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Daily Practice web_admin Thu, 12/23/2021 - 16:24

Ch.8 Management and Facility Administration

Ch.8 Management and Facility Administration web_admin Thu, 12/23/2021 - 16:25

Author: Anne M. Nelsen, MSW, MPA

Although confinement facilities are complex organizations that vary in purpose, size, and structure, the elements of effective management are universal. Certain strategies and practices promote success, whether a facility serves a few or many residents, and whether its function is as a juvenile detention center, a juvenile correctional facility, or an adult facility that also serves youth. The same principles, policies, and practices can work in federal, state, county, or regional systems, as well as in private and public operations. Regardless of the size and structure of the facility, effective performance begins with a clear vision and mission.

Vision and Mission

A cogent mission statement is the first step toward setting a clear direction and gaining a measure of control in the uncertain and changing environment of juvenile justice. Fully and clearly defined purposes become the foundation for decisions and consistent policies. A strong mission statement includes beliefs, values, and expectations about what will happen to confined youth in a particular facility.

The National Juvenile Detention Association (NJDA) definition captures the essence of juvenile detention.[1] That definition addresses the seven essential characteristics of juvenile detention identified by the American Correctional Association (ACA), Juvenile Detention Committee: temporary custody, safe custody, restricted environment, community protection, pending legal action, helpful services, and clinical observation and assessment.[2] Those elements can serve as the basis of a comprehensive juvenile detention program and a mission statement. (See Ch. 2: Types of Facilities: Juvenile Detention)

In 1992, the Academy Division of the National Institute of Corrections (NIC) (formerly referred to as the National Academy of Corrections [NAC]) assembled 30 juvenile detention and corrections experts to address the issue of vision and mission statements for juvenile detention and corrections. The NAC report from that meeting noted the common perspectives of the participating juvenile justice practitioners, particularly the high levels of consensus about the need for intervention before youth become institutionalized. The vision and mission statements promulgated by that group are still pertinent. They read as follows:

Vision Statement

Our vision is that every child experience success in caring families and nurturing communities that cherish children and teach them to value family and community. Our vision is guided by the fact that our decisions and actions affecting children today determine the quality of our life tomorrow.

Mission Statement

The mission of the juvenile corrections and detention system is to provide leadership for change for youth, family units, and communities. It operates by creating legitimate, alternative pathways to adulthood through equal access to services that are least intrusive, culturally sensitive, and consistent with the highest professional standards.[3]

These statements illustrate the broad underlying purpose of juvenile confinement facilities. They can serve as a foundation for a facility to develop its own mission statement—within its jurisdiction and as part of the juvenile justice system. They recognize the challenges faced by the young people the system serves. They point out the importance of professionals in that system asserting their influence in guiding the future actions of facilities and programs to better serve youth. They stress the importance of practices being built on evidence-based research. And, they emphasize the value that juvenile justice experts place on intervention to enhance the future for youth. A facility’s mission statement flows from the organization’s fundamental values, beliefs, and expectations regarding the treatment of youth and goals for their successful future. That mission statement will then influence the policies and procedures.

The External Environment

A central task for facility administrators is to address challenges from the external environment, including such issues as overcrowding or downsizing, commitments that are inappropriate or involve vulnerable or demanding youth, and lack of adequate resources. These issues may undermine the best-designed programs; however, they can be overcome through a variety of management tools, including:

  • Reliable information on population trends, delinquency and crime rates, and demographics.
  • Sound planning.
  • Admission criteria that are clear and understandable.
  • Mechanisms for prompt or regular review of detention or commitment decisions.
  • Availability of an adequate array of non-secure alternatives—such as a continuum of care. Mechanisms for timely disposition, transition, and release—including adequate community and residential resources.
  • A means to constantly monitor the facility population and to ensure that court scheduling, placement assessment and referral, and transportation are timely and do not become obstacles to transition and release. (See Ch. 18: Transition Planning and Reentry)

All of these techniques demonstrate the importance of the relationship between the confinement facility and the broader juvenile or adult criminal justice environment, including courts, probation and parole, placement agencies, law enforcement, and transporting authorities.

One way to meet the challenges and overcome the problems of managing a confinement facility is to build coalitions. Building coalitions means making connections with individuals, groups, organizations, and agencies that can make a difference. Sometimes coalitions are forged through formal means—reports on goals, accomplishments, and shortcomings of the program; speeches and brochures that interpret the philosophy and goals of the program; tours and educational events that open the facility to the community; and advisory boards, committee membership, and public meetings that involve key people from outside the organization. Coalition building is also achieved informally—responsiveness to inquiries from the community; sensitive handling of telephone calls and letters from parents, victims, and concerned citizens; and regular contacts with judges, commissioners, legislators, and other key decision makers.

Although the examples of coalition building presented above apply to the local level, the process is just as critical on the state and national levels. Facility practitioners can build coalitions with one another; with representatives from other parts of the juvenile and criminal justice system and from different levels of government; with the research and academic communities; and with leaders of churches, businesses, corporations, and foundations. Coalitions that have a purpose can help to build support and promote positive change.

Responsibilities of Facility Management

Among the responsibilities of facility managers are four key tasks: 1) development and communication of sound policies, procedures, and standards; 2) acquisition, allocation, and monitoring of resources; 3) selection, training, and development of staff; and 4) evaluation of organization performance and planning for the future.

Policies and Procedures

Effective policies and procedures are discussed in detail later in this chapter. Those written guidelines can help ensure consistent practice.

Resource Management

Resource acquisition, allocation, and monitoring are critical to building a successful program. The physical plant and operating funds are primary resources. Design and maintenance of the physical plant must acknowledge the relationship between space and the objectives of the facility. In addition, designated funding sources and the public in general must be willing to pay the costs of security, safety, health, and well being. Facility administrators have the obligation to define what constitutes adequate funding and to make the case for its allocation. They also have the responsibility to manage those funds with rigorous efficiency and integrity. (See Ch. 3: Physical Plant Design and Operations)

Competent Staff

Competent, conscientious staff are more important than any other element for ensuring quality and achieving the mission of any confinement facility. The most important tasks for management are selecting and training staff. Through the hiring process, administrators and managers seek to identify people with the knowledge, skills, and qualities of character needed to achieve the purposes of the facility. Training supports the development of knowledge and skills, expands understanding of the aims of the organization, and integrates staff into the process of sustaining the values and accomplishing the goals of the program. (See Ch. 4: Developing and Maintaining a Professional Workforce)

Evaluation and Planning

The management responsibilities of evaluation and planning are two sides of the same issue. Evaluation asks how well the organization is doing; planning asks what the organization can improve for the future. Both functions are based on understanding what constitutes organizational performance. A highly performing organization is successful in the following five areas:

  • The organization’s relationships to its environment. How effective are the relationships with the court and with placement or parole agencies? Are admission criteria in place and respected? Can some measure of predictability and control be exercised over admissions and release? What are the organization’s relationships with external stakeholders (e.g., law enforcement and educational institutions)?
  • Acquisition and use of resources. Is the organization able to secure and retain financial and human resources? Is the building or physical plant adequate in size and design? How well does the building or physical plant serve the purposes of safety, security, health, and development? Is funding adequate and managed efficiently? Are the staff scheduled and assigned to work effectively?
  • Internal processes. How many clients are being served? Do activities support goals? How well do support services such as purchasing, food service, and clerical work function?
  • Achievement of purposes and goals. Are the purposes of safety, security, health, and development or rehabilitation being met? To what extent are there escapes, injuries, assaults, or other indicators of performance failure?
  • Satisfaction of clients and employees. To what extent do youth and staff feel safe? Do youth feel that the staff cares about them? Do employees show signs of trust, respect, and loyalty? What is the state of employee morale? How effective are processes for communication, problem solving, and conflict resolution among youth and staff? To what degree are opportunities afforded for innovation, self-expression, and autonomy?

Leadership and Capacity Building

Building Leaders from Within

Effective leaders have many valuable qualities, one of which is the willingness and the ability to build current and future leaders from within the organization. Willingness requires having confidence enough to not be threatened by developing leaders within the organization. It entails recognizing the skills and potential in others and acknowledging their benefit to the facility. The ability to build leaders within the facility, like most leadership traits, is learned. Cebula and colleagues discuss this notion:

When employees are able to put their talents, skills, and knowledge to use, frustration and complacency are rare. Continuous learning also includes giving staff opportunities to build self-confidence through practice. Leaders who build self-confidence in their staff give them the foundation to deal with unexpected events and to make the tough choices this field often requires. Higher performing leaders know that building an organizational culture based on openness and trust encourages employees to suggest how to improve processes, propose innovative ways of dealing with issues and problems, and engage in improving the organization’s effectiveness.[4]

Developing employees involves helping them to achieve their goals at the organizational, unit, or individual levels. It is important to remember that people meet different personal needs as they realize their goals. Some people need to stretch and prefer a challenge, knowing that they may not fully succeed but that they will grow and progress. Some people need more readily achievable goals to foster confidence, raising the bar as objectives are reached incrementally. An effective leader must be aware of and sensitive to those individual needs and work styles and consider them in coaching and mentoring their employees. (See Ch. 2: Types of Facilities and Ch. 4: Developing and Maintaining a Professional Workforce)

Coaching helps leaders increase their effectiveness. And, when they coach others, “they can increase the capacity of the organization by bringing out the best in people: their willingness to be responsible for results, their engagement in solving problems, and their ability to deal with change and complexity.”[5] Coaching skills are enhanced by three primary techniques.

  1. Listening without judgment helps to improve trust and encourage communication.
  2. Asking powerful, open-ended questions rather than directing or giving advice helps to challenge staff members to examine their behavior.
  3. Setting up a system of accountability can lead to changes in old behaviors that are ineffective and establish long-term goals that staff adopt as their own.

In addition to coaching, mentoring is an important technique in developing leaders within any organization. Mentoring can be described as the “transfer of knowledge about the work, the organization, and the network of contacts within it from an experienced, knowledgeable person to someone who has less knowledge.”[6] Mentoring may be formal or informal. Informal mentoring occurs when two individuals agree to work together with the goal of leadership development. Formal mentoring involves structure and may include specific goals, schedules, and oversight. Some juvenile and adult correctional agencies establish formal mentoring relationships for new employees or for new supervisors or managers. That system benefits both the new staff member—through the guidance that is provided—and the established staff member—through opportunities to practice leadership skills and to examine the organization and his or her own knowledge. In some cases, professional organizations may provide mentors. This underscores the value of networking with professional organizations (e.g., National Partnership for Juvenile Services [NPJS], ACA, Council of Juvenile Correctional Administrators [CJCA]), through which a professional may acquire knowledge from peers. (See Ch. 1: Historical Perspective)

Participation in Professional Organizations and Networking

Building and using networks helps leaders at all levels become more effective. Upper-level leaders who learn to develop networks when they are novice supervisors or as they progress through middle management have the benefit of that support system, because they have access to resources at the leadership level. They can turn to the relationships they have developed through professional and interpersonal networks to address challenging issues. Also, through those professional networks, leaders are positioned to be aware and take advantage of current research and innovations and embrace effective practices tested in other facilities and programs.

Staffing Adequacy

Confinement facilities are unique organizations in that they never close; they must be staffed by trained, competent staff 24 hours a day, seven days a week. This makes the need to develop individual leaders—as well as leadership capacity in all employees—even more important. Facilities must have assigned leader decision-makers on duty at all times, and, if the facility has a system for developing them, leaders will be available to make decisions on a routine basis or in unusual, critical situations. In addition to recognized leaders, the facility must also have a sufficient number of qualified line staff who have received training in an accepted juvenile justice curriculum and in facility-specific expectations. The staffing plan must meet accepted staff-to-youth ratios. Those ratios may be based on a variety of factors, which the Prison Rape Elimination Act Standards (PREA) delineate specifically:

  1. The agency shall ensure that each facility it operates shall, develop, implement, and document a staffing plan that provides for adequate levels of staffing, and, where applicable, video monitoring, to protect residents against sexual abuse. In calculating adequate staff levels and determining the needs for video monitoring, facilities shall take into consideration:
    1. Generally accepted juvenile detention and correctional/secure residential practices;
    2. Any judicial findings of inadequacy;
    3. Any findings of inadequacy from Federal investigative agencies;
    4. Any findings of inadequacy from internal or external oversight bodies;
    5. All components of the facility’s physical plant (including “blind spots” or areas where staff or residents may be isolated);
    6. The composition of the resident population;
    7. The number and placement of supervisory staff;
    8. Institutional programs occurring on a particular shift;
    9. Any applicable State or local laws, regulations, or standards;
    10. The prevalence of substantiated and unsubstantiated incidents of sexual abuse; and
    11. Any other relevant factors.
  2. The agency shall comply with the staffing plan except during limited and discreet exigent circumstances, and shall fully document deviations from the plan during such circumstances.
  3. Each secure juvenile facility shall maintain staff ratios of a minimum of 1:8 during resident waking hours and 1:16 during resident sleeping hours, except during limited and discrete circumstances, which shall be fully documented. Only security staff shall be included in these ratios.”[7]

PREA Standards serve as a useful tool in clearly enumerating a range of factors to consider in establishing a staffing plan. PREA Standards must be adhered to; however, to ensure safety and security of both staff and youth while delivering specific treatment programs, a facility may need to exceed those standards. For example, a facility that serves sex offenders may need to increase staffing to provide adequate supervision and programming. A juvenile correctional facility that has a robust treatment component may need a staffing plan that includes a strong clinical staff in addition to the security staff outlined in the PREA requirements.

Long before PREA Standards were finalized, the NJDA promulgated a position statement on staffing adequacy by supporting “regulation, policy, procedure and practice ensure a minimum ratio of one staff to no more than eight (1:8) juveniles during the day, and a ratio of one staff member to no more than sixteen (1:16) juveniles during the night.”[8] That position statement intentionally emphasized the need for those ratios to reflect minimal numbers to ensure the safety and security of the facility and the provision of necessary programming for juveniles. (See Ch. 9: Admission and Intake: PREA Screening)

Evaluating Performance of the Facility and the Staff

There are two basic types of performance management in a confinement facility: Management and evaluation of 1) the performance of the entire facility or one of its components, such as a particular treatment unit or the school program, and 2) the performance of individual staff members. Both types of evaluations are important and are interrelated; their goals and objectives are mutually dependent.

Performance Management and Organizational Performance

The use of performance measures is important for any organization, and it is critical for a publicly funded program. Accountability in the use of tax dollars is the responsibility of the facility, its parent agency, and of each employee. “Few public sector programs are evaluated systematically to determine whether they are achieving their objectives and doing so in a reasonably efficient fashion. Informal judgments of program effectiveness and efficiency tend to be subjective, based on anecdotes of program success or failure, the glowing testimonials of program proponents, or the harsh criticisms of program opponents.”[9] Accountability and, as a corollary, productivity in a public agency have been defined as “responsiveness to the needs, desires, and resources of the community, client, user, or customer.”[10] In confinement facilities that serve youth, this refers to the expectation of improved public safety through effective confinement and the transformation of youth into contributing, law-abiding citizens through the prudent use of resources. And, the “needs, desires and resources of the client, user, or customer” refers to the needs of young people and their families for such services as treatment and education and successful reintegration home, while considering their skills, abilities, and personal and environmental assets.

To measure the performance of an entire facility or one of its components, leaders must help staff set meaningful, specific, measurable, and achievable goals. Goal setting should be a shared activity that provides participants—including all members of the staff—with a clear understanding of their purpose. “It is not the responsibility of management to set goals. Rather, it is management’s responsibility to create an atmosphere where workers set their own goals and feel committed to achieving them.”[11] In addition to establishing organizational goals, the group must also determine how those goals will be measured. Measurement consists of tracking both process or tasks and products or accomplishments. For example, a school program in a facility might count the proportion of youth who attend class at least 90% of the days held, which would be a process measurement. Then, they might count the number of youth who pass their GED exam, receive enough credits to graduate, or enroll in college and complete a full semester. Those would be product measurements. The two types of measurements complement each other and contribute to the success of the facility. Reliable measures of performance in organizations that serve people in any way are rare, and measures of group performance are even rarer, despite the need to evaluate group performance. It is arduous but important to develop relevant criteria to use in evaluating the performance of a group, unit, or facility. The fact that measuring and evaluating a facility’s performance is difficult should not be an obstacle to doing so.

