In Partnership with Juvenile Justice: Humboldts Perspective On
Creating A Continuum of Care
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Presenters Jeremy Nilsen Sr. Program Manager for Children &
Family Services. Jeremy is a MFT and has worked at C&FS for 12
years. Previously worked as a clinician providing Functional Family
Therapy (FFT),Trauma-Focused Cognitive Behavioral Therapy (TF-CBT),
and as a Supervising MH Clinician. Also served as a FFT clinical
lead, TF-CBT supervisor, and FFT State Consultant. Megan Gotcher
Supervising Probation Officer of the Juvenile Field Unit. Megan
originally began her career as a Juvenile Corrections Officer in
the Regional Facility Program. She went on to work in the Adult and
Juvenile Field. Megan has worked with the Probation Department for
15 years. Trained Facilitator in ART and EPICS Coach.
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About Us Humboldt County has a long history of cooperative and
integrated program development between Health and Human Services
and Probation to provide services to youth involved in the Juvenile
Justice System.
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Presentation Objectives Discuss how Juvenile Justice involved
youth and families in Humboldt County benefit from the use of
Evidence Based Practices and Integrated MH and Probation programs.
Discuss the evolution of services, treatment approaches, and view
outcome data. How to overcome implementation challenges and the
lessons learned as weve worked together to stabilize and maintain
youth in our community.
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Department of Health and Human Services Social Services Mental
Health/Alcohol and Other Drugs Public Health Transition-Age Youth
Programs Humboldt County Transition Age Youth Collaboration
(HCTAYC) Independent Living Skills Programs Employment Training
Veterans Services Public Guardian Environmental Health Healthy
Communities Emergency Preparedness & Response Mobile Outreach
Program
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Probation Provides a screening function for the Juvenile Court
Maintains intake services Detention facility for 602s Provides
intake and referral to local services for 601s Provides the Court
with impartial study of minors home situation Provides supervision
to minors as ordered by the Court
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Section 602 of the Welfare and Institutions Code (WIC) Any
person under the age of 18 years when he/she violates any law of
this state or of the United States or any ordinance of any city or
county of this state defining crime other than an ordinance
establishing a curfew based solely on age, is within the
jurisdiction of the Juvenile Court, which may adjudge such person
to be a ward of the Court.
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Goals For Youth Family reunification is the primary goal. To
stabilize and maintain youth in least restrictive and appropriate
placement. Rehabilitation for youth and family utilizing evidence
based practices: PACT, FFT, ART, A-CRA, TIP, EPICS, TFCBT, and
others Comprehensive behavioral health services. Treatment provided
through integrated team approach. Education success.
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Treatment through Integrated Team Approach Team Decision Making
Meeting TDM Family Intervention Team - FIT Wraparound
Interdisciplinary Staffing Treatment Team Meetings Mental Health
Services provided in Juvenile Hall Youth Centered Educational
Services
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Evidence-Based Practices Evidence-Based Practices According to
the Institute of Medicine, its the integration of the best research
evidence with clinical expertise and patient values. Integrating
research, practice, and consumer satisfaction to ensure the best
possible results for all involved.
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We are able to shift service delivery and implement changes
based on what research shows is effective We can avoid under/over
serving clients We need to use our dollars carefully and invest in
effective programs and interventions When a program is working,
everyone wins. Clients win, employees win, and taxpayers win. Why
Is this Important?
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Probations Utilization of EBPs Detention Risk Assessment
Instrument (DRAI) Positive Achievement Change Tool (PACT) Effective
Practices in Community Supervision (EPICS) Thinking for a Change
(T4C) Aggression Replacement Training (ART) Moral Reconation
Therapy (MRT)
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EBPs used at Children & Family Services Adolescent
Community Reinforcement Approach (A- CRA) Aggression Replacement
Training (ART) Functional Family Therapy (FFT) Incredible Years
(IY) Nurse-Family Partnership (NFP) Parent-Child Interaction
Therapy (PCIT) SafeCare Transition to Independence Process (TIP)
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
Wraparound
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PACT The Positive Achievement Change Tool (PACT) is an
evidence-based assessment tool designed to determine a youths risk
for re-offending. The PACT analyzes static factors and dynamic
factors. Static factors are events in a youths life that are
historic and cannot be altered. Dynamic factors are circumstances
or conditions in a youths life that can potentially be changed. The
PACT generates a score which identifies the youths level of risk to
re-offend.
