Eric W. Trupin

Effectiveness of a Dialectical Behaviour Therapy Program for Incarcerated Female Juvenile Offenders

Background: Female offenders incarcerated in Washington State have demonstrated higher rates of mental health needs than boys. Linehan’s (1993a, b) Dialectical Behavioural Therapy (DBT) is an effective treatment for adult women with Borderline Personality Disorder. DBT utilises a combination of skills training, problem solving, and validation to enable patients to reduce self-destructive, impulsive and aggressive behaviours. The prevalence of similar emotional problems among female juvenile offenders suggests that DBT may be an effective strategy for this population. The State of Washington Governor’s Juvenile Justice Advisory Committee sponsored a collaborative project conducted by a research team from the University of Washington and the staff at the Juvenile Rehabilitation Administration’s Echo Glen Children’s Center to evaluate the effectiveness of a DBT intervention. Method: Pre-post intervention records were compared for female offenders from a mental health and a general population unit where DBT was implemented. Youth on a third unit served as a comparison group. Youth behaviour problems, staff punitive responses were compared before and after the intervention period. Results: Youth behaviour problems and use of punitive responses by staff decreased compared to the year prior on one cottage (unit) while no behaviour or staff changes were noted on another. Conclusions: The evaluation demonstrated the efficacy of providing DBT to female offenders in a residential setting and yielded mixed results on behaviour change during the study period that may relate to quality of training and prior youth behaviour problems.

Seattle's mental health courts: early indicators of effectiveness.

Courts specializing in the adjudication of mentally ill defendants are relatively new to the United States. Steadman, Davidson, and Brown (2001) proposed a four-part functional definition of a mental health court (MHC): (1) all identified mentally ill defendants are handled on a single court docket, (2) the use of a collaborative team which includes a clinical specialist who recommends and make linkages to treatment, (3) assurance of availability of appropriate clinical placement prior to the judge making a ruling, and (4) specialized court monitoring with possible sanctions for noncompliance. Other authors have stressed the view that MHCs are primarily vehicles for the practice of therapeutic jurisprudence, defined as the process of fostering therapeutic outcomes by legal means, or at least considering the therapeutic or antitherapeutic outcomes resulting from the legal process (Casey & Rottman, 2000; Wexler & Winick, 1996). Publications on MHCs have been primarily limited to descriptions of MHCs and their implications from legal, health, and social policy perspectives. There remains a virtual absence of empirical data elements in published accounts, with the exception of basic program statistics, such as number of defendants screened, adjudicated, and supervised. Although a major evaluation of the Broward County Mental Health Court is underway, and a description of the evaluation’s methods, measures, and challenges is available (McGaha, Boothroyd, Poythress, Petrila, & Ort, 2002), empirical reports from that research are only beginning to emerge (see Boothroyd et al., this issue; Poythress, Petrilla, McGaha, & Boothroyd, 2002), and analyses for many facets of that study are still in preparation. Heretofore, empirical evidence of the effectiveness of MHCs has been very limited and benchmarks from which different court

Mental health assessments in juvenile justice: report on the consensus conference.

OBJECTIVE At national, state, and local levels, there is increasing recognition of the importance of identifying and responding to the mental health needs of youths in the juvenile justice system, as policymakers and practitioners struggle to find ways to address causes and correlates of juvenile crime and delinquency. The proposed guidelines for mental health assessment provide explicit information about how, why, and when to obtain mental health information on justice youths at each important juncture in processing. METHOD A national group of expert researchers and practitioners convened in April 2002. Experts derived six recommendations, following the expert consensus method, for conducting mental health assessments in juvenile justice settings. Experts had broad experience creating collaborations between juvenile justice, mental health, and child welfare systems and understood the policy and health implications of conducting such assessments in juvenile justice settings. RESULTS Consensus Conference recommendations regarding screening for emergent risk, screening and assessment of mental health service needs, comprehensive mental health assessment components, assessment before community re-entry, need for periodic reassessment, and staff training are presented. CONCLUSION Deriving specific recommendations that can be implemented systematically is a necessary first step toward policy changes that will optimize the standard of care for this vulnerable population.

Children on child protective service caseloads: prevalence and nature of serious emotional disturbance.

A multivariate, criterion-referenced approach was used to assess prevalence of serious emotional disturbance among children on protective service case loads. Of 140 recipients of protective services, 72% were statistically indistinguishable from children in Washington States most intensive mental health treatment programs. School problems, substance abuse, and antisocial behaviors were common in the sample, as were family histories of mental illness or substance abuse. Greatest service needs included family support groups, outpatient treatment, school-based treatment, and diagnostic services. These results underline the importance of structural changes to facilitate cross-system collaboration between mental health and protective services.

