Reclaiming lost opportunities: Applying public health models in juvenile justice
Introduction
In 1899, the juvenile justice system was established to separate adult and juvenile offenders (Mazzotti & Higgins, 2006). At its founding, the goal of the juvenile justice system was rehabilitation. The system has been in existence for over a century, its structure and processes reflecting prevailing views of human nature, development, and the meaning of childhood. As youth with increasingly challenging circumstances are channeled into a system ill-equipped to handle their myriad needs, the contemporary juvenile justice system appears to be both overwhelmed and ineffective. In the words of Todis et al. (2001), “there is perhaps no group as misunderstood and as underserved as adolescents who exhibit extreme antisocial behaviors and who are incarcerated for those actions” (p. 119).
The juvenile justice system was founded on two related notions. First, children and adult offenders are fundamentally different. Adult antisocial behavior is considered to be well ingrained and the sole responsibility of the offender. The adolescent's development is incomplete; behaviorally, the adolescent is mutable and open to influences, both positive (rehabilitative) and negative (antisocial). This perspective on adolescence relates to a second founding notion: juvenile criminals should be separated from their adult counterparts and experience opportunities for rehabilitation outside the influence of adult criminals. Views of juvenile culpability are tempered by the belief that external (social) factors shape the development of criminal behavior and by a corresponding desire to alter the developmental trajectory of youth offenders. The founding of a separate juvenile justice system belies an assumption of societal duty to intervene, both to protect the public from harm and to benefit the offender.
Despite these notions, today's juvenile justice system has a diminished focus on rehabilitation, such that punitive or “retributive” paradigms dominate (Bazemore & Umbreit, 1995). Sentencing and incarceration experiences of juveniles increasingly resemble those of their adult counterparts. The last 20 years have witnessed more punitive sentencing of juveniles (Inderbitzin, 2006, Walker et al., 1996) and a 72% increase in the overall number of children in juvenile detention facilities since the early 1990's despite the lowest rate for violent crimes committed by youth in a generation (Mazzotti and Higgins, 2006, Snyder and Sickmund, 2006). For several decades, scholars and policy analysts have criticized the juvenile justice system's evolution from a mission of social welfare to one of social control. In particular, Feld (1999) argued that the structures that define juvenile justice are irrelevant in today's society, in part because of their disproportionate influence in the lives of poor and minority youth.
The increase in juvenile detention is due in part to a reversal of prior efforts to deinstitutionalize juveniles; recently, more status offenders, including runaways and “incorrigible” youth, have been sentenced to detention (MacDonald & Chesney-Lind, 2001). Youths in the juvenile justice system have high recidivism rates, poor academic outcomes, and limited chances for success in adulthood (e.g., Pullman et al., 2006, Robertson et al., 1998).
Entry into the juvenile justice system is the culmination of a range of risks, the failure of prevention efforts, and the absence of viable, community-based alternatives. Nevertheless, the founding philosophy of the system suggests that incarceration and its alternatives should serve as an opportunity to address risk and build resilience to avert costly, deleterious outcomes. Extensive resources are allocated to the development and validation of programs to rehabilitate juveniles. According to the Coalition for Juvenile Justice, federal funding streams channeled over $300 million to juvenile justice programs, research, and prevention in fiscal year 2006. Despite the best efforts of researchers to determine what works best for young offenders, “unambiguously effective programs were, and are, exceedingly rare” (Fass & Pi, 2002, p. 364).
While entering the juvenile justice system is the culmination of risk, detention itself has become a risk factor for continuing difficulty. The system can be a platform for future criminality, effectively sentencing a juvenile to a lifetime of low expectations, limited academic success, and diminished employment options. Admission into the juvenile justice system can serve as an opportunity to alter a trajectory that may otherwise lead toward increased delinquency and bleak futures. We argue that involvement in the juvenile justice system has the potential to initiate positive change, but that potential is largely untapped. Developmental science has demonstrated that effective interventions can change the balance between protection and risk, leading to more adaptive outcomes (National Research Council and Institute of Medicine, 2000). Systems change is needed if we are to reclaim the opportunities for rehabilitation that framed the original intent of the juvenile justice system.
At its best, the juvenile justice system can provide offenders legitimate chances at rehabilitation; at minimum, the system is charged with responding to the basic educational, behavioral, and health care needs of incarcerated youth. Providing real change opportunities necessitates adopting a different perspective on care. For the purposes of this paper, “care” within the juvenile justice system refers to meeting the behavioral, academic, vocational, mental health, and physical health needs of the juvenile, as well as providing the requisite family and public services to facilitate transition back into the community.