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Continuum of Care Home with active support services Healthy
Alternatives Foster Care Relative Care/NREFM Residential Treatment
Regional Facility Program Department of Juvenile Justice
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Juvenile Hall Services Medication Management Mental Health
Services Clinicians meet with youth on a regular weekly schedule,
upon staff referral, or when there is a self referral. Community
Supports Social Skills Weekly Class(EPICS)
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Team Decision Making Meeting Definition: The Probation
Department hosts a meeting that brings together people who are
involved with the family to make a decision about the care and
placement of the youth. Goal: To identify the least restrictive
placement that is in the best interest of community safety and the
youth.
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Family Intervention Team A multi-agency team designed to
facilitate inter- departmental and inter-agency collaboration. The
focus is on at-risk children and youth with the goal of utilizing
available resources, managing clinical and fiscal risk, to
coordinate treatment, and to monitor client outcomes. FIT includes
staff from CWS, Probation, Mental Health, Education, and Public
Health.
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Out of County Placement Monthly Treatment Team Meetings Monitor
Placement Referrals for services upon returning home
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Outpatient Services at C&FS Screening & Assessment
Adolescent AOD Individual/Family Counseling Targeted Case
Management Medication Support Supplemental services include
Therapeutic Behavioral Services (TBS), Intensive Care Coordination
(ICC), and Intensive Home Based Services (IHBS).
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Adolescent Community Reinforcement Approach (A-CRA) For youth
between the ages of 12-19 with substance abuse issues. Behavioral
intervention that seeks to replace environmental contingencies that
have supported use with healthy community activities and behaviors.
Service includes evaluation, parent/family involvement, 10-14
intensive outpatient sessions.
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Incredible Years (IY) Parent training program focused on
strengthening parenting skills. Effective for decreasing
aggression, reducing disruptive behaviors, increasing academic
engagement, improving conflict management, and increasing
socialization. 12-16 weeks of classes for parents of children ages
3-8. Classes offered throughout various locations in the
county.
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Nurse-Family Partnership (NFP) Nurse-led maternal health and
home visitation program. Targets low-income, first-time mothers.
Services start early in pregnancy and support continues through
childs 2 nd birthday. Goal is to help mothers have a healthy
pregnancy, improve childs health and development, and become more
economically self-sufficient. Provided through the Public Health
division.
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Parent-Child Interaction Therapy (PCIT) Training intervention
with live coaching that teaches specific behavior management
techniques to parents. Focused on improving caregiver-child
relationship and increasing positive behaviors. Approximately 20
sessions for children ages 2-7 exhibiting behavioral concerns.
Provided through our Healthy Moms and Transition Age Youth
programs.
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SafeCare In-home parenting curriculum teaching parents how to:
Interact in a positive manner with their children Recognize hazards
in the home Recognize and respond to symptoms of illness and injury
Targets parents of children zero to five, who are reported or at
risk of child maltreatment. Weekly home visits over the course of
15-20 weeks. Provided through Public Health division.
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Transition to Independence Process (TIP) Goal is to provide
support and services for youth ages 16-26 to make a successful
transition into adulthood. Engages youth in a futures planning
process, facilitates greater self-sufficiency, and achievement of
goals related to specific Transition Domains. TIP model core
practices are used by trained facilitators in our TAY program.
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Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) For youth
ages 4-18 displaying PTSD, depression, anxiety, and other trauma-
related symptoms. 12-20 individual and family sessions focused on
teaching skills to manage symptoms, processing traumas, and
addressing cognitive distortions. Used in a variety of settings
throughout C&FS.
