanic, and <1% were of another race

Age range = 8 to 17
SCY Demographics

For the period April 2003 to March 2007, 232 youth
were enrolled in the SCY project

Of these 232 youth, 82% were male and 53% were
African-American, 29% were Caucasian, 6% were
Hispanic/Latino, 11% were biracial/mixed, 1% were of
another race

Age range=12 to 17, Average age=15.7 years

At least 64% are Medicaid eligible

About half (54%) live in the city of Cleveland
Arraignment Charges
50%
45%
40%
40%
37%
35%
30%
25%
20%
21%
15%
10%
9%
9%
5%
0%
Assault/Menacing
Property
Drug/Alcohol
Weapons
Domestic
Violence
Substance Use

At intake, over 3/4th of youth (87%) reported
using marijuana in the past 90 days
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At intake, over half (59%) reported using alcohol
in the past 90 days

Youth reported they were, on average, 13.1
years old the first time they got drunk or used
any drugs
Mental Health Indices
Internal
Somatic
Depressive
Homicidal-
Anxiety
Traumatic
Mental
Symptoms
Symptoms
Suicidal
Symptoms
Stress
Distress
Thought
Youth Moderate/Severe+
90 (39%)
117 (50%)
148 (64%)
57 (25%)
103 (44%)
81 (35%)
Boys Moderate/Severe^
64 (34%)
89 (47%)
113 (59%)
42 (22%)
79 (42%)
59 (31%)
Girls Moderate/Sever
e^
26 (62%)*
28 (67%)*
35 (83%)*
15 (36%)
24 (57%)
22 (52%)*
Behavior
Attention
Inattentive
Hyperactivity
Conduct
Complexity
Deficit
Disorder
Disorder
Disorder
Hyperactivity
Disorder
Youth Moderate
/Severe+
162 (70%)
123 (53%)
95 (41%)
40 (17%)
163 (70%)
Boys Moderate/Severe^
127 (67%)
98 (52%)
73 (38%)
26 (14%)
129 (68%)
Girls Moderate/Severe^
35 (83%)*
25 (59%)
22 (52%)
14 (33%)*
34 (81%)
DSM-IV Mental Disorders
Diagnosis^
Mood Disorders: depression, cyclothymic,
bipolar, dysthymic, mood disorder NOS
Generalized Anxiety Disorder
Disruptive Disorders: conduct disorder,
ADHD, ODD
Adjustment Disorder
Gender
%1
%2
%3
M: 50
69%
22%
26%
F: 22
31%
9.5%
52%*
Total=72
100%
31%
M: 22
65%
9.5%
12%
F: 12
35%
5%
29%*
Total=34
100%
15%
M: 98
77%
42%
52%
F: 29
23%
12.5%
69%*
Total=127
100%
55%
M: 4
100%
2%
2%
F: 0
0%
0%
0%
Total=4
100%
2%
^ Categories are not mutually exclusive
1 Percentage based on total number with that diagnosis
2 Percentage based on N=232, the total number of SCY youth
3 Percentage based on total number of males (n=190) and total number of females (n=42)
*Significantly higher proportion of females vs. males, p<.05
Comorbidity
 63%
have a DSM-IV mental disorder (are
comorbid) in addition to a DSM-IV
substance use disorder
 A significantly
higher proportion of females
than males were comorbid (79% v. 60%)
Externalizing and Internalizing
Disorders by Gender
90%
80%
88%
87%
73%
70%
60%
50%
61%
51%
49%
Males
40%
30%
36%
27%
20%
13%
12%
10%
0%
At least one Externalizing
Externalizing
Only
At least one
Internalizing
Females
Internalizing
Only
Both
Internalizing
and
Externalizing
Lifetime Charge data (JIMS)

SCY youth were, on average, 14.41 years old at the time
of their first charge
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Total charges=2,571 (N=227)
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On average, SCY youth had been charged with 10.19
(SD=7.30, median=9) offenses (excluding traffic)
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Misdemeanors accounted for the largest proportion of
charges (40%), followed by felonies (30%), traffic
offenses (11%), probation violations (10%) and status
offenses (9%)
Primary Offender Types
 62%
classified as felons
 36% classified as misdemeanants
 1% classified as status offenders
 Did not differ by racial/ethnic group or age
at first adjudicated delinquent charge
 Males (71%) significantly more likely than
females (25%) to be classified as felons
Youth with Domestic Violence Charges