Children's mental health services: A parent perspective

Parents of severely emotionally and behaviorally disturbed children rarely have the opportunity to participate in the policy-making processes that affect their childrens welfare. In the present study, a structured parent interview was developed as part of Washington States Child and Adolescent Services System Program (CASSP). Thirty-five parents of disturbed children provided information about their childrens problems and services histories. Respondents identified unnet needs and barriers to timely, effective intervention. The nature and quality of services received were examined in the context of CASSP service standards. The study confirmed that parents of disturbed children can provide information rich in implications for system change.

Preschool Behavior Can Predict Future Psychiatric Disorders

Little is known about how to identify young children who will develop future psychiatric disorders and who might, therefore, benefit from early evaluation or treatment. To address this problem, a follow-up study (mean 11.5 years later) of 88 normal 3–5-year-old children was conducted to determine the relationship between behavior problem ratings in preschool and subsequent psychiatric disorders. Children with higher ratings of overall behavior disturbance were found to have increased risk for developing future psychiatric disorders. By using a score which reflects overall behavioral dysfunctions, it may be possible to screen for young children requiring future psychiatric evaluation or treatment.

The Partnership Access Line: Evaluating a Child Psychiatry Consult Program in Washington State

OBJECTIVE To evaluate a telephone-based child mental health consult service for primary care providers (PCPs). DESIGN Record review, provider surveys, and Medicaid database analysis. SETTING Washington State Partnership Access Line (PAL) program. PARTICIPANTS A total of 2285 PAL consultations by 592 PCPs between April 1, 2008, and April 30, 2011. INTERVENTIONS Primary care provider-initiated consultations with PAL service. MAIN OUTCOME MEASURES The PAL call characteristics, PCP feedback surveys, and Medicaid claims between April 2007 and December 2009 for fee-for-service Medicaid children before and after a PAL call. RESULTS Sixty-nine percent of calls were about children with serious emotional disturbances, and 66% of calls were about children taking psychiatric medications. Primary care providers nearly always received new psychosocial treatment advice (87% of calls) and were more likely to receive advice to start rather than stop a medication (46% vs 24% of calls). Primary care provider feedback surveys reported uniformly positive satisfaction with the program. Among Medicaid children, there was significant increases in attention-deficit/hyperactivity disorder and antidepressant medication use after the PAL call but no significant change in reimbursements for mental health medications (P < .05). Children with a history of foster care experienced a 132% increase in outpatient mental health visits after the PAL call (P < .05). CONCLUSIONS Primary care providers used PAL for psychosocial and medication treatment assistance for particularly high-needs children and were satisfied with the service. Furthermore, PAL was associated with increased use of outpatient mental health care for some children.

The Effect of Long-Term Chronic Marijuana Use on Neuropsychological Functioning

Ten normal subjects who smoked marijuana daily for an average of 5 years and who denied other drug use were examined on a neuropsychological test battery. When compared with normal nonsmoking Ss, minimal differences were observed. It was concluded that long-term cannabis use does not cause a generalized decrement in adaptive abilities which might be related to cerebral impairments.

Child Welfare Caseworkers as Service Brokers for Youth in Foster Care Findings From Project Focus

Youth in the foster care system have substantially higher rates of mental health needs compared to the general population, yet they rarely receive targeted, evidence-based practices (EBPs). Increasingly emerging in the literature on mental health services is the importance of “brokers” or “gateway providers” of services. For youth in foster care, child welfare caseworkers often play this role. This study examines caseworker-level outcomes of Project Focus, a caseworker training and consultation model designed to improve emotional and behavioral outcomes for youth in foster care through increased linkages with EBPs. Project Focus was tested through a small, randomized trial involving four child welfare offices. Caseworkers in the Project Focus intervention group demonstrated an increased awareness of EBPs and a trend toward increased ability to identify appropriate EBP referrals for particular mental health problems but did not have significantly different rates of actual referral to EBPs. Dose of consultation was associated with general awareness of EBPs. Implications for practice and outcomes for youth are discussed.

Families as full research partners: What's in it for us?

This article describes a childrens managed mental health care program that incorporates both a family participation service model and a family-initiated evaluation model. The authors begin by tracing the evolution of the family support and the participatory research movements leading to current developments in childrens mental health services research. In the King County Blended Funding Project, three service systems pool funds that are spent flexibly by child and family teams. Family advocates have led efforts to design and implement the project evaluation. During this process, many tensions have arisen between meeting the demands of both scientific rigor and multiple community stakeholders. Examples are given of the issues raised by family advocates and research scientists as together they established a theory of change, identified meaningful outcomes, selected measurement tools, and implemented the evaluation protocol. Guidelines are given for how services research partnerships can be successfully built to better address community needs.This article was selected as a distinguished research paper based on a presentation by the authors at the 1998 11th annual research conference titled “A System of Care for Childrens Mental Health: Expanding the Research Base.” This conference is sponsored annually by the Research and Training Center for Childrens Mental Health, Department of Child and Family Studies, Louis de la Parte Florida Mental Health Institute, University of South Florida, Tampa.