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Wraparound Wraparound is a team-based, strengths- oriented,
solution finding process. Goal is to help families stabilize,
identify long- term, sustainable solutions to family needs, and
achieve goals set by the team. Facilitation done by Probation and
MH staff as part of the Regional Facility aftercare and with
Adoptions cases.
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HEALTHY ALTERNATIVES A Program for Youth and Families
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Collaborative Partners Humboldt County Probation Department
Superior Court Judge Department of Health and Human Services
Humboldt County Office of Education Community Partners
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Probationer/Client Goal: To address the needs of youth who are
open to or are eligible for Mental Health services and enter the
criminal justice system, while allowing them to remain in their own
home in the community.
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Entrance and Referral Criteria Youth must be 602 WIC Ward of
the Court age 11-18 Referred as result of 602 Petition or VOP
Probation assesses eligibility and refers the matter to C&FS if
appropriate for screening
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Entrance Criteria Cont Primary Mental Health Diagnosis under
DSM-IV Mental Health Assessment completed by C&FS Court must
order minor and family to participate in program
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Healthy Alternatives Overview Minor attends weekly meetings
with Probation Minor attends bi-monthly Court appearances
(therapeutic Court model) Minor submits to random drug testing
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Overview Cont Probation monitors school attendance and behavior
Probation encourages minors to become involved in the community
through pro- social activities and community service work
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Overview Cont Probation and C&FS empower parents to
participate in the minors academic success and pro-social
activities. Probation and C&FS consult on a regular basis,
attend monthly program meetings, and hold quarterly program review
meetings.
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Program Goals Graduate from the Healthy Alternatives program
and terminate successfully from Probation Education Goals
identified and developed Employment services utilized Family
connected to services to sustain positive changes
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Goals Cont Family participating in pro-social activities on a
consistent basis Victim restoration completed Reduction in negative
impact of minors behavior on the family and in the community
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Program Phases and Treatment Components Length of program
varies depending on needs of family and individualized case plan
Orientation Phase: Youth and family complete assessment and begin
attending Court
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Phases Cont Phase I: Functional Family Therapy Phase II: 100
hours of CSW and/ Pro- Social Activities, Individual
Counseling/Adolescent AOD (as needed) Phase III: Referrals to
community programs as needed, Booster Sessions of FFT as
needed
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Functional Family Therapy Research-based prevention and
intervention program for at-risk adolescents and their families
Targets Youth Age 11-18 Short-term, family-based program at family
home or C&FS office
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FFT Cont Average of 12 to 15 sessions Provides specific skills
to families such as communication, problem solving, conflict
management, negotiation, and supervision Booster sessions offered
as needed Sessions can be done in home Appointments scheduled to
fit with a familys work and school schedule
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FFT Components FFT has three phases which last 4 to 5 sessions
each: Engagement/Motivation Behavioral Change Generalization
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FFT Focuses On Externalizing Adolescent Behavior Disorders
Conduct Disorder Oppositional Defiant Disorder Drug use/abuse Other
Behavior Problems Parent-Child/family conflict issues
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What is Success? FFT success defined as obtainable change. 50%
- 60% completion rates Families relate to each other better Rates
of drug use are reduced Recidivism (re-offending) rates
reduced
Program Overview The New Horizons program is provided to all
youth in the facility and is a collaborative effort between County
Probation Department, Humboldt County Office of Education and the
Department of Health and Human Services Mental Health Branch. At
any one time, there can be 18 youths in the program.
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Target Population Adolescents 12 18 Who show, or are at risk
for, aggressive behaviors History of placement failures History of
traumatic events, perhaps neglect or abuse School related
problems
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Target Population Cont Are juvenile wards of the court With
co-occurring disorders Behavior disorders Substance abuse Other
mental health disorder Have been court ordered into New
Horizons
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Treatment Program Four phases, 4 to 6 month intensive
in-custody mental health treatment followed by 6 months of
aftercare. Structured behavior management, individual and family
therapy, group counseling, substance abuse counseling, independent
living skills. Individualized and strength based youth and family
case plans developed utilizing the Wraparound model. 57
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New Horizons Program Structure and Staffing Procedure 4 phases
Phase 1: 2 weeks Phase 2: 4 weeks Phase 3: 8 weeks Phase 4: 4 - 6
weeks Through each phase of the program probation, mental health,
school and correctional staff communicate and staff the youth.