43% had at least one domestic violence charge

41% had at least one adjudicated domestic
violence charge
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Of the total adjudicated domestic violence
charges, 90% were misdemeanor level and 10%
were felony level

A higher proportion of females than males had
adjudicated domestic violence charges
Youth with Adjudicated Domestic
Violence Charges
Youth with DV
Youth w/o DV
Age at first charge*
14.56 (SD=1.64)
15.19 (SD=1.46)
Race
51.9% African American
28.6% Caucasian
7.8% Hispanic
11.7% Bi-Racial
0.0% Other
54.7% African American
29.3% Caucasian
4.7% Hispanic
10.0% Bi-Racial
1.3% Other
Gender
81.8% Male
18.2% Female
82.7% Male
17.3% Female
Total Delinquent Charges*
8.70 (SD=6.17)
6.25 (SD=5.07)
Environmental Risk Scale
38.55 (SD=8.86)
37.74 (SD=8.53)
General Victimization Scale
3.67 (SD=3.24)
3.10 (SD=3.03)
Substantiated/Indicated
Maltreatment
54.5% Yes
43.3% Yes
Environmental Risk
100%
90%
80%
40.5
41.8
70%
60%
50%
40%
30%
20%
10%
0%
76.1
74.4
High
Moderate
57.7
1.8
Environmental
Risk
Low
55.0
3.2
Living Risk
22.0
25.6
1.8
0.0
Vocational
Risk
Social Risk
General Victimization

On average, youth reported the first time they
were victimized they were 11 years old
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Significantly more females than males report
sexual victimization and emotional abuse at the
hands of someone close to them or that they
trusted
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Significantly more males than females report
being attacked with a weapon
General Victimization
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
37.8
26.2
14.3
None
16.5
Moderate
59.5
45.7
Males
Females
High
Child Welfare Involvement (DCFS data)
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The majority of SCY youth (69%) had at least
one allegation of any type of maltreatment
(neglect, physical abuse, sexual abuse,
emotional maltreatment)
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Almost half (47%) of youth had a substantiated
or indicated maltreatment incident in their
lifetime

On average, SCY youth were 7.7 years old at
the time of first maltreatment allegation
Out-of-Home Placements
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24% of SCY youth had experienced at least one
out-of-home placement (OHP) in their lifetime
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On average, youth who had experienced any
OHP had 3 out-of-home placements (median=2)
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Most commonly, placement was in
foster/adoptive homes or community residential
centers
Victimization
 64%
of youth report any victimization on
the GAIN
 47%
of youth had a substantiated/
indicated incident of maltreatment
 If
considered together, 80% of all SCY
youth have a history of some type of
victimization
Cross-system Involvement
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Juvenile Justice, Alcohol and Drug, Mental
Health, Special Education, DCFS
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12% of youth were involved with only the
juvenile justice and alcohol and drug systems
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88% were involved in at least one other system
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32% involved in 3 systems, 40% involved in 4
systems, 15% involved in all five systems
Cross-system Involvement
System involvement in addition to Juvenile Justice and
Alcohol and Drug (N=232)
N (%)
Mental Health
131 (56%)
Special Education
67 (29%)
DCFS (any contact)
Any allegations
Any Substantiated/Indicated
Out of home placement
173 (75%)
159 (68%)
108 (47%)
56 (24%)
Mental Health and Special Education
41 (18%)
Mental Health and DCFS
104 (45%)
Special Education and DCFS
57 (25%)
Mental Health, Special Education, and DCFS
36 (15%)
Tapestry Cross System Involvement
Tapestry youth cross-system involvement using multiple self report and official data sources.
Indicator
Tapestry (N= 329 enrolled)
Juvenile Justice
Substance Abuse
30% ever arrested, 27% have history of probation, 11% ever sentenced to a
secure facility.
49% of youth report using at least one substance prior to intake, primarily
alcohol, cigarettes and cannabis/hashish.
Mental Health
100% of youth have at least one DSM-IV mental disorder, primarily ADHD
(49%), Mood Disorders (43%), Oppositional defiant disorder (29%) and
Adjustment Disorder (16%). 48% (n=219) reported current use of
psychotropic medication.
Education
49% of 108 Tapestry youth reported receiving special education classes
Child and Family
Services
Year one data (n= 169) 57% of Tapestry youth have at least one allegation of
maltreatment: physical abuse (35%), sexual abuse (20%), neglect (46%) or
emotional abuse (4%).
18% of Tapestry youth had a history of one or more out of home placements.
Medicaid
88% of youth are Medicaid eligible and have received Medicaid services.
SCY Treatment
 Analysis
focuses on the youth who
completed the 12 month GAIN
assessment (“completers”)
 167
youth were completers; 142 (85%) of
completers had received treatment
services
 313
treatment placements for 142 youth
Substance Problems Scale Over Time

