Rethinking Juvenile Justice
Youth with substance abuse problems are often left in the hands of the courts—public health professionals should be doing more to help them.
Substance use is particularly pervasive and frequently untreated among adolescents. Substance use disorders typically begin during adolescence and young adulthood. In fact, 90 percent of all adults with dependence started using under the age of 18; half under the age of 15. The scope of the problem is concerning: 1.8 million teens need treatment; only 1 in 16 actually receive treatment; and fewer than half of those in treatment are retained for 90 days.
Though approximately 343,000 young people are arrested annually for drug- and alcohol-related crimes, there are no national standards for identifying who they are or for getting them the treatment and recovery services they need. Our current system is often ill-prepared to deal with substance-abusing youth and the problems they present—the services it delivers are frequently fragmented and uncoordinated, and publicly supported programs are chronically short of funding.
Our country’s juvenile courts have become the leading service delivery system for children and youth with substance abuse problems, not by choice but necessity. Substance abuse by the young leads to crime and many other high-risk behaviors. Research shows that young people who use drugs and alcohol are more likely to drop out of school, get into fights, break the law and get arrested, and engage in unprotected sexual practices that often lead to disease and unintended pregnancies. Substance abuse among our young is not just a juvenile justice or public health issue—it strikes at the underpinnings of our society.
A New Approach
Promising evaluation results indicate that a multisystemic continuum of care approach—combining prevention with evidence-based intervention and recovery supports, a system of graduated sanctions coupled with incentives for change, and community involvement—is better than traditional justice approaches. One such initiative is Reclaiming Futures, which since its founding in 2002 by the Robert Wood Johnson Foundation has expanded from a 10-site demonstration effort to cover 37 sites in 18 states. Reclaiming Futures is not a program. Rather, it is an organizational change and system reform that uses a six-step model (initial screening, initial assessment, service coordination, initiation, engagement, and transition) to interact with the community and improve outcomes for youth in the justice system. In each Reclaiming Futures community, judges work with local leaders to reframe the way law enforcement, courts, probation, detention facilities, treatment providers, families, schools, and the community cooperate. Under judicial guidance, the initiative pulls together leaders and resources in a collaborative effort to mobilize the community and help troubled young people succeed. Reclaiming Futures is a tested model for this approach (you can find out more about it at www.reclaimingfutures.org).
The Role for Public Health
Many of the competencies that define public health-applied scholarship are at the heart of juvenile justice systems reform. The adoption, implementation, and sustainability of Reclaiming Futures and other evidence-based innovations require dynamic, community-based participatory engagement strategies. In turn, they should be coupled with thoughtful consideration of empirically tested public health assessment, communication, advocacy, and policy intervention design frameworks. Descriptive and analytic epidemiology illuminates the magnitude of adolescent substance use and criminogenic activity and patterns of disparities among court-involved youth. Ecological assessment encourages the identification of social factors and other conditions that contribute to childhood trauma and put youth on the path to drug use and delinquency.
More practice-based public health leadership is needed to promote and translate research, and to advocate for effective policies that reduce delinquency, eliminate disproportional minority contact, and achieve better outcomes for court-involved children. A comprehensive strategy viewed through a public health lens and informed by systems and implementation science will lead to improved outcomes for these youth—and more cost-effective use of scarce resources—through a process of multidisciplinary, collaborative decision-making, better targeting of treatment and recovery needs in service provision, the adoption of evidence-based practices, and improved risk reduction.
Dan Merrigan is a leadership advisor for Reclaiming Futures. A former Jesuit priest, he was the founding director of the New England Alliance for Public Health Workforce Development.