Prenatal exposure to alcohol and other drugs, years of abuse and neglect, bouncing from one home to another in the foster care system, struggling in school due to unidentified learning disabilities, wanting to belong, trying to fit in, following the wrong crowd, experimenting with drugs, participating in illegal activities, truancy, getting in trouble with the law—these are the common precursors for youths entering the Juvenile Mental Health Court (JMHC) in Los Angeles County. How can anyone effectively address the complex and ever-changing needs of these youths? Simply put, one person cannot.
The creators of the Los Angeles County JMHC saw the need for a multidisciplinary team to effectively address the many unique and significant needs of these youths and brought together professionals from the fields of psychiatry, psychology, education, probation, law, and social work. This multifaceted team works collaboratively to address the needs of the youths.
Because of the severity of needs in the youths served, the JMHC team sees the youths much more frequently than typical courts in order to monitor their progress and any changing needs. Youths are typically brought into court every two to four weeks when they first come to the JMHC, and less frequently as their behavior improves and their needs lessen due to the successful implementation of services. The JMHC allows for variation in the youths’ behaviors as they work toward sobriety or are delving into their trauma history with a therapist, with the understanding that recovery and behavioral change are not a straight line, but rather a sometimes bumpy path. The JMHC team works to support the youths as they navigate this new path and try out their new skills. If a youth needs intensive support, the JMHC team has the flexibility to provide that support by seeing the youth more frequently in court, collaborating with outside services, or spending time talking with the youth directly, or a combination of these.
There are about 50 juvenile mental health courts operating throughout the United States. Each is structured slightly differently, serving different subsets of youths in various ways. A list of these courts can be found on the website of the Substance Abuse and Mental Health Services Administration. This article is specific to the approach of the JMHC in Los Angeles County, California.
All of the personnel on the JMHC team have not only professional expertise in their field but also significant experience and understanding of mental health and developmental disabilities and how these may manifest within a youth’s behavior.
Effective conversations with the youth are facilitated by having a judge who is knowledgeable about mental health and has an appreciation of how developmental delays may affect a youth’s communication and social skills. The judge is able not only to take the time to talk with the youth and listen to his or her needs but also to listen through a lens that allows the judge to understand how and why the youth may be responding the way he or she is. The judge is able to perceive how the mental health issues or the cognitive challenges may have affected the youth’s behavior and choices and use this to inform the court’s approach to interventions. Understanding this allows for an insightful and supportive mix of empathy and structure.
The number of youths served and the intensity of support provided requires two full-time probation officers dedicated solely to the youths of the JMHC. These probation officers are able to fulfill their duties to maintain the balance of keeping the youths and the community safe while understanding that, many times, a youth’s consistent challenges with following rules may be due to an unmet need rather than defiance or intentional refusal. Having an understanding of mental health needs and developmental disabilities allows them to see the need for increasing services or changing the treatment plan, rather than just detaining a youth for a violation of probation conditions. The JMHC probation officers are also able to spend more time with the youths and work to guide them toward positive interactions with their community, schools, and families.
The psychologist and psychiatrist share the role of interviewing the youths and their families when they come into the court. The interview aims to gather enough information for a thorough presentation to the JMHC team members and to support a discussion of whether the youth meets criteria for service by the JMHC. This interview is supplemented by a summary of pertinent information gained in a complete file review by the psychologist. In reviewing the court files, the psychologist is able to glean insight into symptoms and red flags that are both explicitly and implicitly noted. This information provides the basis for some of the interview questions and an opportunity to clarify and verify information in the file. The JMHC psychologist and psychiatrist also act as liaisons to the treating psychiatrists and psychologists in the juvenile halls or in the community. They are available to provide consultation regarding the youths’ mental health needs to the court. Resolving the youths’ mental health issues and supporting them in engaging in effective treatments are essential features of the JMHC team.
By integrating an education specialist into the team, the JMHC is able to support the youths and their families in accessing needed educational support through the school systems. The education liaison supports the families and youths with school enrollment, understanding of the laws supporting foster youths’ access to education as well as their educational options, advocating for youths’ needs via the education and special education systems, and facilitating communication and coordination among multiple entities (schools, districts, mental health providers, developmental services providers, etc.). Much of the education specialist’s work involves supporting families in accessing and improving the youth’s special education services through an individualized education program (IEP). Previously unidentified or unaddressed learning disabilities can significantly affect a youth’s self-esteem and school attendance, as well as underscore the need for presenting information in a way the youth can comprehend. For youths with severe needs that significantly affect their educational progress, more restrictive services such as residential placements can be obtained to address the youths’ mental health, educational, and safety needs all within one facility. At the same time, the education specialist is always working to support the least restrictive educational setting for youths while balancing their need for integrated mental health support, often on the school campus. When the educational needs of the youth are effectively met, it has a positive effect on the rest of the youth’s case and often on his or her ability to follow through with probation and court orders.
The JMHC’s defense attorney is dedicated solely to the cases supervised by this court. She, and an alternate defense attorney, work both to safeguard the youth’s legal rights and to collaborate with the team to facilitate the provision of additional supports and services to the youth and his or her family in an effort to ensure the youth’s underlying needs are met. Having an understanding of developmental disabilities and mental health needs allows the youth’s attorney to argue the validity of addressing the youth’s primary needs in order to subsequently reduce the unlawful behaviors.