Statistically significant decrease:

Intake to 3 months

Intake to 6 months

Intake to 12 months
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Statistically significant increase:

3 months to 6 months
4
3.5
3
2.5
2
1.5
1
0.5
0
3.7
1.6
0.9
Intake
3mo
1.3
6mo
Substance problem s in the past m onth
12mo
Substance Use Over Time
40
35
35.7
30
25
Alcohol
20
Drunkeness
15
Marijuana
10
5
8.3
5.9
0
Intake
8.3
1.9
1
3mo
10.9
2.4
1.5
6mo
11.8
2.5
1.4
12mo
Abstinence
 Youth
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reporting abstinence:
Intake - 16 youth (7%)
3 months - 113 youth (49%)
6 months - 102 (44%)
12 months - 103 (44%)
 Overall,
only 18% (n=42) of youth reported
abstinence at all follow-up periods (3, 6,
and 12 months)
Urinalysis Data
 Of
42 youth who reported abstinence on
the GAIN at 3, 6, and 12 months, 31 had
urine screen data available
 Of these 31 youth:
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7 (23%) did not have corroborating urine
screen data (had positive screens)
24 (77%) had abstinence corroborated by
urine screen data (had all negative screens)
Emotional Problems Scale Over Time
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Statistically significant decrease:

Intake to 3 months

Intake to 6 months

Intake to 12 months

6 months to 12 months
0.25
0.2
0.21
0.15
0.15
0.15
0.1
0.13
0.05
0
Intake
3mo
6mo
Emotional Problems over time
12mo
General Crime Scale Over Time

Statistically significant decrease:

Intake to 3 months

Intake to 6 months

Intake to 12 months
4
3.5
3
2.5
2
1.5
1
0.5
0
3.39
0.64
Intake
3mo
0.72
6mo
General Crime over time
0.62
12mo
Recidivism
Time Frame Post Enrollment
Type
Number (Percent) of
SCY Youth
Charges
41 (18.1%)
Delinquent Offenses
34 (15.0%)
Charges
66 (29.1%)
Delinquent Offenses
52 (22.9%)
Charges
82 (36.1%)
Delinquent Offenses
65 (28.6%)
Charges
93 (41.0%)
Delinquent Offenses
73 (32.2%)
3 Months
6 Months
9 Months
12 Months
Discussion: SCY Major Findings
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Comorbidity rates continue to be very high
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Lifetime cross-system involvement high
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63% of youth comorbid for mental health and substance abuse
Females demonstrate higher rates of mental health impairment and
comorbidity (79% versus 60%).
Males more likely to be felons (71% versus 25%), evidence higher
scores on the General Crime Scale.
12% of youth involved with only the juvenile justice and AOD systems
55% of youth involved with 4 or more child-serving systems
29% special education; 18% previous AOD treatment; 41.4% previous
mental health treatment
Victimization



69% of youth have previous child maltreatment allegation; 47%
substantiated/indicated; 24% removed from home
80% of youth either self-report or have substantiated/indicated
victimization or maltreatment histories
Females present with different victimization patterns, greater severity,
and higher rates of domestic violence.
Discussion (continued)

Recidivism rates at 12 months 41% for new
charges and 32.2% for adjudications; 14.1% for
felonies. Males 7.5x more likely to recidivate.


These figures should be compared to other
comparable juvenile justice youth.
Significant reductions in substance use
frequency, substance use problems, emotional
problems, and general crime at 12 months.


18% of youth report abstinence across all three
follow-up time points; 44% of youth abstinent during
last six months.
Of youth who report abstinence across 3, 6, and 12
months, 77% correspondence rate between selfreport and drug screens.
SCY: Implications and Next Steps
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Substance use frequency, substance-related problems,
emotional problems, general crime, and environmental
risk strongly interconnected and related to treatment
outcomes.
Client comorbidity, cross-system involvement, gender
differences, and victimization histories (including
domestic violence) require earlier, comprehensive,
coordinated, and integrated treatment responses.
Heavy reliance on residential treatment may be reduced
by strengthening IOP treatment models.
Cuyahoga County is in a strong position to develop and
evaluate promising IOP alternatives under the Tapestry
system of care umbrella.