Juvenile Delinquency Treatment

In 1998, the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration reported approximately 71% of juvenile detention centers provide screening services and 56% provide more extensive assessments. However, advocates for juvenile justice youth state these figures are misleading. Advocates maintain that having someone available to provide mental health screening, assessment and treatment does not necessarily indicate that care is adequate or that all youth needing services receive treatment. Moreover, screening does not diagnose mental illness, nor does it compensate for professional evaluation. Professional evaluation, in turn, is not equivalent to treatment intervention. Thus screening alone will likely fall short of the comprehensive treatment approach this population demands.

Recommendations for treatment include psychological/pharmacological therapies and planning for re-entry into the community. From a nursing perspective, these youth also need specific interventions to help them restore a sense of meaning and thus a sense of self, a psychological center that likely becomes skewed as they moved through the rigors of the juvenile justice system. Advanced Practice Psychiatric Nurses’ education in medical science, neurobiology of psychiatric disorders, psychopharmacology, systems theory, assessment/treatment methods and relationship science situates them as ideal clinicians for practice in the juvenile detention systems. In addition nurse-managed programs such as Connecticut’s HomeCare Program, a short-term medication management program for youth leaving juvenile detention centers, have demonstrated effectiveness in providing a bridge back to the community and meeting the continuity of care needs of this population.

A further complication: Funding streams do not favor services in juvenile justice
State and local governments provide most funding of mental health services for juvenile justice youth. However, these government mental health programs are frequently underfunded. Complicating the situation is the fact that youth in the juvenile justice system have no legal entitlement to receive mental health services. Unlike youth in the child welfare system, Medicaid does not pay for mental health care for those in correctional facilities. Juvenile justice officials view lack of access to Medicaid funding as a major barrier to providing an adequate array of mental health services.

Position Statement
Given the issues involved with addressing the needs of this vulnerable population, the International Society of Psychiatric- Mental Health Nurses takes the position that:
1. Innovations in mental health screening in Juvenile Justice are occurring but these practices need to move into broader dissemination.
2. A quality reporting system should be established monitoring a system’s compliance with the Department of Justice’s recommendations on screening and treatment.
3. Outcome systems must be developed that track data on the effectiveness and costeffectiveness
of programs which address PMH needs of youth in juvenile justice.
4. Model programs for treatment in Juvenile Justice do exist; they should be replicated with fidelity and the outcomes available for benchmarking.
5. Data on model program effectiveness should be used in lobbying for funding and public attitude change.
6. As services bridge to the community, programs must be built that would provide a continuum of primary mental health care for youth involved in juvenile justice.
7. Intervention programs for youth in juvenile justice must be culturally relevant and trauma informed.
8. Since psychiatric mental health nurses are uniquely suited to work with this population, the PMH Advanced Practice Nursing educational system should recruit and educate a nursing workforce to work with and advocate for the juvenile justice
population.