Performance of Employees

A more familiar type of evaluation for most practitioners is the measurement of individual employee performance. Unfortunately, all too often, many managers view employee evaluation as an interruption of their primary duties, rather than an essential one of those duties, and, as a result, conduct it in a perfunctory manner, if at all. If a manager fails to recognize the importance of honest feedback and tries to avoid the sometimes emotional process of evaluating performance, neither the employee nor the organization benefits. Employees should expect constructive criticism, guidance, and training for their continued growth and development as professionals.

An effective performance-evaluation system begins with a comprehensive job description on which the evaluation criteria are based. A job description should include the major objectives of the particular position and then list specific tasks to be completed in accomplishing each objective. For example, an objective might be “to maintain safety and security for detained youth.” Tasks would then be identified for the employee(s) in that position for that objective. In this example, tasks could include such things as, “complete visual, random room checks of all confined youth no less frequently than every 15 minutes” or “complete head counts of all youth before and after any group movement within the facility or its grounds.” In addition, the accomplishment of those tasks would be documented in specific ways. The first task might require the completion of room check logs, and the second task might require the completion of unit logs that document head counts. (See Ch. 4: Developing and Maintaining a Professional Workforce: Hiring Professional Staff)

Related to job descriptions are performance plans, which refine the job description and provide levels of ratings, which relate to the employee’s performance. The performance plan uses the major objectives from the job description and defines levels of assessment. For example, if an objective in the job description is to provide quality programming for confined youth, the performance plan would designate the kind and the amount of programming (dosage) to result in a rating of “exceptional,” “above standard,” “standard,” “below standard,” “and unsatisfactory” on a five-level scale. An “exceptional” rating may be achieved if “the employee keeps youth engaged in mentally and physically stimulating activities for the entire programming period and introduces at least six new programming activities during the one-year evaluation period. When surveyed, youth report a positive response to these activities.” An “above-standard” rating may be earned if the “employee keeps youth engaged in mentally and physically stimulating activities for at least 75% of the programming period and introduces at least three new positively reviewing activities.” A standard rating may be earned if “the employee provides moderately stimulating programming on all shifts but introduces no new activities.” A below-standard rating may be earned if the employee fails to provide programming on some shifts and introduces no new activities.” And, an unsatisfactory rating may be earned if “the employee fails to provide programming on most shifts.” Of course, there are limitless variations, but it is important for performance objectives to be as specific as possible and relate to the mission and goals of the facility. In addition, performance plans should be negotiated between the supervisor and the employee. In general, all employees in a particular job category would have identical or similar performance plans that are individualized based on the employee’s experience, performance goals, and training needs. Performance plans should be reviewed at least annually and updated as needed.

The final step in employee performance management is the actual performance evaluation. Often, agencies have a designated form for evaluating performance, but that form should allow for the flexibility to consider the employee’s performance plan. In evaluating employee performance, “most criteria fall into the following general categories: output quality, output quantity, work habits and attitudes, accident rates, learning ability, and judgment and problem-solving ability.”[12] Many performance evaluations “tend to concentrate too much on subjective personality traits or on the peripheral aspects of the worker’s performance (e.g., attitude, punctuality, orientation to managers) and not enough time examining the degree of attainment of specific outcome criteria for the job.”[13] Closely tying the performance appraisal to specific expectations in a negotiated performance plan can also mitigate the impact of the “halo” or “horns” effect. The halo effect occurs when an employee receives unreasonably high ratings based on such things as past performance, pleasant personality, or friendship. The horns effect occurs when an employee receives arbitrarily low ratings based on a tendency to disagree with management, membership in a poorly performing team, or weak past performance.

A successful employee performance appraisal occurs when the supervisors and employees have jointly developed performance plans that spell out specific tasks to be accomplished, based on major objectives that draw from the mission of the facility. That job description informs a performance plan that is negotiated by the employee and supervisor and that clarifies the levels of performance required for designated ratings. The evaluation is based on the performance plan and includes quantifiable measurements that are fair and are perceived as being so. Such a system should not result in surprises at the annual evaluation. It is advisable to meet at least one time mid-year to review the performance plan to help keep the employee on track and focused.

Labor Law Issues

Union and Nonunion Staffing

Confinement facilities may have unionized or nonunionized staff; there are advantages to each model. However, the most significant issue in an effectively operating facility is not whether or how the staff is represented, but whether there is a positive culture that encourages collaboration between management and direct care staff and between staff and youth. Unions have tended to oppose differential treatment of employees based on varying levels of productivity, employee reductions, civilianization, contracting out government functions, innovations in personnel deployment, and use of technology when the result is considered disruptive or threatening to employees.[14] On the other hand, “in some instances, adversaries have become allies with major productivity gain achieved through the cooperative efforts of management and organized labor.”[15]

One successful superintendent at the country’s largest juvenile detention center in Cook County, Illinois, has worked well with employee unions by viewing them as partners and “bringing them to the table.” Teresa Abreu says that believing that there is a shared goal—“a safe and secure environment for kids”—has helped her and facility employees to address concerns and deal with real or potential conflicts.[16] Abreu reports that the union representatives often have very good ideas, and it is helpful to have them involved in as many issues as possible. They are experienced workers who can provide insight and identify issues that management may not see. Unions and the collective bargaining agreements that they negotiate with management can help establish clear rules for employees, can help ensure fairness and due process when management fails to consistently do so, and can encourage management to meet with and address difficult issues with employees that they might otherwise be able to sidestep.

Union representatives in high functioning facilities also acknowledge that it is important to have a healthy working relationship with management. Shop Steward George Sanchez, of Cook County states that it is important to “remember that each side has an assigned role and it is a professional relationship, not personal.”[17] Sanchez points out that a union can be an asset to employees in representing their position by presenting their perspective to management and helping to examine a situation in comparison to similar situations. Both Abreu and Sanchez agree that a disadvantage of unionization is that the political aspect of the union can lead to losing sight of the ultimate goal of the facility as serving youth. In addition, the average union member might say they want more of a voice, especially when the union is large and influential, and some employees feel that if they do not get their individual needs met, the union is not representing them. A union has to represent all of its membership. It has to consider long-term needs that may only be achieved by short-term sacrifices. To serve its membership, the union may need to compromise in the short term and work with management in the process. Unions can protect their employees from capricious and unfair decisions by management while cooperating to achieve shared goals.

Many facilities operate in jurisdictions that have no or limited union involvement. When these facilities are government operated, and there is typically a civil service system that provides protections for employees, based on federal and state statute and case law. Even when there is no collective bargaining agreement, employees have protections under the Fair Labor Standards Act (FLSA), the Family Medical Leave Act (FMLA), the Americans with Disabilities Act (ADA), and civil rights laws enforced by the Equal Employee Opportunity Commission (EEOC). In addition, states and localities have related laws and ordinances that protect employees. Generally, states have employee indemnification laws that shield government employees who do not act with maliciousness or negligence. Those laws vary, and it is wise for practitioners to be familiar with protections available in their own states. Even in the absence of union representation, employees have rights, and they should be aware of those rights while meeting the obligations of their jobs.

FLSA Exempt Salary, Hourly, and Contracted Employees

Another element of facility staffing is the use of salaried employees, employees who are paid by the hour, and contracted employees. Generally, administrators, managers and—usually—supervisors are paid by salary and are classified as “exempt” under the FSLA. The exempt status basically means that those employees are not eligible for pay at a time-and-a-half rate for hours worked above 40 each week. The U.S. Department of Labor classifies jobs as either exempt or non-exempt based on a number of factors, including salary level and professional or administrative duties. Under the FLSA, exempt employees have “ ‘no rights at all’ ” other than the right to receive “the full amount of the base salary in any work period during which s/he performs any work.”[18]

Employees who are non-exempt under the FLSA are entitled to be paid time and one-half for every hour they work above their regular work period, usually a seven-day week. Normally, overtime pay is due after an employee works 40 hours in the workweek. Most employees in a juvenile or adult confinement facility are classified as non-exempt and must be paid overtime. That includes direct care staff, many supervisors, clerical employees, and support staff. It is often necessary to have employees work extra hours to ensure that a facility is adequately staffed.

Some agencies also have part-time employees who work a limited number of hours or who work exclusively in place of full-time employees who have time off. Those part-time employees are limited by law and policy in the number of hours they may work and generally are not allowed to accrue overtime pay.

Many facilities also use contract employees to meet specific staffing needs. There may be services that do not require a full-time employee, and it is more cost-effective to contract for that service. For example, a small confinement facility may need only occasional or part-time psychiatric services, and—rather than hire a psychiatrist as an employee with a salary and accompanying benefits—that facility may contract only for the number of hours of service provided. In many cases, entire programs within a facility may be contracted such as food services or custodial services. Again, that relieves the facility of the costs of hiring employees. When contracting for any type of service, it is important to balance the monetary value of the contract with the benefits of having committed, loyal employees as part of the organizational team.

Foundations for Sound Facility Operations

Policy and Procedure Manual

Experience has shown that direct care staff members who work with youth are best able to perform their jobs and provide the services those youth most need when they work in an environment that includes:

  • A clear mission statement.
  • Goals and objectives.
  • A departmental code of ethics.
  • Written standards that meet requirements for state or national accreditation or certification.
  • Comprehensive training and continuing education.
  • An ongoing program of personnel evaluations.
  • Written policies and procedures.

What Is a Policies and Procedures Manual?

The NIC discussed the importance of all juvenile and adult correctional agencies having “clear and concise written directives for staff, offenders, and the community. Given the issues of administrative liability, accreditation standards, case law, and the need to support professional behavior, written policy and procedure is a necessity.”[19] That NIC statement goes on to say that “well-written policy and procedure is the core of modern correctional operations. It informs and governs staff behavior, sets clear expectations, and confirms that the administration has performed its role. It is also the basis for staff supervision, training, and supporting a defense when things go wrong.”[20] Policy should be based on defensible rationale and legitimate correctional outcomes, such as safety, security, sanitation, resident programs, and legal rights. Sources of policies may be established standards such as those promulgated by the ACA. Policies must address applicable case law in the jurisdiction. The procedures that accompany written policies offer more detail to help the practitioner implement the policy.

A policy and procedure manual contains the department’s or the facility’s mission statement, goals and objectives, code of ethics, and guidelines that facility staff require in performing both their routine and nonroutine tasks. The manual is intended to be a tool that makes the job of the confinement facility professional easier. It contains an accumulation of information handed down from previous juvenile professionals—information that the field believes is good practice.

What are the benefits for staff?

Staff members in confinement facilities for youth are entrusted with the responsibility of supervising troubled young people and must have common sense and knowledge about interacting with challenging youth in a secure environment. Acquiring a good command of the information in the policies and procedures manual is the first step for staff to gain that knowledge and fulfill their responsibilities.

Specifically, a policy and procedure manual may provide:

  • Parameters for making decisions. Facilities usually develop written policies that govern the use of discretion in decision-making. Within the policy guidelines, staff members are able to make informed decisions about relating to and providing for the juveniles. Guidelines help ensure that staff will not handle juveniles based on personal values, working conditions, or other factors that may lead to arbitrary decisions.
  • An overall picture of the connection between one unit and another and between each unit and the facility’s mission. As staff members see their part in the picture, they will be more willing to work as a team and be more accountable for their own actions.
  • A method for communicating more effectively with other staff, board members, families, youth, placing agencies, and other involved agencies and individuals. The policies and procedures manual provides a common language and reference points.
  • Consistency in the program, especially among the staff in their actions and behaviors. Consistency is crucial for the safety and the mental well-being of the youth and staff.
  • Assurance of compliance with legal requirements, including respect for the legal rights of youth in custody.
  • Protection from liability, audit exceptions, and criminal procedures. The threat of liability is reduced when staff members function in a proactive manner, using sound principles.
  • Assurance that emergency procedures will be carried out effectively.
  • Protection from any sanctions for noncompliance that may be built into the personnel policies of the agency.

Definitions

Policies. In general, a policy reflects the facility’s philosophy about a particular issue. For example, each facility should have policies that cover a range of issues, from the security of the building (key and tool control, the use of official vehicles, and emergency procedures) to the discipline of youth (rules and regulations for resolving minor violations).

Policies are statements of the general course of action a facility wishes to take. They give staff the reasons and the directions needed to function effectively in the facility. Policies tend to be general and goal oriented. For example, a policy statement on “Visitation” might read:

“To encourage healthy family and community ties and to increase the likelihood that a youth will succeed after release, visits with family members and others who may have a positive influence are encouraged. Visits shall occur in a manner that allows maximum contact between the youth and the visitor while ensuring the safety and security of the facility.”

In a few limited instances, however, an item of specific information, such as a time or location, may be of such importance to the understanding of the policy that it should be included in the policy statement. Timing in an emergency is critical; therefore, emergency procedures should be highly specific, although staff members may have to make some on-the-spot judgments. In most instances, however, such detail should be left out of the policy statements and included only in related procedures.

The policy answers the question, “what?” as if to say, “This is what we stand for, this is what we do.” The format of the policy and procedure manual may have a statement of Purpose or Rationale component for each policy or that may be included in the policy statement. The purpose answers the question, “Why?” “It is the rationale and basis for the policy, documenting that it is grounded in more than preference or administrative whim.”[21]

Procedures. A procedure is the detailed, step-by-step description of the sequence of activities necessary to implement the policy and achieve the stated goals. The procedure answers the questions who?, where?, when?, and how? In the example above, the procedures would describe who is able to confine the youth, where the youth would be confined, how long the youth can be confined, how the confinement should be documented, and what information should be recorded.

Because procedures usually involve a series of actions to be performed by certain responsible persons under certain circumstances, include the following information in the procedure:

  • The steps involved in completing the action in the order in which they occur.
  • The individual (by title) or operational unit responsible for the actions described by the procedure.
  • The times and locations relevant to the operating procedure.
  • The relevant forms to be completed.
  • The form of communication involved (telephone, written notice, etc.) in completing the procedure.
  • When and to what extent discretion is allowed.
  • Provisions for handling major problems or emergencies that may occur during the implementation of the procedures.

In addition to the policy and procedure, a section that lists “References” is often included. References provide the background and sources behind the policy and serve as supporting documentation. References might include information like a national or state standard or a court order.

Content Sources for the Policy and Procedure Manual

Ideally, the development of policies and procedures should flow from the fundamental agency philosophy. That philosophy generates the facility’s vision and mission discussed above. Therefore, before the first draft is written or before the manual is revised, the agency leadership should set aside time for defining and reviewing organizational philosophy, vision, and mission.

A workable philosophy statement should include:

  • The purpose of the facility.
  • The facility’s responsibility to its youth, the funding sources, the community, and other agencies and organizations with which it has a legal or professional relationship.
  • The short-term, intermediate, and long-term goals or the direction in which the facility is or should be headed.

In general, policies and procedures are also based on a variety of other sources, including:

  • The facility’s charter or bylaws.
  • Existing written policies and procedures.
  • Administrative rules, regulations, and memoranda.
  • Recommendations of staff, unions, and youth (when appropriate).
  • Existing but unrecorded practices.
  • Problems encountered in the past.
  • Local codes for fire, building, safety, sanitation, and health.
  • Standards issued by a variety of groups, including the ACA, National Commission on Correctional Health Care (NCCHC), American Bar Association (ABA), American Medical Association (AMA), the American Academy of Pediatrics (AAP), Juvenile Detention Alternatives Initiative (JDAI); the Performance-based Standards (PbS) of CJCA, the U.S. Attorney General; state agencies; and others.
  • Model policies and procedures manuals from the ACA, other states, agencies, or institutions.
  • Issues identified in audit reports.
  • Suggestions from the community and involved agencies.
  • Legal and professional requirements, including:
    • Court decisions that determine the legal criteria for facility operations. Because courts in various areas may rule differently on particular issues, it is advisable to rely on decisions from State and Federal courts in one’s jurisdiction, keeping in mind that federal law supersedes state law.
    • Federal statutes and administrative rules and regulations relevant to the operation of confinement facilities that serve youth.
    • State statutes and administrative rules and regulations relevant to the operation of confinement facilities.
    • National and state corrections standards.