This paper envisions youth involvement in the juvenile justice system as a public health concern. The authors' perspective is informed by behaviorism, educational reform, and an emphasis on empirically-validated practices. We articulate a public health approach to prevention and management of chronic conditions. Rather than viewing the system as a tertiary, terminal intervention, we embed juvenile justice within a public health model with the intent of applying an alternative framework for examining risk, outcome, and potential solutions relevant to one of our country's most vulnerable populations. Accordingly, subsequent sections define the juvenile population, provide a truncated history of juvenile justice, delineate public health definitions and models, and apply these definitions and models to juvenile justice. We then summarize current knowledge of risk, examine associated conditions and outcomes, and briefly review current screening and intervention. Subsequently, we discuss the promise of comprehensive models of intervention and make general recommendations for systems change.
Section snippets
Definition of juvenile
There are nearly 73 million people under the age of 18 in America, roughly 25% of the population (Snyder & Sickmund, 2006). For the purposes of this paper, the term “juvenile” is used interchangeably with “youth” and refers to any person under age 18. The population of interest to the authors, youths involved in the juvenile justice system, consists of juveniles who have been incarcerated. Youths who have probation officers, who are arrested, and who exhibit antisocial behavior are not the
The public health model
The public health approach to prevention and intervention has been applied successfully to education, youth violence, and mental health (e.g., Walker et al., 1996). Preventive interventions were first introduced and defined from a public health perspective by the Commission on Chronic Illness over 50 years ago (Commission on Chronic Illness, 1957). Often represented by a triangle with three levels (see Fig. 1), the public health model encompasses primary, secondary, and tertiary interventions.
Juvenile justice as a public health concern
The public health framework that guides health care delivery in the U.S. is arguably the dominant paradigm in behavioral health and educational reform as well (e.g., Mellard, 2004, Walker et al., 1996). We follow this framework and use public health terminology in our discussion of youth in juvenile justice; an outline and definitions of key terms follow.
Earlier, we defined youth in the juvenile justice system and juvenile delinquency. Subsequently, we review characteristics and associated and
Overview of characteristics
The juvenile justice population is racially disproportionate; two-thirds of incarcerated youth are from minority backgrounds, compared with one-third of the general population (Mazzotti & Higgins, 2006). Concern about the extent to which the juvenile justice system serves as a system of youth development, particularly for poor and minority youth, has been documented by researchers for nearly 50 years. Zimring (1998) argues that drastic (punitive) countermeasures that disproportionately affect
Identification, surveillance, and interventions
The following section examines the identification and surveillance of youth in juvenile justice as well as juvenile justice interventions to address associated conditions and deter future criminality. Within each section, we discuss current practices and review known outcomes. In addition, we identify relevant evidence-based practices and the extent of their use. These evidence-based practices are incorporated into the application section, which follows later.
To extend the public health
Applying prevention logic and evidence-based practices in juvenile justice
With estimated recidivism rates above 50% (Heilbrun et al., 2000, Wiebush et al., 2005), current outcomes for the juvenile justice population are not promising. Were a disease to recur more than half of the time (especially after costly intervention), effective solutions would be demanded. Public health officials would likely track risk factors and outcomes, investigate quality assurance programs, and expand research endeavors. Adjudicated youth often face academic, vocational, and mental
Recommendations
Our primary recommendation for the juvenile justice system, outlined above, is the implementation of a system of care paradigm to organize, integrate, and evaluate service delivery based on public health prevention logic. An integrated public health infrastructure requires changes in national and state policy to ensure that agencies have the guidance, resources, and data necessary to select best practices, monitor outcomes, and alter intervention as necessary. A fundamental shift in philosophy
Conclusion
Currently, America has a fragmented, expensive juvenile justice system with little accountability, dubious results, and some promising practices. Research demonstrates disparities in care and outcomes between youths in JJRFs and their non-incarcerated peers, as well as within and among juvenile justice entities. The screening systems for mental health needs are poor and inconsistent; assessment and treatment options exist, but are not consistently available. Current research emphasizes the
References (127)
- et al.
Oral health needs of adolescents in a juvenile detention facility
Journal of Adolescent Health
(2006) - et al.
Deaths in juvenile justice facilities
Journal of Adolescent Health
(2006) - et al.
