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<p>A multi-agency program in Western North Carolina offers care to adolescents at the first signs of trouble.
By Taylor Sisk
Juvenile justice is of particular concern.
The North Carolina legislature has been debating legislation for several years to raise the age at which young people are tried in adult courts from 16 to 18. North Carolina and New York are the only states that still prosecute 16-year-olds as adults.
On the federal level, the Supreme Court ruled in January that inmates who were years ago given mandatory minimum sentences prior to their 18th birthday can apply for reduced sentences or parole. The same month, President Obama declared an end to solitary confinement for juveniles.
Meanwhile, in rural North Carolina, communities are taking an innovative multi-agency approach to helping kids make a quick exit from the criminal justice system, or keeping them out of it altogether.
In the largely rural western counties of the state, the Juvenile Justice Treatment Continuum offers kids in trouble, or in danger of easily finding it, coordinated behavioral health care. Kids as young as 7 with truancy issues are screened to determine if they should be given a clinical assessment. If issues are detected, they’re then guided to supports and services to help them and their families get back on course.
“When kids are committing lower-level offenses, or they’re truant, or they’re acting out in school, we’re catching those things early,” said Judge Monica Leslie of the 30th Judicial District, which covers the seven westernmost counties of the state. “We’re intervening early, getting them and their family into treatment, identifying their needs, and meeting them.”
According to the Juvenile Justice Information Exchange, the U.S. leads the world in the number of incarcerated young people: 336 of every 100,000, for a total of about 70,000 presently behind bars. South Africa is second, with 69 of every 100,000 incarcerated.
Adolescents are still developing cognitive skills and often can’t fully process the consequences of their behaviors. According to research from the John D. and Catherine T. MacArthur Foundation, those young brains are easily receptive to change, and interventions at this stage can be highly effective – if, that is, time and care is taken to determine a child’s particular needs.
Taking such care is what the Juvenile Justice Treatment Continuum is about. It’s a partnership of the juvenile justice division of the state Department of Public Safety, the Department of Social Services, the schools, Smoky Mountain LME/MCO and service providers from throughout the region.
The program is in practice across the state, and is now well established in Western North Carolina. It’s primarily for Medicaid and NC Health Choice recipients, though DPS provides some additional funding.
(Medicaid provides health care for low-income kids and their parents, while Health Choice allows low-income working families who make too much to qualify for Medicaid to buy into the program to cover their children.)
The idea is to get a jump on perceived issues. If a child accumulates a half-dozen or so unexcused school absences, team members mobilize to meet with the family. Are there issues at home? A plan is developed to short-circuit the consequences.
Dianne Whitman, chief court counselor for the district, stresses that it’s not about pointing the finger: “bad parent.” It’s about finding solutions to specific issues. Maybe there’s an undiagnosed health issue – asthma, for example, exacerbated by something in the home that can be remedied.
“I think it’s the teamwork involved that makes it so successful,” Whitman said.
The program is self-sustaining; no one is being paid specifically to sit on a treatment continuum team. The expectation is that a bit of extra effort today can save a ton of grief down the road.
Rhonda Cox, Smoky Mountain’s senior director of care coordination, said she and Whitman strongly believe children should be kept in their home communities; an institutional setting should be a last resort.
Over the course of a decade or so of forging relationships and piloting programs, Cox said, Smoky staff became increasingly conversant with evidence-based treatment interventions within the community that can work for court-involved youth or those in danger of becoming so.
One such program – now a staple of the Juvenile Justice Treatment Continuum – is multisystemic therapy. MST is for kids who are deemed at risk of being removed from their homes by a judge.
George Edmonds, assistant director of the Asheville-based offices of Youth Villages, providers of MST for the district, said MST counselors are on the lookout for the contributing factors of disruption. They advise in, for example, resolving conflicts between parents and children, or how to develop good supervision plans – “action-oriented interventions,” Edmonds calls them, toward a goal.
The first objective, he said, is to offer hope: “How would you write the perfect story for your family? What would it look like in six months if we’re successful?”
Edmonds said a family’s level of involvement and their goals for treatment are the best predictors of success.
“The perception is that if you have a kid in the criminal justice system, you must have done something wrong,” he said. Instead, the goal is to engage the family as part of the solution and assess the family’s strengths, needs and barriers to progress.
MST counselors generally work with families about three times a week for four or five months. Research indicates that MST reduces out-of-home placements by 47 to 64 percent and reduces the likelihood of substance use.
On a recent Tuesday morning, in an office in the Waynesville courthouse, Brian Matlock, juvenile court counselor for Haywood County, has convened a staffing meeting of treatment continuum team members: representatives from the provider agencies, the schools and the court system. These meetings are held at least twice monthly.
Among the open cases discussed is a boy enrolled in MST. Things seem to be going well, though, as Kaitlin Mullins of Youth Villages observes, “He’s ready for us to be gone.”
Mullins is working with the boy’s mom to build her confidence moving forward, “Just making sure things continue to go well and that the family has a plan in place.”
He’s doing well in school, Matlock notes: “He finally likes it.”
Another MST client is then discussed: a 16-year-old girl whose home life one team member describes as “chaotic.”
The counselors are having issues getting family members to recognize individual roles and responsibilities. They’re trying to help the young woman develop some long-term goals – something she, herself, really wants to get out of this effort.
Her mom gets frustrated because she feels her own parents are undermining her authority with her daughter, and often walks away from encounters frustrated – much as her daughter does at school – perpetuating the unrest. There’s much work yet to be done.
Not all cases are resolved successfully. But Judge Leslie sees a clear difference in kids in her district who are served by the treatment continuum. The “vast majority” of them, she said, are never again seen in court. “We’re seeing very few kids coming back off of diversion contracts. The treatment is really working.”
Reducing the cost of care
Resources in these rural counties are even more scarce than in the state’s metro areas. As such, “We have to be creative, and communication is critical,” Matlock said.
“It’s not fancy,” Rhonda Cox said of this approach to keeping kids on a productive path. “It’s a very simple, straightforward process, but everybody knows their part and they know who to talk to.”
Interventions like MST aren’t cheap, she said, but it’s money well spent.
“Our hope is that it will reduce the cost of care,” Cox said. “If we reduce the number of children in residential group homes, we reduce the cost of care. If we reduce the number of children that are entering the legal system, we’re reducing the community cost of care. If we can improve their overall outcomes, we reduce the multigenerational cost of care.”
“I think it is working amazingly well,” Leslie said.[box style=”2″]This story was made possible by a grant from the Winston-Salem Foundation to examine issues in rural health in North Carolina. [/box]