Key Content Areas

Although policy and procedure manuals will differ slightly in their format, ACA identified the following four areas commonly addressed: administration, support services, programs, and security.[22]

Administration includes:

  • General facility administration.
  • Fiscal affairs, including purchasing.
  • Personnel services.
  • Public information.

Support services include:

  • Food.
  • Health care.
  • Laundry.
  • Supplies and storeroom.
  • Maintenance.
  • Communication—mail, visiting, telephone.

Programs include:

  • Court liaison.
  • Intake and admission procedures.
  • Programming—education, recreation, counseling, nutrition, reading, communications, religious, medical, and health care services.
  • Release preparation.
  • Community volunteers.

Security includes:

  • Security and control.
  • Youth supervision.
  • Rules and discipline.
  • Emergency preparedness.

These four areas can be further sub-divided into sections of the policy and procedure manual. Major sections of the manual may be selected to meet the needs of the facility’s operation. Often facilities use the table of contents from the related standards manual—usually ACA or state standards—to set up a policy manual to ensure that policies and procedures are written to meet those standards. Policies and procedures are then written on each topic within the major headings.

A policy and procedure manual should be a fluid document that evolves as issues arise or change. All policies and procedures should be reviewed on a regular basis—at least annually—and updated as necessary.

The Policy and Procedure Format

A number of jurisdictions use the following format, which is based upon ACA standards, to provide structure for the development of facility policies and procedures manuals.

Administration. The administration section formally sets the direction for the facility and includes admissions, goals, staff patterns, and critical program accountability. Sections cover the following topics:

  • Vision, mission, and values. Policies should clearly state the philosophy and goals of the organization, which flow from the overall mission.
  • Policies and procedures. Procedures should be set forth that detail staff access, training, and opportunities for revising policies and procedures.
  • Incident reporting. A system should be in place to ensure the timely reporting and documentation of such issues as major behavior violations, emergency medical situations, threats to the security of the facility, and professional misconduct. Additional procedures should be in place to report child abuse allegations, address sexual abuse allegations as required under PREA, respond to new crimes, and preserve evidence of crimes that may have occurred within the facility.
  • Organizational staffing. The facility should define staff responsibilities, assign staff to units to promote efficiency, and provide a clear chain of command.
  • Population accountability. Maintain a daily population roster as an accountability system that notes changes in the population status or in the physical or emotional condition of youth.
  • Referral, screening, and placement of youth. Procedures should define placement criteria so that youth are placed in the least restrictive level of supervision. Placement may involve the use of a risk-assessment tool. The requirements of PREA should be considered in screening and classification decisions.
  • Program reporting. An effective information system must include the opportunity for reporting and monitoring the program activities at every level of the organization. Reporting may include shift reports, monthly reports, or statistical reports.

Fiscal Management. General accounting practices should be detailed, including a specific protocol for small and large purchases and an annual audit process of all facility finances. Guidelines should delineate how resident funds and cash income are to be handled within the facility. Strict accounting procedures should be in place to protect the integrity of those handling such funds. Also, information should be available on employee liability insurance, insurance for volunteers, and vehicle insurance.

Personnel. Although most facilities are part of a larger organization (e.g., county or state government), personnel guidelines should include compensation and benefits, performance evaluations, codes of ethics, and an employee grievance process. Employees should be aware of procedures to access personnel files, and they should receive training in how to report harassment in the workplace.

Facility Management. Guidelines should be in place to demonstrate compliance with zoning and building ordinances. In addition to specific procedures on how the facility space is to be used, policies should define the following:

  • Rated bed capacity. Procedures should address the licensed, rated bed capacity of the facility, which provides optimum operation for a safe, secure environment and meets the standard for conditions of confinement. Procedures should clearly define strategies to maintain the rated capacity of the facility and offer guidelines when that capacity is exceeded. Procedures should address sleeping arrangements, activity areas, dayrooms, population movements, and staff responsibilities when the facility is under or over capacity.
  • Facility utilization and access. Clear procedures should detail use of the facility’s resources (e.g., recreation equipment), specific access, and perimeter control.
  • Hazardous chemicals and materials control program. Standards should be in place to coordinate the identification, use, and storage of any hazardous chemical within the facility. Potentially hazardous materials may be found in maintenance areas, storage areas, the kitchen, the arts and crafts area, and general supply. All containers of hazardous chemicals should be properly labeled and inventoried. Material safety data sheets contain manufacturer’s cautions, ingredients, and usage guidelines should be prominently displayed on each container. Strict control should be in place to prevent unauthorized access by the youth. All staff should be trained in the use of hazardous materials.
  • A cleaning or housekeeping schedule. Procedures should detail a schedule for routine and specialized cleaning of every area in the facility, detailing the responsibilities of direct care staff, maintenance staff, and youth.
  • Risk management program. Regular inspections of the facility should review the hazardous chemicals and materials control program, health standards throughout the facility, fire prevention measures, and facility maintenance. Findings should be reported to the director and key staff responsible for addressing these concerns. Routine inspections ensure ongoing compliance with critical quality of life issues.

Security and Control. The security and control sections of the policy and procedure manual should address the following topics:

  • Perimeter control and surveillance. Procedures should identify staff and visitor access, control of contraband, guidelines to address visitor problems, and public access to the facility (e.g., tours).
  • Key control. Staff should be assigned security keys according to specific work assignments. Key control should include a process for signing regular inventories in and out on each shift.
  • Searches. To maintain security of staff and the population, frisk searches of the resident population or strip searches, when needed, should occur as established by protocol that has been reviewed by legal counsel. The use of strip searches should be restricted, and the policy and procedure manual should include specific guidelines for the protection of the youth and staff. Search policies should include schedules for regular room and property searches, guidelines for the use of metal detectors, and procedures for handling uncovered contraband.
  • Fights, disturbances, and use of force. Specific procedures should be established to address emergencies related to behavior, using only the minimum amount of force necessary to control a youth or situation within the facility. Guidelines should detail the use of mechanical and humane restraints, including authorization for use, duration of use, and documentation of use. Safe physical management approaches, use of facility and external resources available to address major disturbances should be included in training.
  • Escape and absence without leave (AWOL). Guidelines should be established to identify measures that prevent escapes or attempted escapes. In the event of a completed escape, procedures should detail staff response, guidelines for apprehending escaped youth, notification of administration, and guidelines for returning to normal programming.

Emergency Procedures. An emergency procedures section of the policy and procedure manual should be posted at each work site and easily accessible to staff at all times—physically, electronically, or in both forms. Emergency procedures should detail the fire and other emergency evacuation plan, routinely documented drills, emergency notification procedures for facility administration, the community response, and specific guidelines for natural disasters (e.g., snow, tornado, earthquake, and flood). Annual training for staff and review of these procedures with the local fire marshal can help ensure staff readiness. Procedures should identify responsibilities for all staff members during an emergency situation. (See Ch. 19: Complex Issues and Vulnerable Populations: Facility Emergency Preparedness)

Healthcare. The mental and medical healthcare sections in the policies and procedures manual should address the following topics:

  • Access to medical and mental health services. All facility staff should be aware of the process of access and notification for routine and emergency medical care.
  • Health hazard and exposure control plan. Employees have a right to know about potential health hazards associated with their work. However, information available to employees may not include specific facts about health hazards or risks protected under the Health Insurance Portability and Accountability Act (HIPAA).[23]An exposure control plan should include policies, procedures, and responsibilities involved in eliminating or minimizing employee exposure to hazards. Employees should have access to applicable safety information and appropriate personal protective equipment to avoid potential risks. These are federally mandated guidelines.
  • Health services delivery. All staff should be aware of and trained in the initial medical screening process and youth access to medical services, including sick call. Specific procedures and training should occur for the distribution of medication.
  • Suicide prevention plan. A detailed plan reviewed by mental health and social service professionals should address levels of risk identified during the initial screening. For each level of risk, staff should be trained in behavior indicators, monitoring guidelines, housing guidelines, referral guidelines, counseling, and reporting notification.
  • Communicable disease precautions. Procedures should address the prevention and handling of any potential communicable disease within the facility.
  • Medical emergency response. Staff should be trained in cardiopulmonary resuscitation (CPR) and standard first aid.
  • Staff health responsibilities. All facility staff members must meet proper health guidelines as specified in policy. Food service handlers must meet special guidelines.

Communications. The communications section in the policies and procedures manual should address the following topics:

  • Internal staff communication. Procedures should include staff guidelines for primary communication within the facility. Clear lines of communications and authority ensure timely reporting during emergency situations.
  • Resident communication. Procedures should address youth access to staff, the court, their attorney and probation officer, mail, and telephone. Detailed visitation guidelines should also be in place.

Youth Rights and Responsibilities. Policy should grant youth personal, programmatic, and environmental rights, including the right to nutritious meals, the right to exercise, the right to be housed in a safe environment, the right to be treated fairly, and the right to privacy. The youth rights and responsibilities section of the policies and procedures manual should address the following topics:

  • Youth complaints. Policy should detail a youth’s right to file a grievance about services, and should offer youth at least one level of appeal.
  • Reporting rights. Written policies should describe multiple means of reporting allegations of abuse in a safe manner and should protect the individual from retaliation. That includes the reporting of sexual abuse as required by PREA.
  • Responsibilities. Staff should communicate the general responsibilities of youth during the orientation process.

Resident Behavior Management. Policy should address the following guidelines to properly manage resident behavior:

  • Orientation. An orientation process should include general youth rules, expected behavior in different areas of the facility and at different times of the day, access to medical services, staff-youth relations, and access to all basic youth rights.
  • Encouraging positive behavior. The behavior management program may include specific behavior levels in achievement, offering privileges and opportunities at each level. Youth should be well informed of what options they have related to their positive behavior within the facility.
  • Discipline. Policy should include specific training and guidelines for staff on verbal intervention, the use of time out, and the use of minor and major behavior consequences. Due process hearings are required for major facility infractions prior to imposing discipline. The use of isolation, which refers to separating youth from other residents during non-sleeping hours by placing them along in a room or cell, and should be used only when no other means can reasonably be used to accomplish the safety and security of the youth and staff. (The use of isolation is under intense scrutiny at present; therefore, the current thinking about what constitutes best practice is in flux.) Policies and procedures should identify specific reasons for use, options for early release, and strict staff monitoring guidelines
  • Program variety. Staff and residents should be aware of schedules and opportunities to access a variety of programming features, such as education, religious services, libraries, social services, and recreation. (See Ch. 15: Service and Treatment Plans and Ch. 18: Transition Planning and Reentry)

Youth Records. Procedures should detail a record management and accountability process that includes official records content, signatures, monitoring of record content, release of information, and confidentiality.

  • Admissions and intake. Procedures should address the initial legal authorization for confinement, the process for medical and mental health screening, and a youth’s basic rights during the admission and intake process. The youth orientation should include immediate access to medical services, the nature of the charge, the opportunity for a phone call, and details of the intake process. Procedures should detail property control.
  • Food services. Procedures should detail access and the use of dietitian-certified cycle menus. Specialized procedures for training food services staff should include food service preparation and handling, meal service, and equipment control.

Optional Materials. Policy and procedure manuals may also include materials of administrative interest, such as organizational charts, personnel rules and regulations, and copies of relevant forms. These optional addenda should be carefully selected so that the manual does not become a catchall of miscellaneous or marginally valuable materials.

Evaluating Policies and Procedures

Before policies and procedures are finalized or placed in the manual, they should be evaluated for their effectiveness. In terms of policies, the following test questions may be helpful:

  • Does this policy conform to overall agency philosophy?
  • Does this policy conform to the general policy guiding a special operational unit?
  • Is this policy consistent with other policies, or are there contradictions?
  • Is this policy repetitious, unnecessary, or trivial?
  • Does this policy conform to relevant laws, codes, and standards?

In terms of procedures, further checks should be made by acting out the various steps involved (when needed) and by asking the following questions:

  • Is the information needed to carry out the procedure complete?
  • Are the steps in a logical sequence?
  • Could the procedure be simplified or made more efficient?

Format of Policy and Procedure

There are many possible variations in the format for presenting policy statements and procedures. Any format must include certain key elements and facts. The following list includes information that should be included and placed either in a masthead or in the body of the document:

  • A classification or policy number that uniquely identifies and distinguishes each policy and procedure.
  • A date to indicate when the policy was issued or revised.
  • An indication of whether the policy or procedure supersedes another policy or procedure document, memorandum, or directive.
  • A chapter title that covers a particular area, such as “Budget and Finance” or “Personnel.”
  • A subject title that describes or identifies the specific subsection of the chapter, such as “Budget Request and Justification” or “Personnel Records.”
  • A signature that indicates that the policy or procedure has the approval of an issuing authority.
  • A citation that references the official document, law, regulation, or opinion (including the specific article, chapter, or section) that served as the foundation of the policy. The appropriate authority for the policy could be a federal or state law, regulation, or guideline; a court decision; an attorney general’s opinion; or an executive order.
  • A briefly stated purpose or goal of the policy.
  • An indication of the division, department, or personnel to whom the policy is directed.
  • A list of definitions for key terms and phrases that have a specific meaning in the policy or procedure or that could be misinterpreted.
  • A statement that indicates when the policy will be put into effect and how frequently it will be reviewed and updated.

Performance-Based Policies

When policies, procedures, or standards are not based on performance or results, they fail to connect to identifiable practice and fail to help the facility improve that practice. A 1993 Office of Juvenile Justice and Delinquency Prevention (OJJDP) study pointed to the lack of a clear relationship between complying with standards and improving conditions of confinement, reflecting the need for further study in this area. [24] After that study, the field recognized the need for outcome or Pbs to improve accountability and the quality of data and to enhance conditions of confinement for youth. In 1995, OJJDP funded the CJCA to develop and implement PbS in juvenile jurisdictions and facilities.[25] The ACA has also promulgated PbS for several of the facility and program types for which it sets standards and is in the process of updating other standards manuals to a performance-based format.

Pbs is designed to ensure regular and consistent data collection, to use that data to develop performance reports and outcome measure analysis, and to create a facility improvement process that focuses on conditions of confinement for youth. When a facility has adopted PbS, its policies and procedures should be modeled after those standards so that daily practice and expectations are motivated by continuous improvement efforts. Experience with PbS has indicated that this internal quality assurance approach can lead to safer conditions for youth in custody and the promotion of public safety, offender accountability, and rehabilitation. (See Ch. 17: Quality Assurance)

Who Develops the Policy and Procedure?

The manual is usually developed by the facility’s administration. However, to ensure that the manual is useful and meets legal and professional standards, it is important to have input from a range of stakeholders, including the governing body; its legal consultant; its human resources advisor; its fiscal and budget specialists; its citizens advisory board or other community volunteers; and key representatives from the court, probation, child welfare, local colleges or universities, law enforcement, and medical and mental health agencies. In addition to these subject matter experts, policies and procedures should have input from staff at all levels and even—where appropriate and possible—from the facility’s youth.

How are the Policies and Procedures Communicated?

After policies and procedures are developed, written, and signed by the appropriate person, they become the basis for all activities and programs carried out in the facility. For this reason, communicating the policies becomes essential for putting them into effect. Administrators need to be sure that many avenues of communication are used, especially when they change policies or introduce new ones. These avenues might include individual memos, posted memos, email distribution, staff meetings, supervisory sessions, or formal training sessions. There also should be a special announcement of the policy or policies on the effective date.