The health status of youth in juvenile detention facilities
Journal of Adolescent Health
(2006) Need for attention to mental health of young offenders (commentary)
The Lancet
(2002)Lessons from a systematic review of effects of multisystemic therapy
Children and Youth Services Review
(2005)- et al.
Comorbid psychiatric disorders in youth in juvenile detention
Archives of General Psychiatry
(2003) - et al.
Different pathways to juvenile delinquency: Characteristics of early and late starters in a sample of previously incarcerated youth
Journal of Child and Family Studies
(2006) - et al.
Reintegration, supervised release, and intensive aftercare
(1999) - et al.
Academic achievement in juvenile corrections: Examining the impact of age, ethnicity, and disability
Education and Treatment of Children
(2005) - et al.
Individualized Supports for students with problem behaviors
(2005)
Therapeutic jurisprudence, preventive law, and creative problem solving: An essay on harnessing emotion and human connection
Psychology, Public Policy, and Law
Rethinking the sanctioning function in juvenile court: Retributive or restorative responses to youth
Crime and Delinquency
Recidivism among adolescent serious offenders
Criminal Justice and Behavior
Juvenile justice and juvenile justice in America
Can mentoring or skill training reduce recidivism? Observational study with propensity analysis
Prevention Science
Multisystemic treatment of adolescent sexual offenders
International Journal of Offender Therapy and Comparative Criminology
Offender ethnicity and mental health service referrals from juvenile courts
Criminal Justice and Behavior
Therapeutic jurisprudence and preventive law in child welfare proceedings: A family systems approach
Journal of Psychology, Public Policy and Law
Multisystemic treatment of violent and chronic juvenile offenders: Bridging the gap between research and practice
Administration and Policy in Mental Health
Comparison of multisystemic therapy and parent training in the brief treatment of child abuse and neglect
Journal of Consulting and Clinical Psychology
Comprehensive community-based interventions for youth with severe emotional disorders: Multisystemic Therapy and the wraparound process
Journal of Child and Family Studies
Juvenile justice and mental health: Working together for the best outcomes for youth with serious emotional disorders
The Massachusetts Youth Screening Instrument as a predictor of institutional maladjustment in severe male juvenile offenders
Criminal Justice and Behavior
Risk and protective factors among youth offenders
Adolescence
Predicting first time involvement in juvenile justice system among emotionally disturbed youth receiving mental health services
Psychological Services
Annual report to congress on the e valuation of the Comprehensive Community Mental Health Services for Children and Their Families Program, 2001
Updated guidelines for evaluating public health surveillance systems: Recommendations from the Guidelines Working Group
Toward the ideal of community justice
National Institutes of Justice Journal
Second Step, grades 6–8, pilot project 1989–90, summary report
Evaluation of Second Step, preschool–kindergarten, a violence-prevention curriculum kit
The prediction of criminal recidivism in juveniles: A meta-analysis
Criminal Justice and Behavior
Preventive law before and after therapeutic jurisprudence: A foreword to the special issue theme
Psychology, Public Policy, and Law
Self-concept change and positive peer culture in adjudicated delinquents
Child and Youth Care Forum
Mental health care in juvenile justice facilities: A review
Journal of the American Academy of Psychiatry and the Law
Effects of positive youth development programs on school, family, and community systems
American Journal of Community Psychology
Psychopathy in adolescence and criminal recidivism in young adulthood: Longitudinal results from a multiethnic sample of youthful offenders
Assessment
Building systems of care for youth with serious mental illness
Hospital and Community Psychiatry
Introduction
The comparative advantage of juvenile versus criminal court sanctions on recidivism among adolescent felony offenders
Law and Policy
Early predictors of adolescent violence and adult violence
Violence and Victims
Getting tough on juvenile crime: An analysis of costs and benefits
Journal of Research in Crime and Delinquency
Bad kids: Race and the transformation of the juvenile court
Can juvenile justice detention facilities meet the call of the American Academy of Pediatrics and National Commission on Correctional Health Care? A national analysis of current practices
Pediatrics
Peer influence in children and adolescents: Crossing the bridge from developmental to intervention science
Journal of Abnormal Child Psychology
Society's retributive response to juvenile violence: A developmental perspective
Law and Human Behavior
Screening and assessing mental health substance use disorders among youth in the juvenile justice system
Does mentoring work? An impact study of the Big Brothers Big Sisters program
Evaluation Review
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