Having a psychiatric social worker supporting the defense attorney brings additional expertise to the team. Connecting the families with resources, identifying additional needs or changes in the youth’s mental health needs over time, and supporting the attorney with outreach to the youth’s family and service providers improve the team’s ability to address the varied and complex needs of the youth as well as the family’s ability to navigate services and systems.
The prosecuting attorney is also a member of the JMHC team. While traditional settings often end up with the prosecuting attorney and defense attorney working against one another, in the JMHC there is much more collaboration. The prosecuting attorney still represents the people and the needs of the community for safety, while simultaneously taking into consideration how the developmental disability or mental health needs manifest in the youth’s presentation and behaviors. Understanding the need for treatment, the prosecuting attorney works to balance public safety with the need to ensure that the youth’s underlying needs are met.
In the early years of the court, the psychiatrist, psychologist, and education liaison were county entities; however, because of the nature of their roles, conflicts of interest became apparent, and over time these three roles have transitioned to private entities. This allows for more flexibility within the role and more effective advocacy for the youths’ needs.
In addition to the individual roles of the team members, through the collaborative efforts of the team, the JMHC is able to bring a more holistic view of the youth into perspective. This unique perspective influences the creation of the treatment program.
All of the JMHC’s cases are referred post-adjudication or after a finding of incompetence. The court’s purview is to provide an alternative to traditional sentencing by creating an individualized program of supports and services that will address the primary issues that have led to the secondary behaviors and involvement with the law. Cases are referred solely by the defense attorney from any juvenile delinquency court within Los Angeles County and are reviewed individually to determine need.
The JMHC’s process begins with a thorough review of the legal file and a written summary of pertinent issues and needs, including the youth’s mental health diagnoses, symptoms, prior treatment, any child abuse or trauma experienced, prenatal exposure history, the youth’s current school and whether the youth has an IEP, the facts and charges of the case at hand and any prior cases, and other pertinent information.
The psychologist or psychiatrist—along with the defense attorney, psychiatric social worker, and if needed, the education specialist—will meet with the youth and then with the youth’s family for interviews. The interviews are designed to secure a better understanding of the mental health, developmental, and educational needs of the youth as well as to gain more knowledge about how these factors may have contributed to the current charges.
After the team has reviewed the case summary, the psychologist or psychiatrist presents the pertinent findings of the interviews to the JMHC team, and the entire team participates in a discussion regarding the appropriateness of this youth for the JMHC. The following are among the factors considered:
- Can the JMHC team provide anything more than what has already been tried?
- Are both the youth and his or her family willing to participate in the JMHC program?
- Are the youth’s mental health needs severe enough to require the unique structure of the JMHC?
The team considers not only the above questions but also how to keep the youth and the community safe and what services would need to be put in place in order to meet this objective. Because the JMHC is a voluntary court, families must agree and be willing to participate. At times, additional information is requested in order to further explore the youth’s needs and ensure the team has a solid understanding of how best to approach the youth’s service plan.
If the JMHC cannot effectively serve the youth, the case goes back to the referring court, along with recommendations. Those cases that are accepted to the JMHC (and even those temporarily supervised by the JMHC while further information is gathered) have immediate access to the resources and knowledge of the entire JMHC team. Collaboratively, the team negotiates the most appropriate and least restrictive placement options that will meet the needs of the youth while keeping the community safe, and simultaneously begins working on engaging additional community services to enable the family to have the support needed to assist the youth in complying with the court-ordered requirements.
Collaboration with additional entities is an essential component of the JMHC. Wraparound, Full Service Partnership (FSP), mental health services, Regional Center services (California’s program for addressing the needs of developmentally disabled persons), schools, local education agencies, and community-based placements are all regularly accessed to provide services to the youths and families served by the JMHC. There are sometimes significant differences in service availability, such as those within juvenile hall versus in the community, variability in supports available within the home setting versus a residential placement made a part of probation, or occasionally via the school district through the IEP process, as well as differing services and sometimes differing quality of, and access to, services in various locations throughout the county. Because the needs of the youths change as their situation and service options change, the JMHC team is consistently monitoring each youth’s progress and making adjustments to the program as needed. Having the unique perspectives of each of the disciplines involved in supporting the JMHC youth allows the team to identify needs early and work to secure services promptly.
A unique feature of the JMHC is that most charges are dismissed and available for sealing when the youth completes the treatment program successfully.
The JMHC was designed to serve 30 to 35 youths each year, though at times it has served as many as 90, and it reviews 2 to 4 new cases per week. Youths are seen frequently and typically create relationships with the JMHC team that nurture their progress and their self-esteem. Having a team that understands a youth’s needs and supports the youth’s efforts for change in tangible ways decreases the youth’s likelihood of recidivism.
Because of the severity and complexity of many of the youth’s needs, as well as the need to be able to respond efficiently to issues that shift as the youth’s treatment program progresses, it is essential to have the perspectives and expertise of all of the members of the multidisciplinary team. Without each of these professionals working collaboratively, the youth’s needs would go unmet.
While efforts are being made to reduce detention rates for youths in California, without substantial changes to the way mental health and other developmental and learning needs are addressed, it is likely that those detained will continue to be disproportionately youths with significant mental health needs. These are the youths who have typically fallen through every crack in every system and who are now involved with the law as well. Participation in the JMHC provides youths and families an opportunity to access specific and comprehensive services that target the underlying needs rather than focusing on the charges alone. Having an entire team that understands mental health needs and is able to support those needs collaboratively can change the long-term outcome for youths coming through the juvenile justice system.