The policy and procedure manual must be easily accessible to all facility staff and other relevant parties. A small agency may find it feasible to issue a copy to each staff member. In most cases, however, if the manual is large, the cost of printing a large number of copies may be prohibitive. The agency can provide access to electronic copies of the manual by using agency intranet systems or issuing manuals to staff on data storage devices. At the very least, distribution should include the following:

  • Each agency working directly with the facility.
  • Each administrator and section chief within the facility and all staff in the section.
  • At least one copy in each area of the facility including the school, the mental health office, and the medical office or clinic.
  • Several additional copies in a central location for staff and public access.

Usually, staff members who receive a manual must sign for the manual. In most facilities, direct supervisors are responsible for ensuring that their staff members are familiar with the contents of the manual, particularly with those sections that relate directly to a staff member’s tasks and duties. However, the facility administrator has the ultimate responsibility for training on new and revised policies and procedures. Direct care workers should receive initial as well as ongoing in-service training on the content of the policies and procedures manual.

Process for Making Changes

Because the manual provides the framework for facility operations, the policies and procedures need to be sound, realistic, and current, which means that the manual is never a finished document. Sometimes, agencies will discover changes in the philosophy that guides existing policies and procedures. Sometimes—especially with changes in the administration or with shifts in the current belief systems—facility mission statements, goals, and policies that reflect those goals also shift. For example, the goals of the juvenile justice system historically have fluctuated with regard to the philosophies of justified punishment (let the punishment fit the crime) and parens patriae (the State takes the place of the parents). In addition, current legislation and case law may require changes in specific procedures. When the philosophy of a department or facility changes, policies and procedures may also need to be changed.

Furthermore, as laws change, as legal decisions are made, and as research reveals new and better ways to run the facility or relate to the youth, the administration (with input from the staff) needs to revise the policy and procedure manual. In fact, every facility should have a policy for ongoing review and revision of their policy and procedure manual on both an annual and an ad-hoc basis. At least once a year, the administration and all staff should review the manual formally. Non-administrative staff, especially, should be urged to provide criticism and suggestions for its improvement, because only through active staff participation of everyone does the manual become a truly useful aid or guidebook. Supervisors need to ensure that each staff member is familiar with the facility’s procedures for making changes, additions, and deletions.

During the review, policies and procedures should be rewritten if they are not clear, complete, or representative of what the staff are actually required to do in certain situations. Other policies and procedures that have become outdated should be removed. Also, policies that reflect new or expanded agency operations and practices should be written, evaluated, and added to the manual.

After the revisions are completed and approved, all staff must be notified immediately about changes. Bulletins should be distributed to all staff, telling them which pages in the manual have been revised, removed, or added. Staff should be asked to sign a form indicating that they have received the updates. These measures ensure that all staff members are aware of changes, revisions, and deletions as soon as they are made.

In the final analysis, putting what a facility does into writing is a definite and necessary stage in the development of a quality program. The policies and procedures manual must be treated as a living organism, responsive to change, growth, and refinement. The review process ensures a level of continuing creativity and flexibility in identifying and meeting the needs of the staff and youth.

Policy Cycle

The policy cycle is more than writing or developing policies and procedures. The cycle includes additional steps to ensure that policies and procedures are meaningful and workable for a specific facility; are consistent with accepted juvenile justice philosophy, theory, research and practice; and retain relevance and applicability. To maximize the manual’s effectiveness and relevance, staff must be trained on its contents, and thoroughly understand how to implement the manual’s directives.

The implementation of policies and procedures requires monitoring by administration or, if available, outside reviewers to ensure that practice is consistent with policy—that the written policy is doing what it is intended to do. Daily monitoring requires administrators to review documents, observe activities, and interview both youth and staff. Administrators should expect implementation of new or revised policies to take time and consistent effort. Customary practices and habits do not change readily. To facilitate that process, it is important to involve staff in the development of policies to the extent possible. And, it is essential that staff understand the purpose and rationale behind each policy and procedure to achieve their buy-in. Monitoring of implementation may also be done through an established, structured quality-assurance process using individuals or bodies that are either internal or external to the facility. (See Ch. 17: Quality Assurance)

A parent agency or facility may also conduct a formal or informal policy analysis through which individual policies are scrutinized to determine whether there are other alternatives to that policy and procedure. If statute, case law, or research findings recommend changes to practices outlined in written policies, a formal analysis can be of help in determining more appropriate, permissible, or effective approaches. For example, when research on suicide in juvenile confinement facilities became available in 2009,[26] many juvenile facilities in the country revised their suicide prevention policies to limit isolation and ensure that youth were observed more frequently than had previously been the case. As discussed above, the entire policy and procedure manual should be reviewed annually, and individual policies and procedures should be analyzed more frequently—if necessary—as new information becomes available.

Adult facilities that serve youth will follow the same procedures described here in implementing and updating their policy manual. In addition, it is important that those facilities also have specific policies and procedures that address any and all issues involving youth, including instructions for staff members who work directly with those youth. Those policies and procedures may be in a separate manual or in a distinct section of the facility’s general manual.

Effective Communication

Effective internal and external communication is essential in a confinement facility of any kind. “Organizational survival is related to the ability of management to receive, transmit, and act on information. The communication process links the organization to its environment as well as to its parts.”[27] It is important to establish numerous lines of communication, both formal and informal. Communication should occur vertically between management level staff and line staff and horizontally, among or within workgroups. Communication must be two-way and open.

Vertical communication may be downward or upward. The former type “flows downward from individuals in higher levels of the hierarchy to those in lower levels. The most common forms of downward communication are job instructions, official memos, policy statements, procedures, manuals, and other publications.”[28] An effective organization needs upward communication as much as it needs downward communication. In such situations, the communicator is at a lower level in the organization than the receiver. Direct care staff members can offer feedback on the effectiveness of a policy and procedure when it is implemented on a trial basis. Based on that feedback, the procedure may be modified to achieve its stated purpose. For example, a facility’s grievance procedure states that youth may submit grievance forms to any staff member of their choice, assuming that a youth will feel safe delivering those forms to at least one staff member. But, the direct care staff members recognize that youth often distrust that system and recommend that a locked grievance box be available where youth can place completed forms. That information can result in a process that is more effective for both youth and for the facility.

Horizontal communication is often overlooked in structuring facility operations, which can result in silos of activity wherein specialty groups do not integrate and, as a result, youth are not fully served. For example, unless key staff who work in the facility’s education and mental health units, and staff in the living units (who spend upwards of 40 hours each week with the youth) share information regularly, youth needs may go unmet or be dealt with inappropriately. Or, unless routinely and timely communication occurs across the various components of the facility, security breaches may occur. As communication improves within or among groups in a facility, confidence is enhanced and communication increases even further.

The effective communication process includes “who says what, in what way, to whom, with what effect?” Those elements break down as the communicator sends the message through a selected medium to the receiver and gets feedback.

Feedback Loop: Communicator, Message, Medium, Receiver, and Feedback

When the structure does not include a feedback loop, the communicator or sender cannot know how effectively the message was received or how it was interpreted. Too often, confinement facilities use communication systems that are exclusively downward, which do not provide feedback. That can be frustrating for the sender and cause confusion for the staff. That frustration can be aggravated when the medium used to communicate does not readily allow for feedback. Memos, written policies and procedures, and emails, as methods of communication, may not provide feedback unless the sender—usually an administrator—actively solicits it. Feedback must occur if internal communication is to be effective. And, it is important to be alert to “noise,” or factors that distort the intended message. Noise can occur in any of the elements of communication—in the sender, the message, the receiver, or the feedback. Noise can occur in written communication that is ambiguous and unclear. Noise may occur through nonverbal communication. Nonverbal factors include such things as head, face, and eye movements; posture; distance; gestures; and tone of voice. It is important to be aware of one’s nonverbal cues and not let that distort or confuse the intended message.

Effective communication requires appropriate timing and means of delivery. Ideally, material will be communicated in more than one way with enough advance notice for the receiver to fully absorb and utilize the information. Advance notice is not always possible, but every effort should be made to at least ensure the message was received as intended. Using multiple instruments and tools of communication can help to ensure understanding and is always advisable. Information may be relayed in a staff meeting where minutes are taken; copies of those minutes go to each attendee either in hard copy or electronically. Follow-up of formal communication occurs through informal means, such as staff meetings or memos, to see if staff understand what is expected of them.

External communication is also an important aspect of effective leadership. The facility director or a designee should be assigned to provide official information to community stakeholders and the media. Press releases or press conferences are useful ways to respond to questions or concerns about ongoing or crisis-related issues. Media relations should also be cultivated when the facility is not in an emergency situation and there are positive events and news items. An astute administrator develops relationships with members of the local media and calls on those professionals when there is a human-interest story. It is wise to reach out in a proactive way to representatives of the local press rather than expect them to make the contact. Media outlets often want ideas for stories and can easily be persuaded to provide positive publicity. When an administrator fosters relationships with members of the media, they are more likely to treat the facility honestly and fairly if and when problems arise. A representative of local media on the facility’s advisory board or council can be helpful in this process.

In addition to the media, a wise leader will maintain open lines of communication with other community stakeholders such as judges, law enforcement officials, school district administrators, religious leaders and community groups. Operating in an insular, secretive manner fosters mistrust. Open and straightforward communication with the public can facilitate support and advocacy for the youth at the facility. One way of developing that kind of support is through a citizen advisory board or council that brings together a group of interested parties to advocate on behalf of the facility and the young people it serves. The fact that such a group is advisory does not negate its potential influence. Listening to a citizen board’s advice does not necessarily translate into compliance, but it can bring new ideas and a fresh perspective. This will only work, however, if the administrator is willing to listen while reminding the board that its function is advisory rather than governing.

Finally, the most critical communication that a facility leader engages in and encourages in his or her staff is communication with family members. It is important for youth to maintain contact with the people who are important to them during periods of confinement. Family members, particularly parents or guardians, often feel that they are held responsible for their child’s problem behavior. When the facility staff deal with family members in a supportive and non-judgmental manner, that family is more likely to reinforce the facility’s efforts on behalf of the youth. Effective family engagement can help a youth successfully reenter the community after release. Family engagement should occur through flexible and generous visitation, phone, and mail policies and procedures. (See Ch. 12: Healthcare; Ch. 15: Service and Treatment Plans: Engaging Families and the Community)

Critical Incident Debriefing

A final aspect of sound accountability in facility operations is the need for critical incident debriefing to review any errors that may have occurred and to promote improvement going forward. It is a reality that human beings learn in many different ways, including visually, auditorily, and through action (experientially). People can also learn indirectly from the experiences, mistakes, and failures of others. A critical incident “can involve any situation or event faced by emergency, public safety personnel (responders) or employees that causes a distressing, dramatic or profound change or disruption in their physical (physiological) or psychological functioning.”[29] Debriefing following a stressful incident can “mitigate fall-out and enhance recovery and sustainability in the event of an acute or short-term, man-man or natural workplace stoppage.”[30] Debriefing is also recommended for events that are less dangerous in nature but which create a disruption for the facility.

Critical incidents that result in psychological trauma can result in either immediate or delayed emotional and physical reactions. They may “include such diverse symptoms as shock, denial, anger, rage, sadness, confusion, terror, shame, humiliation, grief, sorrow and even suicidal or homicidal ideation.”[31] A trained, crisis response specialist must conduct such a debriefing. Timing is important to achieving effectiveness. Initial debriefing may occur soon after the event, but it will likely need to be followed by multiple subsequent sessions, usually with individual staff members. A facility or its parent agency should have clinical staff available or a contract or other arrangement with an agency or clinician who will be available for debriefing a crisis incident.

In addition to considering the psychological or emotional damage experienced by staff involved in critical incidents, youth may also experience trauma. The emotional and mental health needs—both acute and ongoing—of those youth must be addressed as well. In addition to debriefing the critical incident with youth to examine what occurred, it is essential to provide group and individual clinical intervention to address the emotional impact on each youth. Those clinical services should occur as soon as possible after the incident. In addition, staff and clinical consultants should attend to subsequent behaviors and reactions of youth to ensure that their ongoing mental health needs are addressed through appropriate treatment services.

Debriefing following incidents that are deviations from normal operations should also occur to analyze the event and better prepare for the future. The key questions in that debriefing session are:

  • What did we do well?
  • What did we do poorly?
  • What did we learn from this?
  • How can we do better the next time?[32]

There must be established rules for such a debriefing session. Everyone must check his or her ego “at the door.” All staff members—including management—must be comfortable talking about errors they might have made, be ready to provide constructive criticism, and be willing to accept it.[33] The debriefing session must have a designated leader, who might be selected specifically for that assignment from either within or from outside the facility. The facility director or other administrator might also lead the session. In that case, the leader must maintain an atmosphere of safety and openness for all participants. A facilitator who was not involved in the incident has the advantage of being perceived as fair and objective. The leader should present a process to the participants. The session should have attainable goals and should ensure that thorough notes are taken and subsequently distributed to all participants. The leader should use group work techniques to encourage participation and draw out quieter staff members. Most important, the debriefing session must not be used as an occasion for assigning blame or creating divisiveness. It is an important aspect of ensuring facility and staff accountability and should be an opportunity for team growth and cohesiveness.

Facility Security

Security (secure) is defined as: “being free from danger or risk of loss; safe, free from fear or doubt, anything that gives or assures safety.”[34]

Security is an intricate and essential component of every confinement facility. Historically, security was limited to locks, blocks, and bars. As the field of juvenile and adult corrections has grown, security has also moved beyond the “hardware” definition of security and incorporated the notion of safety of the confined youth. Today, security is incorporated in budgets, specific policy and procedure manuals, training seminars, and the daily operation of every shift.

Facility security is a combination of personal security, youth security, and building security. In addition to the security issues discussed in a facility’s policy and procedure manual, the following suggestions may be helpful.

Personal Security

The notion of personal security may seem unimportant at first, but the most basic of security precautions starts at home, before the employee even gets to the job.

Clothing. When uniforms are not required, the articles of clothing an employee chooses for the job are important. Just as one would not wear a tuxedo to change motor oil, an employee should not wear certain articles of clothing to work. The following concepts apply:

  • Tight-fitting clothing may restrict movement in crisis situations.
  • Loose-fitting clothing may get in the way during emergency situations or be easy for a youth to grab and hold.
  • Revealing clothing may elicit from youth inappropriate advances and comments or distract other staff from doing their job.
  • Slogans on T-shirts can be very troublesome. The agency’s policies and procedures manual should offer guidance, but staff should not wear clothing that contains words or graphics that advertise or promote alcohol, drugs, sex, violence, or political positions.
  • Clothing should be comfortable, neat, clean, and professional.

Hair and Hygiene. The length and style of a staff member’s hair may affect job performance. Long hair (shoulder length and longer) worn loosely may interfere with vision, specifically peripheral vision. Long hair may also be grabbed more easily by a youth and tangled in his or her fingers. If the employee chooses a longer hairstyle, the hair should be pulled back and secured. However, shorter hairstyles are often recommended. Good personal hygiene is also very important to demonstrate professionalism and individual and professional pride. Poor hygiene can result in ridicule from both youth and staff.

Accessories. Employees should be familiar with agency policies and procedures on wearing jewelry on the job. Jewelry is also potentially dangerous.

  • Necklaces are the most dangerous because of the ease with which they can be grabbed by a youth, damaged, broken, or used for strangulation. The same principles apply to neckties and scarves.
  • Pierced earrings pose a significant danger of being ripped out.
  • Rings pose a danger to both youth and to staff. Large rings and rings with raised stones or insignias can scratch or cut youth or other staff members during restraint maneuvers.

Whenever possible, staff should wear minimal jewelry. It is recommended that any jewelry should be small, not raised or exposed, and not valuable. Staff should understand that they wear jewelry at their own risk.

Position. The position that a staff member takes when interacting with youth is essential. Staff should always know where the nearest exit is located and how to get help in case of emergency. It is wise for the staff member to keep his or her back to the wall or at least keep youth in the line of sight to prevent them from getting behind the staff person. Staff should also be careful not to allow youth to surround them and not to become separated by youth from other staff working on the unit. (See Ch. 14: Behavior Management and Ch. 16: Behavior Observation, Recording, and Report Writing)

Shoes. Shoes should be comfortable, fit securely, and have rubber soles for good traction. Leather-soled shoes tend to slip when staff need a strong foothold. Clean athletic shoes are very effective but should not be worn unlaced or untied. Inappropriate and potentially hazardous footwear include sandals, flip-flops, loafers, high heels, and combat boots.