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Aggression Replacement Training at New Horizons Evidence-based,
comprehensive intervention strategy for aggressive youth New
Horizons staff trained by experienced trainers Implemented with
fidelity/fidelity measures to ensure quality control Utilization
and reinforcement of ART principles and skills throughout the
Regional Facility programmingProbation, Mental Health, Schools
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ART - Expected Results ART is an Evidence Based Practice (EBP)
that began in 1987 and has been tested in schools, community, and
detention environments. The majority of youth show substantial
changes in the following areas: Improved social skills
Development/improvement of moral reasoning skills Decreased
aggressive behaviors Reduction in recidivism
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ART Program Components Skill Streaming To teach social-skills
and alternatives to aggression. Anger Control Training To help
youth behave less aggressively less often. Youth learn to reduce
angry outbursts and to improve self control. Moral Reasoning
Training To improve moral development and reduce the use of
cognitive distortion or thinking errors. 61
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Anger Control Training ABCs Triggers 1. External 2. Internal
CuesReducers RemindersSelf-Evaluation Skill Streaming Skill UseFull
Sequence
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ART Outcome Monitoring
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Aggression Questionnaire (AQ) Pre/Post
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Skills Taught to Regional Facility Youth Knowing Your Feelings
Expressing Your Feelings Understanding the feelings of others
Dealing with Someone Elses Anger Expressing Affection Dealing with
Fear Rewarding Yourself 65
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Skillstreaming Checklist: Parent Pre/Post
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Skillstreaming Checklist: Student Pre/Post
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Skillstreaming Checklist: Staff Pre/Post
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Moral Reasoning Dilemma discussion groups designed to teach
youth how to: Think about moral issues. Deal with moral situations
that do not have clear-cut solutions. Use principles of fairness
and justice in their interactions with others. 69
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Moral Reasoning Goals Increase the moral reasoning stage of the
trainees and teach more balanced ways of thinking. Help the
trainees use newly learned and more advanced reasoning skills in
the real world. 70
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AOD Groups in the Regional Facility Modified Matrix curriculum
used for the substance abuse treatment component of the New
Horizons treatment program. Features of the A-CRA model are
presented in groups and used as part of the aftercare program.
Groups held twice weekly. 71
Youth Outcome Questionnaire- Self Report (YOQ-SR) Total Scores
Pre/Post
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How I Think (HIT) Problem Area Scores Pre/Post
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How I Think (HIT) Summary Scores Pre/Post
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Regional Facility Aftercare Individual and Family Counseling
Case management Wraparound meetings Probation support Pro-social
activities A-CRA
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Program Re-Incarcerations Since program implementation, 58
(21%) of the 270 youth who have participated in the New Horizons
program have been re- incarcerated in the Regional Facility. The
table on the next slide shows the elapsed time between
incarcerations.
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Time Between Incarcerations 0-3 months3-6 months6-12 months>
12 monthsTotal 1st repeat1417161158 2nd repeat514414 3rd
repeat11002 4th repeat00101
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Goals Attained by Humboldt County Inter-Agency Collaboration
Several EBPs built into programs serving Juvenile Justice involved
youth (A-CRA, FFT, TF- CBT, Wraparound) Co-location of Case Manager
at Probation Department (AOD) Critical Incident Training(Multiple
County Agencies have participated) Hostage Negotiation Team(Mental
Health and Law Enforcement)
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Challenges Lack of community resources Shortage of out-ofhome
placements Staff turnover/transitions Fidelity of Evidence Based
Practices
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Lessons Learned Its hard! flexibility is mandatory. Frequent
inter-disciplinary staff meetings are important. Can be mutually
beneficial reduced recidivism, shared burden, input from differing
perspectives, and responsibility. Client services improved right
amount of services, the right service, at the right time. Better
able to help families navigate the system.