Note that the initial letters from these items—clothing, hair and hygiene, accessories, position, and shoes—spell CHAPS, which makes it easier for employees to remember a checklist for personal security.

Youth Security

Youth security is the most important component of facility security. A line worker will be with the youth at least eight hours per shift. In some facilities, staff work ten- or twelve-hour shifts or even back-to-back eight-hour shifts. In addition to knowing the facility’s policies and procedures, employees should also know the individual youth under their supervision. The more staff members know about the youth they supervise, the better they will be able to ensure youth safety. Furthermore, staff should know the rules that govern youth behavior to enforce the rules consistently and create and support a secure environment. The following basic guidelines apply to youth security:

Smell. Alert staff use their sense of smell as they make the rounds (routine checks) among the youth. Staff should immediately investigate smoke from cigarettes, fire (paper, clothing, or electrical), marijuana, or anything else that can burn.

Observe. The critical part of youth security in any type of confinement facility is observation of the youth. Every youth will have a particular pattern of behavior, and any deviation in this pattern should prompt the staff’s increased attention. Suicidal thoughts, intimidation by other youth, depression, and other factors associated with confinement cause youth to act differently. Any deviation from an established behavior pattern should be reported immediately to a supervisor, social worker, or mental health professional. (See Ch. 16: Behavior Observation, Recording, and Report Writing)

Youth often intimidate each other for various reasons and in many different ways. Several youth crowding around a single youth usually indicates some form of intimidation, and it is staff’s responsibility to investigate and intervene appropriately. Gang members often try to recruit new members, exact revenge against rival gang members, or enforce gang rules on recruits who do not conform. In an adult facility, despite the requirement of sight and sound separation, there may still be times when youth are in the presence of adult offenders. In those instances, staff should always be present and closely observe and limit any interactions between youth and adults.

In addition, the alert staff will always be looking for anything out of the ordinary in a youth’s clothing. Unusual bulges may be caused by contraband and should be investigated immediately. Staff should also notice a youth’s movement and body positioning, which could also indicate that the youth is concealing something under his or her clothing.

Because youth in confinement facilities possess numerous risk factors, self-mutilation and youth-on-youth assaults are an unfortunate part of life in a confinement facility. Surveys by the Bureau of Justice Statistics (BJS) also reveal that staff-on-youth sexual assault is even more prevalent than youth-on-youth.[35] Staff should always be observant of a youth’s physical appearance and affect for this reason and should ask questions and investigate whenever they suspect that a youth has been injured or abused or may be in fear of harm.

Listen. One of the greatest tools a staff member has, other than vision, is the sense of hearing. Staff should always be listening for plans of illegal activity, such as assault or escape. Eavesdropping on youth conversations is viewed by youth as a sign that staff mistrust them, but security requires that youth in confinement facilities forfeit some of their privacy. Listening closely to what youth are saying will help to keep staff informed of youth plans and activity. Staff should make it clear to all youth that listening is a part of the job.

Youth will often tell each other about some illegal or harmful activity in a voice loud enough for the staff to hear. In these cases, preventive action should be taken. When staff members develop a relationship that is based on mutual honesty and when staff demonstrate genuine concern for the young people they work with, the youth will often come directly to them to offer information about planned illegal activity. Listening for key words and tone of voice—not just surface content—will also alert the staff about how youth are feeling or what they are experiencing. Such listening during telephone calls with parents and others will tell staff if the youth is upset, depressed, or angry.

The alert staff will get to know the normal sounds of the institution. An increase or decrease in noise levels may be an indication that something is happening. Other sounds offer clues about the proper functioning of security equipment. For example, security locks usually have a distinctive click when they shut, or hand-held room monitoring devices may beep to indicate that a check has occurred.

Explore. Walking around the area where youth are present is called “exploring.” While exploring, the alert staff will use the senses of smell, sight, and hearing as described above. Exploring should be random and frequent. Staff presence should not be predictable or anticipated. Certainly, when a staff member feels something is wrong, he or she should explore and take appropriate action to prevent or resolve an incident.

Note that the initial letters from these items—smell, observe, listen, and explore—form the acronym SOLE, which makes it easier to remember youth security.

Building Security

The last component of facility security is building security. All staff members must be familiar with all aspects of the physical plant itself. Building security includes the following:

Building. Every employee must know the physical layout (floor plan) of the facility. In the event of an emergency, all employees must know how to get from any point to any other point using the most direct path. Fires, bomb scares, and other emergencies that require building evacuation must be practiced on a regular basis. Staff must also know where emergency equipment is stored and what is contained in closets, offices, and rooms.

For the safety of the staff and youth, all employees should know:

  • Where the boiler room and maintenance areas are located.
  • Where hazardous materials are stored.
  • Where electrical panels and controls are located.
  • Where exit doors are located and whether they are clear of hazards and obstructions.
  • Where basic maintenance tools (screwdriver or pliers) are located.
  • How to shut off water supplies to rooms or commodes.
  • How to loosen a stuck (water control) valve.
  • How to summon maintenance staff on weekends and evenings.

It is always a good idea for the staff member to walk through the facility, or at least the area of his or her responsibility, prior to beginning a shift.

Utilities. In the event of emergencies, staff should know where all utility shutoff controls are located—for example, the main shutoffs for water, gas, electricity, and lights as well as the alarm panels for fire and door alarms. Staff should know where the emergency generator is located and how to operate it. The telephone numbers of utility companies should also be readily available to all staff in case of emergencies.

Illumination. Lights are critically important for safety and security. All staff should know the location of the switches for all lights needed for security. All staff should also be familiar with the emergency generator for lighting. Emergency flashlights should be readily available in strategic locations throughout the facility.

Locks and Keys. Security always depends on adequate, well functioning locks. All staff members must know the purpose for every key on the set they carry. In the event of an emergency, staff should know where the keys are for various “off limits” sections of the facility. All locks must be in proper working order. If a staff member discovers a lock that is in disrepair, that should be reported immediately to the designated maintenance staff person. Keys should be checked at the beginning of every shift to ensure that they are all accounted for and that they are in good condition (not cracked or bent).

Doors and Windows. The most frequent breaches of security come from unlocked doors and windows. Many people use the doors and windows during the day, including maintenance workers, probation officers, social service staff, and administration. However, it is every staff member’s responsibility to make sure that doors and windows are secure at all times. It is a good habit to physically check each door and window as one walks by. It is always best practice for a line staff or the shift supervisor to check them prior to every shift.

Individuals. Many individuals are in the facility at various times during the day and night. All staff members on duty must be aware of the location of youth, staff, and visitors in the facility, particularly in their own area of supervision. The following are helpful strategies:

  • Each employee should have some form of identification.
  • Visitors should have some form of identification so that line workers can determine who belongs in certain parts of the facility and who does not.
  • Head counts are suggested at regularly scheduled intervals, including after each group movement in the building or on campus, after shift changes, and after evacuations or fire drills.

Notations. Because of the amount of information facility staff need to track, careful note-taking is essential. If an employee notices faulty equipment, fixtures, or other hazards in the facility, he or she must make written notation (often in the form of a Work Order) to inform fellow staff, administration, and maintenance staff as soon as possible. Staff should regularly document head counts, youth schedules, activities (e.g., court, social worker interview, medical services), locations of staff or visitors, and youth disciplinary actions, using the agency’s forms and following the facility’s policies. Most facilities have requirements for regularly recording occurrences during the shift by making log entries. Doing so helps to effectively communicate important information about a group or an individual to other staff on subsequent shifts. Those logs notes are also a record for supervisors, mental health clinicians, and others who need essential information to meet a youth’s needs and to ensure the smooth operation of the facility. Staff must record their information leaving his or her shift, in addition to any information they provide verbally. Even if the staff member’s notations are just feelings based on observing or listening, they should be noted to inform other staff. (See Ch. 16: Behavior Observation, Recording, and Report Writing)

Grounds. The alert staff member must also be familiar with the grounds (outdoor area) of the facility. The most basic perimeter security should include a patrol of the outside yard before the youth enter the area. Staff should check for contraband that may have been thrown over the fence or planted (hidden).Facilities may also have surveillance cameras to monitor perimeter security. Staff must know directions (north, south, east, and west) to describe the location of an incident or problem, to give directions about an escaped youth, or to pinpoint the location of a stranger approaching the outside of the facility.

Note that the initial letters from these items—building, utilities, illumination, locks and keys, doors and windows, individuals, notations, and grounds—spell BUILDING, which makes it easier to remember building security.

Searches

Searches are an integral component of a facility’s overall security program. By conducting searches judiciously and conscientiously, facility staff can help to provide an environment that is safe and to minimize incidents. There are several types of searches that may be conducted in a confinement facility. Some searches are intended to discover any contraband that may be concealed. In addition, regular searches can serve as a deterrent to youth who might be otherwise tempted to bring contraband into the facility. (See Ch. 9: Admission and Intake)

Searches must always be conducted in accordance with the facility and the parent agency’s rules, regulations, policies, and procedures. Those policies and procedures must adhere to state and local laws and to relevant case law. Administrators should become familiar with current statutes and case law and be aware of any changes that could impact policy. Search policies and procedures must be written specifically to provide clear guidance to staff and to ensure that a youth’s constitutional rights are not disregarded. Policies and procedures should designate when searches occur, who is responsible for conducting them, and how they must be documented.

Types of searches and guidelines for each of them include:

Frisk Search. The frisk search, or clothed-body search, is a thorough pat-down of a youth’s body and outer clothing. The frisk search does not require a youth to remove any clothing, except a coat or jacket and, sometimes, shoes. A frisk search should be conducted anytime that a strip search is not allowed, either by case law, statute, or policy. Generally, youth should be frisk searched immediately upon entry to the facility for admission, upon return to the facility from outside, after contact visits, and in some cases subsequent to movement from one area of the facility to another, such as return from school or recreation. PREA Standards prohibit cross-gender frisk or pat-down searches in juvenile facilities except in exigent circumstances.[36] A frisk search may also be accompanied by a wand search.

Wand Search. A search using a magnetometer, often referred to as a “wand” search, involves the use of a hand-held device that detects metal. That device may be used alone or in conjunction with other types of searches. Wand searches do not involve touching the person and are not intrusive, so they are often used to search visitors at confinement facilities.

Strip Search. Strip searches are more invasive and are subject to closer scrutiny. Court rulings regarding strip searches of youth in juvenile facilities have varied around the country, and it is essential that the facility policy be consistent with the relevant court’s rulings and state statute. Court rulings and well-crafted policies often require that strip searches may only be conducted when staff have reasonable suspicion that contraband may be found. Reasonable suspicion is a legal standard that “exists when a reasonable person under the circumstances, would, based upon specific and articulable facts, suspect that contraband will be found or that a crime has been or will be committed.”[37]

Rules regarding strip searches of youth in adult facilities vary, depending on whether the youth has been transferred or certified as an adult for purposes of prosecution or whether that youth is considered a juvenile under state statute. In the latter case, the youth may still be under juvenile court jurisdiction and subject to relevant juvenile facility PREA Standards. Administrators and line staff members in adult facilities that serve youth should be familiar with both juvenile and adult PREA Standards and ensure that policies, procedures, and practices are in compliance.[38]

Some juvenile facilities conduct strip searches on all youth immediately upon admission; others have more limited criteria, such as the seriousness of the admitting offense. Limitations are often the result of court rulings or legal advice mandating or recommending the “reasonable suspicion” criteria. Adult facilities that serve youth often have a single procedure for their inmates, regardless of their age; they commonly strip search both youth and adults in the same way. However, some adult facilities also adhere to the “reasonable suspicion” criteria for all inmates, either at the time of admission or at other times.[39]

When the admission staff of a juvenile or adult facility are authorized to conduct a strip search, they should observe following guidelines for the protection of both the staff and the youth:

  • A strip search may occur only by staff members who have had training on how to conduct a strip search.
  • Only staff of the same gender may conduct strip searches. Policy may require that two staff members be present for all strip searches.
  • Strip searches must be conducted in a private area of the facility.
  • Staff must maintain a professional demeanor throughout the process.
  • Youth should be asked to remove all of their clothing, and staff should refrain from inappropriate comments and staring.
  • Staff must not touch a youth during a normal strip search.
  • Strip searches must be documented as required by agency policy, including documenting the justification for the search, such as reasonable suspicion. Justification may include unusual, visible, or partially visible bruising when fully clothed, and cuts or marks or other concerns that could indicate abuse; a medical professional should examine the youth. Strip searches may require administrative approval, which also should be documented.

Body-Cavity Search. Body-cavity searches are extremely invasive, should rarely be necessary, and should occur only within strict guidelines. If a body-cavity search must be conducted, the following guidelines should be followed:

  • Only a licensed healthcare provider with authorization from the responsible physician and facility administrator should ever conduct a body-cavity search.
  • The facility’s policy and procedure must require that body-cavity searches be allowed only if there is reasonable suspicion that contraband will be found.
  • Body-cavity searches may only be performed by same gender medical staff and must be conducted in private. It is generally advisable that two professionals be present during a body-cavity search.
  • The primary role of facility healthcare staff is to serve the health needs of their patients. Conducting body-cavity searches for contraband can create an ethical conflict. Therefore, some agencies’ policies require that body-cavity searches be conducted by outside professionals or someone on the facility staff who is medically trained but not involved in a therapeutic relationship with the juvenile.
  • Body-cavity searches must be documented as required by agency policy, including the justification for the search, such as reasonable suspicion.[40]

Inventory Search. The inventory search is a thorough search of a youth’s clothing or personal property that they have brought into the confinement facility at the time of admission, visitation, or official activity outside the facility. The youth’s property is itemized, and the written inventory is stored securely with the property until the youth is released. Youth should be asked to sign the property inventory sheet to confirm that all items brought into the facility are listed in the inventory.

Room, Cell, or Dormitory Search. The living quarters of confined youth should be searched regularly to discover any hidden contraband and to deter efforts to conceal unauthorized items. Such searches shall also address maintenance needs such as the operation of doors, locks, lights, plumbing, intercoms, and graffiti or other damage. The facility should have a regular schedule for such searches (such as daily) and should conduct random searches as well. In doing random searches, staff must not discriminate or appear to discriminate against any individuals or groups.

Searches of the living quarters should generally be conducted by two staff members with the youth present or in the vicinity, to avoid false accusations by youth that a staff planted items or damaged property. Searches of the living quarters should be documented on the facility’s designated forms, including notification of maintenance personnel of any needed repairs.

Perimeter Check or Grounds Search. Searches outside the building or buildings (for a campus-based facility), should also occur regularly and after any unusual occurrence at the facility. Minimally, perimeter checks should always occur before youth are allowed to go outside for recreation. A staff member should visually inspect the security fence and the ground near that fence for any potential contraband. If the employee discovers any contraband or damage or if it appears that there has been an intruder or that fencing or equipment has been tampered with, he or she should report it to administration and to maintenance staff.

Vehicle Search. Before any youth is transported in an official vehicle, the transporting officer should search that vehicle to ensure that no unauthorized objects or potential contraband is present.

Staff should document all searches of property and youth as specified in facility policy and procedure and in accordance with any statutory or other legal requirements.

(See Ch. 9: Admission and Intake)

Conclusion

Leadership in a confinement facility that serves youth requires a range of skills that are developed through training, experience, supervision, coaching, and mentoring. Effective facility management and administration requires ongoing attention and dedication to broad issues such as the establishment of a philosophy and mission, resource management, evaluation and planning, and staff and leadership development. However, an effective facility administrator must also emphasize operational details such as the implementation of a current, comprehensive policy and procedure manual and a safety and security program. The effective administrator must be engaged with the staff and with confined youth while also maintaining active communication with outside stakeholders. No leader can succeed without the involvement and participation of key individuals and groups. The success of a facility and its programs requires commitment from its administration as well as internal and external participants.

 

References

American Correctional Association. 1992. Guidelines for the Development of Policies and Procedures: Juvenile Detention Facilities. Laurel, MD: Author.

Ammons, David N. 1992. “Productivity Barriers in the Public Sector.” In Public Productivity Handbook, edited by Marc Holzer. New York: Marcel Dekker, Inc.

Beck, Allen J., David Cantor, John Hartge, and Tim Smith. 2013. Sexual Victimization in Juvenile Facilities Reported by Youth, 2012. Washington, DC: Bureau of Justice Statistics. https://bjs.ojp.gov/redirect-legacy/content/pub/pdf/svjfry12.pdf.

Cebula, Nancy, Elizabeth Craig, John Eggers, Marge Douville Fajardo, James Gray, and Theresa Lantz. 2012. Achieving Performance Excellence: The Influence of Leadership on Organizational Performance. Washington, DC: National Institute of Corrections.

Davis, Joseph A. February 12, 2013. “Critical Incident Stress Debriefing from a Traumatic Event.” Crimes and Misdemeanors: The World of Forensic Psychology (blog). https://www.psychologytoday.com/blog/crimes-and-misdemeanors/201302/critical-incident-stress-debriefing-traumatic-event.

Epstein, Paul D. 1992. “Measuring the Performance of Public Service.” In Public Productivity Handbook, edited by Marc Holzer. New York: Marcel Dekker, Inc.

Fair Labor Standards Act (FLSA). “Coverage under the FLSA. (Exempt or Nonexempt).” http://www.flsa.com/coverage.html.

Guy, Mary E., 1992. “Managing People,” In Public Productivity Handbook, edited by Marc Holzer. New York: Marcel Dekker, Inc.

Hayes, Lindsay. 2009. Characteristics of Juvenile Suicide in Confinement Facilities. Washington, DC: Office of Juvenile Justice and Delinquency Prevention.

Ivancevich, John M., and Michael T. Matteson. 1990. Organizational Behavior and Management, 2nd ed. New York: Richard D. Irwin.

Kouzes, James M., and Barry Z. Posner. 1995. The Leadership Challenge. San Francisco: Jossey-Bass.

Legal Information Institute, Cornell University Law School. “Reasonable Suspicion.” https://www.law.cornell.edu/wex/reasonable_suspicion.

Merriam-Webster. adj. “secure.”

National Commission on Correctional Health Care. 2011. Standards for Health Services in Juvenile Detention and Confinement Facilities. Chicago, IL. Author.

National Institute of Corrections, Office of Juvenile Justice and Delinquency Prevention. 1992. A Common Vision and Mission: A Report of the Juvenile Justice Detention and Corrections Executive Assembly. Longmont, CO: Author.

National Institute of Corrections. 2013. “Correctional Policy and Procedure.” https://nicic.gov/policy.

National Juvenile Detention Association (currently NJPS). “Definition of Juvenile Detention.” http://npjs.org/detention/.

National Juvenile Detention Association (currently NJPS). “Position Statement: Minimum Direct Care Staff Ratio in Juvenile Detention Centers.” .

National PREA Resource Center. “Juvenile Facility Standards.” Standard 115.313, “Supervision and Monitoring.” https://www.govinfo.gov/content/pkg/CFR-2014-title28-vol2/pdf/CFR-2014-t....

National PREA Resource Center. “Juvenile Facility Standards.” Standard 115.315, “Limits to Cross-Gender Viewing and Searches.” https://www.prearesourcecenter.org/implementation/prea-standards/juvenile-facility-standards.

National PREA Resource Center. “Standards for Prisons and Jails.” https://www.prearesourcecenter.org/implementation/prea-standards/prisons-and-jail-standards.

Parent, Dale G., Valerie Leiter, Stephen Kennedy, Lisa Livens, Daniel Wentworth, and Sarah Wilcox. 1994. Conditions of Confinement: Juvenile Detention and Correctional Facilities (Research Report). Washington, DC: Office of Juvenile Justice and Delinquency Prevention. https://www.ncjrs.gov/pdffiles1/ojjdp/1FrontMat.pdf.

PbS Learning Institute. “Performance-based Standards: Safety and Accountability for Juvenile Corrections and Detention Facilities.” https://users.pbstandards.org/cjcaresources/93/PbS_InfoPacket2011.pdf.

Pecora, Peter J., and Michael J. Austin. 1987. Managing Human Services Personnel. Newbury Park, CA: Sage.

Schmidt, Billy. 2011. “How and Why to Conduct an Incident Debriefing.” Firefighter Nation. https://www.firefighternation.com/photo-gallery/how-why-to-conduct-an-incident-debriefing/

Smith, J.S., D.W. Roush, and R. Kelley. 1990. “Public Correctional Policy on Juvenile Services: Juvenile Detention.” Unpublished manuscript. Laurel, MD: American Correctional Association, Juvenile Detention Committee.

U.S. Department of Health and Human Services. “Health Information Privacy.” https://www.hhs.gov/hipaa/index.html.

 

Endnotes


[1] National Juvenile Detention Association (currently NPJS), “Definition of Juvenile Detention.”

[2] J.S. Smith, D.W. Roush, and R. Kelley, “Public Correctional Policy on Juvenile Services: Juvenile Detention,” Unpublished manuscript, (Laurel, MD: American Correctional Association, Juvenile Detention Committee. 1990).

[3] National Institute of Corrections, Office of Juvenile Justice and Delinquency Prevention, A Common Vision and Mission: A Report of the Juvenile Justice Detention and Corrections Executive Assembly, (Longmont, CO: Author, 1992).

[4] Nancy Cebula, Elizabeth Craig, John Eggers, Marge Douville Fajardo, James Gray, and Theresa Lantz, Achieving Performance Excellence: The Influence of Leadership on Organizational Performance, (Washington, DC: National Institute of Corrections, 2012): 24–25.

[5] Ibid., 25.

[6] Ibid., 26.

[7] National PREA Resource Center, “Juvenile Facility Standards,” Standard 115.313, “Supervision and Monitoring.”

[8] National Juvenile Detention Association (currently NJPS), “Position Statement: Minimum Direct Care Staff Ratio in Juvenile Detention Centers.”

[9] David N. Ammons, “Productivity Barriers in the Public Sector,” in Public Productivity Handbook, ed. Marc Holzer (New York: Marcel Dekker, Inc., 1992): 128.

[10] Paul D. Epstein, “Measuring the Performance of Public Service,” in Public Productivity Handbook, ed. Marc Holzer (New York: Marcel Dekker, Inc., 1992): 165.

[11] Mary. E. Guy, “Managing People,” in Public Productivity Handbook, ed. Marc Holzer (New York: Marcel Dekker, Inc., 1992): 314.

[12] Peter J. Pecora and Michael J. Austin, Managing Human Services Personnel, (Newbury Park, CA: Sage, 1987): 58–59.

[13] Ibid.

[14] Ammons, “Productivity Barriers,” 125.

[15] Ammons, “Productivity Barriers,” 125–126.

[16] Abreu, Teresa, Acting Director, Cook County Juvenile Temporary Detention Center, phone interview, September 9, 2013.

[17] Sanchez, George, Chief Union Steward, Cook County Juvenile Temporary Detention Center, phone interview, September 9, 2013.

[18] Fair Labor Standards Act (FLSA), “Coverage under the FLSA, (Exempt or Nonexempt).”

[19] National Institute of Corrections, “Correctional Policy and Procedure.”

[20] Ibid.

[21] Ibid.; See https://hspolicy.utah.gov/files/jjs/Section%2003%20-%20Juvenile%20Treatment%20-%20Programming/03-03%20Intake%20Screening.pdf for an example of an Intake Screening Policy from the Utah Department of Human Services, Division of Juvenile Justice Services.

[22] American Correctional Association, Guidelines for the Development of Policies and Procedures: Juvenile Detention Facilities, (Laurel, MD: Author, 1992).

[23] U.S. Department of Health and Human Services, “Health Information Privacy.”

[24] Dale G. Parent, Valerie Leiter, Stephen Kennedy, Lisa Livens, Daniel Wentworth, and Sarah Wilcox, Conditions of Confinement: Juvenile Detention and Correctional Facilities (Research Report), (Washington, DC: Office of Juvenile Justice and Delinquency Prevention,1994).

[25] PbS Learning Institute, “Performance-based Standards: Safety and Accountability for Juvenile Corrections and Detention Facilities.”

[26] Lindsay Hayes, Characteristics of Juvenile Suicide in Confinement Facilities, (Washington, DC: Office of Juvenile Justice and Delinquency Prevention, 2009).

[27] John M. Ivancevich and Michael T. Matteson, Organizational Behavior and Management, 2nd ed. (New York: Richard D. Irwin, 1990): 15.

[28] Ibid., 556.

[29] Joseph A. Davis, “Critical Incident Stress Debriefing from a Traumatic Event,” Crimes and Misdemeanors: The World of Forensic Psychology (blog): 2013.

[30] Davis, “Critical Incident Stress Debriefing from a Traumatic Event.”

[31] Ibid.

[32] James M. Kouzes and Barry Z. Posner, The Leadership Challenge, (San Francisco: Jossey-Bass, 1995): 84.

[33] Billy Schmidt, “How and Why to Conduct an Incident Debriefing,” Firefighter Nation.

[34] Merriam-Webster, adj. “secure.”

[35] Allen Beck, David Cantor, John Hartge, and Tim Smith, Sexual Victimization in Juvenile Facilities Reported by Youth, 2012, (Washington, DC: Bureau of Justice Statistics, 2013).

[36]National PREA Resource Center, “Juvenile Facility Standards,” Standard 115.315, “Limits to Cross-Gender Viewing and Searches.”

[37] Legal Information Institute, Cornell University Law School, “Reasonable Suspicion.”

[38] National PREA Resource Center, “Standards for Prisons and Jails.”

[39] Dickson, Maggie, Inmate Management Specialist, Washoe, NV, County Jail, Email correspondence, August 25, 2013.

[40] National Commission on Correctional Health Care, Standards for Health Services in Juvenile Detention and Confinement Facilities, Standard Y-l-03, (Chicago, IL: Author, 2011): 137–138.

Ch.9 Admission and Intake

Ch.9 Admission and Intake web_admin Thu, 12/23/2021 - 16:37

Author: Anne M. Nelsen, MSW, MPA

Admission and intake into confinement facilities that serve youth varies considerably, depending on the type of facility. The function of each type of facility within in the justice system determines the range of activities and types of services available. This chapter discusses admission and intake as both an event and as a process in 1) juvenile detention facilities, 2) youth correctional facilities, and 3) adult confinement facilities that hold youth on both a short-term (jail) and long-term basis (prison). This chapter presents a separate section for each scenario.

Admission and Intake to Juvenile Detention—An Event and a Process

Decision to Detain and Legal Authority

Admission to juvenile detention is an event that involves the act of taking physical and legal custody of a juvenile on the basis of the statutory authority specified in the juvenile code of a particular state. Admission is a legal matter involving the physical transfer of custody of the juvenile into a detention facility.

According to the National Juvenile Detention Association (NJDA):

Juvenile detention, as part of the juvenile justice continuum, is a process that includes the temporary and safe custody of juveniles whose alleged conduct is subject to court jurisdiction, who require a restricted environment for their own and the community’s protection while pending legal action. Juvenile detention may range from the least restrictive community based supervision to the most restrictive form of secure care.

The critical components of juvenile detention include:

  • Screening to ensure appropriate use of detention.
  • Assessment to determine the proper level of custody, supervision, and placement.
  • Policies that promote the safety, security and well being of juveniles and staff.
  • Services that address immediate and/or acute needs in the educational, mental, physical, emotional and social development of juveniles.[1]

This definition is intentionally broad to blend the concepts of non-secure detention alternatives with secure confinement. However, the focus of this chapter and this publication is on facilities that confine youth not the confinement continuum defined in the NJDA definition. It is also important to address the screening and assessment process that must occur as well as the policies related to the admission and intake event. (See Ch. 2: Types of Facilities)

Practices and policies used in determining whether the detention facility has the legal authority to admit a youth to detention vary by jurisdiction and may involve a screening or assessment instrument. There may also be specific written admissions guidelines. There may simply be an informal requirement that any youth brought to a detention facility by a law enforcement officer, subsequent to the alleged commission of a delinquent offense, shall be admitted. Or, a youth may be detained based on an order from a judge. The legal authority to detain, as well as other admissions-related matters is often based on state statute. The facility’s written admission and intake policies and procedures should include the following:

  • Determination that the youth is legally committed to the facility.
  • Complete search of the youth and his or her possessions.
  • Inventory and disposition of personal property.
  • Shower and hair care.
  • Issue of clean clothing.
  • Issue of personal hygiene articles.
  • Medical, dental, mental health, and safety screenings.
  • Assignment to a housing unit.
  • Recording of basic personal information to be used for the mail and visiting lists.
  • Assistance to youth in notifying their families or guardians of admission and procedures for mail, phone calls, and visiting.
  • Provision of written orientation materials to the youth.[2]

Admission to juvenile detention in many jurisdictions does not occur until a risk assessment has been completed. The risk assessment instrument (RAI) is generally designed and validated for a particular jurisdiction to determine two primary factors: 1) the youth’s risk of reoffending pending adjudication if not detained and 2) the youth’s likelihood of appearing for a court hearing without secure detention in the interim. An RAI may also be completed at various times—at the time of referral to court, prior to and to aid in dispositional decisions (such as out-of-home placement), and in preparation for release from a facility or program. Risk assessment often precedes or occurs in conjunction with needs and strengths assessments and risk management decisions, which help to identify and employ methods for inhibiting risk factors and enhancing protective factors.

Screening using a validated RAI must meet three primary goals:

  1. Objectivity—the need to base detention decisions on neutral and objective factors rather than on the screener’s subjective bias or opinion about an individual youth.
  2. Uniformity—the application of criteria equally to all youth referred for the detention decision.
  3. Risk based—the measurement of specific detention-related risks posed by the youth.[3]

The application of these key concepts helps to ensure fairness and equality, to minimize racial bias resulting in disproportionate minority detention, and to achieve cost-effective services by not confining youth unnecessarily, while still enhancing public safety

Not all jurisdictions, base the decision to detain on a risk assessment or other screening tool. Many jurisdictions have written guidelines for admission to detention on which decisions are based, often including such things as the seriousness of the alleged current delinquency offense. Many jurisdictions simply detain any youth with an alleged delinquency offense who is brought to the facility by law enforcement or any youth who is ordered detained by the court. Such facilities lack any real control over the number or type of youth they hold, which may result in unnecessary overcrowding. These same facilities may be required to house low-risk youth together with high-risk youth, often resulting in deteriorating behavior and attitudes among the former. Facilities may not have the option of diverting youth to non-secure alternative programs that can serve low-risk youth more effectively and less expensively. In many detention facilities, the authority to make the decision to detain is generally defined in statute and assigned to the court. (See Ch. 2: Types of Facilities)

Many jurisdictions around the country have been visionary in the management of their juvenile detention facilities and other resources for at-risk youth and have participated in detention reform efforts. These efforts have included the development and implementation of RAIs to support detention decisions that more successfully meet the needs of the community as well as individual youth.

Initial Information Gathering

Staff responsible for the admission and intake process should focus attention immediately on the youth to establish contact and to determine the youth’s physical and mental condition. Staff should also use the transporting officer as a source of information. As part of the transfer of custody, detention staff should ask the officer if there is any vital information about the youth that the detention facility staff should be aware of or that would affect the youth’s immediate safety.

Juvenile detention staff members often face situations at intake that present significant challenges. An intoxicated youth is a prime example. Direct care detention staff members generally lack the expertise to determine whether a youth may be admitted safely or if that youth requires medical care, such as detoxification, before admission to detention. It is important to know what a youth may have consumed, in what quantity, and over what period of time.

Only adequately trained medical personnel should manage detoxification. Detention facility staff members are usually not trained to evaluate a youth’s need for medical care or to provide the necessary intervention. In the best situations, the detention facility has trained medical and mental health staff available at all times to determine whether a youth is safe to admit and to provide necessary care such as detoxification from alcohol or drugs. In the absence of such staff, a detention facility should provide written policy and procedure accompanied by training to guide staff decision-making. However, in many institutions, the policies, procedures, and training do not exist, forcing juvenile detention staff to make some very important decisions based on their own instincts.

Preliminary Safety and Security

The first moments of the admission process are important to establish the legal authority to detain the youth, to make an initial assessment of his or her physical and mental condition, and to begin establishing a rapport. It is also a time to begin implementing security measures. For example, conducting an immediate frisk search will assist in making sure that a youth has no contraband or weapons that could be used to hurt himself or herself or others. The transporting officer may have already completed a frisk search, but the detention facility staff should also do so.

Any kind of search is invasive and a potential violation of the youth’s sense of well-being. Continuously orienting a youth to the admission process and explaining what is going to happen next may mitigate feelings of violation. This technique reduces fear and anxiety, while placing the admission staff member in a nonthreatening and helpful role during an important security function.

As part of the frisk search, the detention worker should have the youth remove coats and other outer clothing and anything from his or her pockets so those items may be inventoried and secured. (See Ch. 8: Management and Facility Administration: Searches)

Rapport and Information Gathering

The process of admitting a youth to detention is equally important. Although admission procedures are often hastily completed under adverse conditions, admission is critically important, because it is the first encounter the facility staff have with the youth and the youth with the staff. It is the first impression, it sets the tone for the entire stay in detention, and it is likely to affect outcomes. There is an art to engaging youth in the detention process. Each detention facility should establish clear policies and procedures to ensure that the admission experience is as positive as possible.

Confinement in detention is a complex situation, placing troubled youth together in a restricted environment with high levels of uncertainty. The risk of problems is very high for both the youth and staff. The mission of juvenile detention is the health, safety, and well-being of both the youth and the staff, and achieving these objectives requires good information, which is the foundation of good decision-making. To get this information, staff must be able to establish positive rapport with the new juvenile to ask the questions that will uncover the key bits of information.

The first moments after the youth comes through the door are critically important, because they set the tone—which is why well-trained and skilled staff should be assigned to perform admission and intake duties. It is a mistake to assume that the process consists simply of a list of tasks to be completed. The quality of the intake process is just as important as the duties involved.

For an effective process, staff must quickly establish that they are concerned for the youth’s well-being. Rapport and information are the twin goals at admission and intake and are entirely complementary. To make sure that the process operates as effectively as possible, staff must gather good information. Staff decisions about what is in the best interest of the youth are no better than the information they acquire, and to get good information, staff members have to be able to establish rapport very quickly.

Effective detention facilities establish procedures to ensure that staff have as much information at admission as possible from the arresting officer or other individual delivering the youth to the facility. It is also important to acquire as much information as possible from the youth. Although delinquent youth are often remarkably candid, it is important to obtain information that can be very embarrassing to discuss, such as history of violence, drug use, depression and other mental health concerns, suicidal behavior, evidence of victimization, and sexually transmitted diseases. Therefore, the better the relationship, the easier it is for the youth to be truthful and forthcoming with staff.

Admission Interview

The information-gathering process should begin with informal conversation. Through a relaxed and casual exchange, staff can uncover and address many of the youth’s fears and apprehensions that can cause serious anxiety. After this initial informal conversation, the youth moves on to the more structured admission interview. During this process, the interviewer will collect much of the information necessary to manage the youth during his or her stay at the facility. One helpful technique is to establish positive patterns of responding.

To establish positive patterns, it is helpful to have some accurate information about the new detainee before his or her arrival at the detention facility or immediately thereafter, from the youth’s facility file, from the agency’s computer-based record, or from the transporting officer. Throughout the initial information-gathering process, the admissions staff member asks questions that confirm existing facts about the youth. In other words, staff should ask simple, non-threatening questions that require a simple yes or no answer, with the intention of getting mostly yes answers.

An example of a confirming question is: “You are 15 years old?” (Staff may have that information in the record.) Using the information available, staff should construct as many simple “yes” questions as possible to get the youth into the pattern of affirmative responses.

Next, the staff member asks questions that require very short and simple answers. “Where do you live?” “How many brothers and sisters do you have?” “What are their names and ages?” “What school do you attend?” “What grade are you in?” The positive pattern of responding is emphasized as youth continue to answer questions successfully and cooperatively. As this occurs, staff should reinforce this cooperative behavior through increased interaction, informal conversation, eye contact, smiles, and attention. This establishes the relationship and helps to build trust.

Once cooperation is established, staff can ask tougher questions to find out the key pieces of information that are critical to safeguarding the youth during his or her stay in the institution. Specific tools or instruments are used for that purpose to ensure that all vital topics are addressed. In addition, instruments that have been validated for a juvenile population (often normed for the specific jurisdiction) provide useful information. These instruments are designed to identify such issues as current feelings, emotional states, unusual behaviors, and potential for physical harm by asking questions such as, “Have you ever hurt yourself?” or “Have you ever tried to commit suicide?” Other questions relate to drug and alcohol abuse, such as “Do you use alcohol?” and “If so, how much, and how often?”[4] (See Ch. 5: Rights and Responsibilities, Ch. 12: Healthcare, and Ch. 15: Service and Treatment Plans)

Admission Documents

Admission intake form. Each facility has documentation that must be completed as part of the admission process. Required paperwork usually includes questionnaires or instruments (see Admission Screening and Assessment), designed to gather information about a youth’s physical and mental health, drug and alcohol use history, suicide potential, and risk for violence or victimization. In addition, a general admission or intake form should be completed for every juvenile admitted to the detention facility and should contain at least the following information:

  • Name, age, sex, date of birth, and place of birth.
  • Race or ethnic origin.
  • Name of person to notify in case of emergency.
  • Date and time of admission.
  • Social history.
  • Special medical problems or needs.
  • Personal physician.
  • Height, weight, hair color, and eye color.
  • Address and telephone number.
  • School and grade.
  • Employer, if applicable.
  • Driver’s license and Social Security and Medicaid numbers, if applicable.
  • Name and relationship of the person with whom the youth lives.
  • Parent or guardian’s name, address, and telephone number.
  • All identifying marks, scars, and tattoos.
  • Name of the probation officer, if applicable.
  • Religion.
  • Referral (person that brought the youth to admission).
  • Name and signature of the admitting official.
  • Offense (charge indicated on police record, petition, court order, or bench warrant).
  • Assigned identification number from the admission log book.
  • Name of the person authorizing admission.[5]

Case record. The youth’s case record is established at admission. All entries made into the case record should be dated and initialed or signed. If the case record is computer based, the staff member entering the information should include his or her own identifying information. At a minimum, the case record should include the following information:

  • Initial intake information.
  • Individual plan or program.
  • Documented legal authority to accept the juvenile.
  • Record of court appearances.
  • Completed screening and assessment forms.
  • Medical history.
  • Signed receipt from the youth indicating acceptance of the facility’s rules and policy handbook.
  • Signed informed consent form.
  • Notations of temporary absences from the facility.
  • Visitors’ names and dates of visits.
  • Record of telephone calls made and received.
  • Progress and counseling reports.
  • Daily behavior logs.
  • Grievance and disciplinary reports.
  • Referrals to other agencies.
  • Psychological and/or psychiatric evaluations.
  • Educational assessments.[6]

Confidentiality laws and regulations may require that a juvenile’s case record consist of more than one file. For example, the Health Insurance Portability and Accountability Act, 1996 (HIPAA)[7] establishes privacy requirements that generally mean that only medical professionals may access much of a youth’s medical information. A medical file should be established and safeguarded from access by non-medical staff. In addition, a facility may establish a legal file with documentation of court information and admission authorization that is maintained centrally and separately from the unit file that contains such things as screening and assessment information, behavior and disciplinary reports, and daily logs. Any files or records from prior admissions must be readily accessible at the time a youth is readmitted to a juvenile detention facility. The case record consists of all official files compiled on behalf of a youth in detention.

Admission Screening and Assessment

Targeted screening and assessment. In addition to the facility’s basic admission or intake form, other screening and assessment paperwork must be completed as part of the admission process. Grisso and Underwood, noted experts in juvenile screening tools, describe the process as relatively brief and “designed to identify youth who are at increased risk of having disorders that warrant immediate attention, intervention or more comprehensive evaluation. Screening, therefore, is a triage process, often employed with all youth entering a particular component of the juvenile justice system.”[8] Screening is usually brief (10 to 30 minutes) and is not intended to provide psychiatric diagnosis. Screening is designed to suggest where there is a need for further assessment and indicate relatively immediate responses, such as suicide watch. All youth admitted to juvenile detention should be screened.[9]

Grisso and Underwood defined assessment as “a more comprehensive and individualized examination of the psychosocial needs and problems identified during the initial screening…and recommendations for treatment intervention.”[10] Assessment is more time consuming and expensive and requires the expertise of a mental health professional. Assessment is usually reserved for a subset of screened youth.

Behavior screening. A behavior screen, which inquires about recent changes in behavior patterns in relation to social stressors, allows staff to make informed judgments about the youth’s potential adjustment to the facility and its programs.

Suicide screening. All youth must be screened for suicide potential “immediately upon confinement and housing assignment.”[11] Suicide screening policies must include referral for further mental health assessment as indicated by the screen.

Drug and alcohol screening. A drug and alcohol use screening is important for all youth as part of the admission process. Staff need to be alert to possible withdrawal symptoms or other drug-related effects. The effort extended in establishing rapport with the youth will pay off greatly at this point to help the youth respond honestly during this screening.

Initial medical screening. Comprehensive detention intake incorporates an initial medical screening that gathers basic, preliminary information such as recent hospitalization or other medical care, recent injuries or illnesses, current medications, allergies, and the name of the youth’s primary healthcare provider. This screening is often completed by a non-medically trained staff member who can then provide the information to the medical staff for further assessment.

Other specialized forms or screening instruments are used to determine a youth’s needs and to ensure youth and facility safety and security. Those instruments effectively and efficiently screen for issues such as substance abuse, symptoms of disorders, problems/strengths/needs, and cognitive abilities.

PREA screening. The Prison Rape Elimination Act (PREA) requires intake screening for a detainee’s potential as a perpetrator or a victim of sexual abuse. PREA Standard 115.341 states:

  1. Within 72 hours of the resident’s arrival at the facility and periodically throughout a resident’s confinement, the agency shall obtain and use information about each resident’s personal history and behavior to reduce the risk of sexual abuse by or upon a resident.
  2. Such assessments shall be conducted using an objective screening instrument.
  3. At a minimum, the agency shall attempt to ascertain information about:
    1. Prior sexual victimization or abusiveness;
    2. Any gender nonconforming appearance or manner or identification as lesbian, gay, bisexual, transgender, or intersex, and whether the resident may therefore be vulnerable to sexual abuse;
    3. Current charges and offense history;
    4. Age;
    5. Level of emotional and cognitive development;
    6. Physical size and stature;
    7. Mental health or mental disabilities;
    8. Intellectual or developmental disabilities;
    9. Physical disabilities;
    10. The resident’s own perception of vulnerability; and
    11. Any other specific information about individual residents that may indicate heightened needs for supervision, additional safety precautions, or separation from certain other residents.
  4. This information shall be ascertained through conversations with the resident during the intake process and medical and mental health screenings; during classification assessments; and by reviewing court records, case files, facility behavioral records, and other relevant documentation from the resident’s files. Some of this information is already obtained as part of the standard admission and intake process.[12]

    In addition to the requirement that each youth admitted to a confinement facility be screened during intake (defined in the PREA Standards as within 72 hours of arrival,) PREA Standard 115.342 requires:
  5. The agency shall use all information obtained pursuant to §115.341 and subsequently to make housing, bed, program, education, and work assignments for residents with the goal of keeping all residents safe and free from sexual abuse.[13]

There are validated instruments available for this required assessment.[14] Detention is intended to be short term. Timely completion of the mandatory PREA screening and assessment can be a challenge. Staff at the detention facility should use the critical period of admission to obtain at least initial self-report evidence along with any other details that may be immediately available, such as anecdotal information from prior admissions. The full screening must then be completed as expeditiously as possible to ensure appropriate classification as well as to offer essential services. The PREA screening is part of the admission process and must be completed within 72 hours. Other detention screening can and usually does occur within the first 24 hours. (See Ch. 12: Healthcare: Sexual Behaviors and the Prison Rape Elimination Act)

Classification and Housing

In some contexts, “classification refers to the process of determining at what level of custody an offender should be assigned.”[15] Generally, the RAI is used to help make that determination, and the youth may be placed in a non-secure detention alternative program based on an objective assessment of risk of reoffending or of absconding. In this chapter, however, classification refers to placement in particular housing units and programs within the juvenile detention facility.

Most juvenile detention facilities use some kind of classification system at admission. From the perspectives of conditions of confinement and legal liability, juvenile detention facilities have a constitutional mandate to protect the safety of youth in detention, which generally means the establishment of a classification system that identifies and separates violent youth from nonviolent or vulnerable youth. That separation primarily affects housing assignment and sleeping arrangements. It does not require an entirely separate program during waking hours.

When all rooms in a detention facility are single occupancy, initial classification is somewhat simplified. Unless the facility is over its rated bed capacity, each youth is assigned to an individual room. However, if the number of detainees exceeds the capacity of the facility or of a living unit, special housing arrangements must be made. If the facility has double- or multiple-occupancy rooms, or the need to double bunk in single-occupancy rooms arises due to overcrowding, the detention facility must have a clear system of classification to ensure the safety of residents and the facility. That system must be designed to protect low-risk, nonviolent, or vulnerable youth from others who are identified as potentially violent.

Even if a detention facility has all single-occupancy rooms and does not exceed its rated bed capacity, it should still implement a classification system that addresses each youth’s individual issues and needs. Just as teachers assess new students to determine the level of their schoolwork, detention facility staff are responsible for determining how a new detainee fits into the group living environment of the detention facility. Classification systems are used to assign detainees to particular programs and housing units. A classification system should evaluate the following information:

  • Sex and age.
  • Physical characteristics.
  • Prior sexual victimization or abusiveness.
  • Any gender nonconforming appearance or manner or identification as lesbian, gay, bisexual, transgender, or intersex.
  • Nature of the offense.
  • Prior offense history.
  • Behavioral reports and summaries from prior detentions.
  • Social history.
  • Psychological assessment.
  • Conversations with admitting police officers.
  • Information from probation officer or caseworkers.
  • Status of gang membership.
  • Physical indicators of violence (scars from fights or gunshots).
  • Reports from other agencies.
  • Self-reported data.

This information acquired during the admission process is also used to alert program staff to the need for additional information and assessment.

At admission, the first classification decisions are housing or group related. In medium or large facilities that have more than one housing unit and various program groups, classification usually involves the following issues: 1) separation of violent from nonviolent detainees, 2) separation of male from female detainees, and 3) separation of detainees based on level of sophistication and maturity. Classification may also be based on objective criteria such as age or size or on more arbitrary conditions such as mental maturity. Additional classification decisions are based on the number and range of programs offered at the detention facility and the varying needs of detained youth.

Another distinction among the youth held in custody is their status vis-à-vis the court. The role of juvenile detention facilities in the juvenile system has typically been to hold youth that are awaiting court adjudication or a long-term placement. In most states and jurisdictions, the function of detention has broadened; it is used as a post-adjudicatory placement as a consequence or punishment for delinquent behavior. This use has expanded as other secure placement options, such as antiquated training schools, have been closed or downsized.

Detention facilities have also become de facto mental health placements. The mental health system is often unable to meet the needs of dual diagnosis youth—those youth who have histories of delinquency along with mental health issues or serious drug or alcohol abuse problems. Detention facilities are often required to accept these youth based on their delinquency charge and then must step up to the challenge of addressing mental health or substance abuse concerns. Detention facilities end up providing diagnostic and treatment interventions on a crisis basis, while arrangements are made for a more appropriate placement and corresponding treatment. The need to address these diverse issues begins at intake through appropriate classification. (See Ch. 2: Types of Facilities)

Because detention staff usually have very little information about youth at the time of admission, the distinction between violent and nonviolent offenders is often based solely on the current offense. This can be misleading; some violent youth are charged with nonviolent offenses. In these cases, admitting staff members run the risk of mistakenly mixing violent and nonviolent detainees, with potentially detrimental results. In the absence of adequate information at admission, all new detainees should be housed in single-occupancy rooms until more information is assembled. When the facility exceeds capacity or when multiple-occupancy rooms are involved, the risk is increased. At this point of intake, accurate self-reported information is critical.

Property Inventory, Showers, and Searches

Inventory. The property inventory is an essential part of the admission process. Explaining clearly how the facility will safeguard the youth’s property helps establish the interviewer and the institution as being trustworthy. The detention staff must list in detail any items that the youth has in his or her possession at admission, including the youth’s clothing when that youth changes into facility clothing. The youth should be asked to sign the inventory form and be given a copy of it. Securing and storing the inventory in the presence of the youth will increase the youth’s trust.

Showers. Youth admitted to detention should be required to shower before being placed in the housing unit to ensure the hygiene and health of the new youth as well as other youth in the facility. The shower should include the youth thoroughly shampooing his or her hair. Some facilities require that all youth use head lice shampoo during their admission shower. Although that may be a good precaution, head lice shampoo does not guarantee that the youth will be free of lice or nits. In either case, medically trained professional should follow up with a thorough examination for head lice.

After the youth showers, he or she should dress in facility clothing. A youth also receives basic hygiene items and is informed of the facility’s system for replenishing those items.

Searches. Searches are a legitimate part of the admission process, because they ensure safety and order in the detention facility by controlling access to contraband. Several types of searches are used in confinement facilities, including inventory search, frisk search, strip search, body-cavity search, room or cell search, perimeter search, and vehicle search. The first two searches are always part of the admission and intake process. The other types of searches are conducted in detention facilities as required and authorized by state statute, applicable case law, and policy.

The inventory search is a thorough search of a youth’s clothing or personal property brought into the detention facility at the time of admission, visitation, or official activity outside the detention facility. The youth’s property is itemized, and the written inventory is stored securely with the property until the youth is released.

The frisk search, or clothed-body search, is a thorough pat-down of a youth’s body and outer clothing. The frisk search does not require a youth to remove any clothing, except outer clothing such as a coat or jacket and, sometimes, shoes. A frisk search may also be accompanied by a wand search using a metal detecting, hand-held device.

The strip search and the body-cavity search are much more invasive and are subject to closer legal and professional scrutiny. The courts and professional associations have set guidelines for strip searches and body-cavity searches.[16] A line staff runs a substantial risk when conducting a strip search without the authorization of the facility administrator or supervisor. A common guideline adopted by courts and agencies in determining the appropriateness of admission strip searches is whether there is reasonable suspicion that contraband will be found. Facility policy, procedure, and training should define and explain “reasonable suspicion,” including examples. Strip searches should always comply with applicable statute, case law, and agency policies; facility staff members should be familiar with those.

Strip search. When authorized to conduct a strip search, the admission staff should observe these guidelines for the protection of both the staff and the youth:

  • Only specifically-trained staff may conduct a strip search.
  • Only same gender staff may conduct strip searches. Policy may require that two staff members be present for all strip searches.
  • Strip searches must be conducted in a private area of the facility.
  • Staff must maintain a professional demeanor throughout the process.
  • Youth should be asked to remove all of their clothing, and staff should refrain from inappropriate comments and staring.
  • Staff must not touch a youth during a normal strip search.
  • Strip searches must be documented as required by agency policy, including the justification for the search, such as reasonable suspicion. Documentation may include notations about unusual bruises, cuts, marks, or other concerns that could indicate abuse. This information should be passed on to the appropriate medical professional.

Body-cavity search. If a body-cavity search is to be conducted, staff should follow these guidelines:

  • Only a licensed healthcare provider with authorization from the responsible physician and facility administrator should ever conduct a body-cavity search.
  • The facility’s policy and procedure must require that body-cavity searches be allowed only if there is reasonable suspicion that contraband will be found.
  • Body-cavity searches may only be performed by same gender medical staff and must be conducted in private. It is generally advisable that two staff members be present during a body-cavity search.
  • The primary role of facility healthcare staff is to serve the health needs of their patients. Conducting body-cavity searches for contraband can create an ethical conflict. Therefore, some agencies’ policies require that body-cavity searches be conducted by outside professionals or someone on the facility staff who is properly trained but not involved in a therapeutic relationship with the juvenile.[17]
  • Body-cavity searches should be extremely rare and must be documented as required by agency policy, including the justification for the search, such as reasonable suspicion.

(See Ch. 8: Management and Facility Administration: Searches)

Orientation and the Resident Handbook

As a final step in the admission process, the youth should be oriented to the expectations of the facility. It is recommended that this orientation be done through a verbal review of a resident handbook, which contains information about the facility rules, sanctions, and rewards available for cooperative behavior; the youth’s rights including visitation, mail, telephone use, and grievance procedure; how to access services such as medical, mental health, and clergy; and facility programs such as education, recreation, and volunteers. The handbook may be supplemented with video information, but neither should replace the process of a staff member explaining the rules verbally to the youth. The resident should sign a statement indicating that he or she has received a copy of the handbook and understands the staff member’s explanation. During the orientation process, staff should be sensitive to the youth’s educational level. If help reading the handbook is necessary, it should be provided in a nonjudgmental manner that does not embarrass the youth. If the juvenile does not speak English, an orientation should be conducted in the juvenile’s native language and, if possible, a copy of the written handbook should be provided in that language as well.

An adequate amount of time is necessary for the orientation to be thorough and effective. The admission staff may not have time to complete that process thoroughly with their other duties. Therefore, orientation is often assigned to a direct care worker in the living unit to which the youth is assigned.

Special Concerns at Admission to Detention

Fear and apprehension. When youth come to detention and are clearly apprehensive and fearful, staff should take the time to convey several important messages to them. First, staff should explain that they are concerned about the youth’s health, safety, and well-being, and should show concern directly by asking them how they feel and what has happened to them. Such expressions of concern are important in establishing a sense of trust on the part of new detainees. It is also important to verbally walk youth through the whole admission process when they are apprehensive. Staff can reduce a young person’s sense of uncertainty by simply telling them in detail with calm reassurance what is going to happen next, at each step in the admission and intake process. Fear and apprehension are typical feelings for a youth admitted to a detention facility for the first time. And, an adolescent may attempt to mask that fear through anger or hostility.

Hostility. Hostile or belligerent youth behavior presents a number of different problems. If the youth’s hostility is verbal bravado and not a physical assault, the admission staff member need not change strategy. The strategies that work with apprehensive youth apply to most other types of youth as well. Some of the more difficult youth require staff to be more patient and persevering in this approach. Establishing the positive patterns of responding discussed above can be helpful in dealing with a hostile youth.

To ensure an effective admission process, staff must get past the youth’s anger and calm the youth so that the admitting staff member can ask the questions on the admission intake form and complete other necessary paperwork. For example, an admitting staff member can persist in asking questions without becoming personally involved with the insults or name calling commonly associated with hostile youth. Staff must put that kind of expression of anger in its proper perspective. When a youth is truly angry, hostile, and belligerent, staff should expect venting. When this venting occurs, staff need to calm the youth to achieve necessary goals—establishing the relationship, getting good information, and making sure that the youth is successfully integrated into the program.

Anger and hostility at admission is not uncommon and should be expected. That emotional response may be the natural result of harsh and punitive treatment by an arresting officer. Such an interaction can escalate an already tense situation. However, many law enforcement officers are very skilled in defusing a youth’s antagonism. A youth may also behave uncooperatively and aggressively because of being angry with himself or herself for committing an offense that resulted in arrest. The youth could be upset with parents, teachers, or peers for reporting an incident. If the detention staff responds in a calm and neutral manner, recognizing that the youth’s reaction is not personal and perhaps not unreasonable, the intake can proceed.

Some institutions require or allow staff to confront anger and uncooperative behavior to immediately try to establish control, authority, and power—which may explain why so many detention facilities use solitary confinement or locked-room confinement as part of the admission process. Using confrontation with verbally inappropriate and hostile behaviors is unnecessary as a means of establishing control or authority. Doing so can aggravate a situation. A youth will notice the cinder block and concrete construction, the security hardware and locks, the wire glass, the metal doors, the steel handcuffs, or the security furniture. Control and security permeate most detention environments so pervasively that staff do not have to remind a youth who is in charge. Furthermore, it is rare for a youth to physically challenge the staff or the facility’s security at the time of admission.

Depression and suicidal behavior. Another condition that requires each staff member’s special attention is despondency or depression. Although despondency occurs at the opposite end of the emotional spectrum from hostility, the despondent or depressed youth can be more dangerous than the overtly hostile youth. During the admission process, staff must watch for signs that alert them to the risk of self-inflicted injury. As discussed earlier in this chapter, all youth must be screened for suicide potential during the intake process, “immediately upon confinement and housing assignment.”[18] For purposes of suicide screening, the admission process may involve more than one staff member. There may be a staff member who is responsible for making the legal decision to detain and a different staff member assigned to complete the suicide and other specialized screening instruments. If the initial screening signals a suicide risk or if the staff learns that a youth has tried to hurt himself or herself, the facility must have policies and procedures in place that ensure a follow-up assessment by a mental health professional. If a suicide screening indicates that the youth is a risk for potential self-harm, staff should observe the youth constantly until a mental health professional conducts an assessment. (See Ch. 11: Mental Health)

Admission and Intake to a Youth Correctional Facility—An Event and a Process

Admission and intake to a juvenile correctional facility differs from juvenile detention admission, as the two types of institutions have different roles and purposes within the juvenile justice system. However, juvenile correctional facilities also have necessary tasks to accomplish as part of the event and process of admission.

The juvenile correctional facility usually has much more information about committed youth than detention facility staff have, and a great deal of that information is available prior to admission. Ideally, the juvenile correctional facility has information on each youth prior to that youth’s arrival. Most youth placed in a juvenile correctional facility are transferred there from a juvenile detention facility where screening and assessment should have already occurred. In many states, youth come to a juvenile correctional facility from an intake and diagnostic unit. The juvenile court, a youth’s probation officer, case manager, the detention facility, and others may provide formal information about a youth before he or she is transferred for long-term commitment. The availability of information on each committed youth helps the facility to individualize the admission process and facilitates prompt provision of essential programs and services.

The American Correctional Association (ACA) recommends that the facility’s written policies include at least the following:

  • Determination that the juvenile is legally committed to the facility.
  • A thorough and complete search of the juvenile and of his or her possessions.
  • Inventory, storage, or disposition of personal property.
  • Shower and hair care, if necessary.
  • Issue of clean, laundered, properly fitting clothing, as needed.
  • Issuance of personal hygiene articles.
  • Medical, dental, and mental health screening.
  • Assignment to and brief tour of the housing unit.
  • Recording of basic personal data and information to be used for mail and visiting lists.
  • Assistance to youth in notifying their families of their admission and procedures for mail and visiting.
  • Assignment of a registered number to the youth.
  • Provision of written orientation materials to the juvenile and verbal or multi-media orientation to the facility and program.[19]

Legal Authority

Although the decision to accept a youth to a juvenile correctional facility is much less complicated than to a juvenile detention facility, the facility must still ensure it has written legal authority to accept each youth. That documentation may arrive in advance of the youth’s transfer, or it may accompany the youth. Legal authorization to place a youth in a juvenile correctional facility is usually in the form of a court order committing the youth. That order may be for commitment to a specific facility but is more often an order of commitment to the state agency responsible for long-term juvenile correctional facilities.

Depending on the state, the agency that receives the court’s commitment order will then assign the youth to a specific facility. Placement decisions are based on a variety of factors that may include:

  • Geography—the desire to place youth close to his or her home and family.
  • Gender—facilities that program specifically for males or females.
  • Security—ranging from maximum to staff secure.
  • Treatment needs—such as programs to serve sex offenders.

Information Gathering

The event of admitting a youth to a juvenile correctional facility is similar to what occurs in a juvenile detention facility. The staff members involved should employ similar techniques, which are intended to defuse any potential anxiety or hostility. Staff have the opportunity at this point to ease a youth’s fears and build trust. These are skills that staff can learn and develop and that can help to reduce problem behavior during admission. However, the court has committed these youth to a juvenile correctional facility, and the youth know in advance that long-term, secure confinement has been mandated for them. They have generally been in a detention facility or diagnostic unit prior to transfer and are more accustomed to institutional practices and expectations than those youth being admitted to a juvenile detention facility. A juvenile correctional facility is the most restrictive placement option in a juvenile justice system. Although many youth placed in a detention facility are experiencing their first out-of-home placement, many youth entering a juvenile correctional facility have had previous placements, making the commitment experience less intimidating for them.

Just as with the detention admission process, establishing rapport while gathering information can and must be done simultaneously. As with intake in detention, this process creates the initial impression and sets the tone for the youth’s subsequent adjustment. Each juvenile correctional facility should establish clear policies and procedures to ensure that the experience is a positive one.

Systematic information gathering helps to ensure youth safety, facility security, and that the juvenile correctional facility is providing services and treatment designed to meet each youth’s individual needs. As indicated above, this process may begin before the youth arrives. All information about a youth must be included in the youth’s facility case record. In some state systems, youth may have a permanent case record that follows them to any placement to which the agency assigns them. When this is the practice, the juvenile correctional facilities are able to use that information in making classification decisions and developing treatment and service plans. (See Ch. 15: Service and Treatment Plans)

Even if the facility receives written information on a committed youth in advance of placement, or if the facility receives a traveling file with extensive historical material, each youth must have a case record established at intake that contains information about the youth prior to placement, currently and on a continuing basis. The youth’s individual service or treatment plan is based on all available information. The file will incorporate details about the youth’s progress in achieving the goals and objectives in that plan.

The case record should include current health and medical information that may be recorded and maintained securely and available only to appropriate medical staff. The case record will include the youth’s service or treatment plan (or both), educational information such as testing and credit details, and behavior logs that are linked to the service or treatment plan. Other information, such as family history, drug and alcohol use history, and treatment history will also be in in the case record.

Preliminary Safety and Security

Similar to the detention admission process, it is imperative that the admission event includes tasks that will aid in ensuring safety and security. Primary to that goal are searches of the youth and his or her property. As with admission to detention, an immediate frisk search should occur to make sure that the youth has no contraband or weapons that could be used to hurt himself, herself, or others. The frisk search is often accompanied by a wand search, using a metal detecting, hand-held device. A more invasive strip search or body-cavity search should only be conducted in accordance with applicable statute, case law, and agency policy.[20] As with youth admitted to juvenile detention, a strip search or a body-cavity search of a youth entering a juvenile correctional facility may occur only if there is reasonable suspicion that the youth may be concealing contraband. The case law regarding strip searches or body-cavity searches in juvenile correctional facilities is less clear than in juvenile detention facilities. However, juvenile PREA Standards that address strip searches are applicable to both types of juvenile facilities.

As with admission to juvenile detention, any kind of search is invasive and a potential violation of the youth’s sense of well-being. A youth’s feelings of violation may be mitigated by continuously orienting a youth to the intake process and explaining to the youth what is going to happen next. This technique reduces fear and anxiety, while placing the admitting staff member in a nonthreatening and helpful role during an important security function.

When a youth is admitted to a juvenile correctional facility his or her personal property is usually delivered securely and is not in the youth’s possession. Even so, any personal property that a youth arrives with should be inventoried in his or her presence and stored securely.

Basic Needs

All youth should be required to shower and wash their hair upon admission if they are entering the facility from the community. Some facilities allow youth to forego that requirement if they are transported directly from another secure facility.

Some facilities allow youth to wear their personal clothing, but most require a uniform. Juvenile correctional facilities require youth to wear uniforms for several reasons—to ensure hygienic clothing; to avoid any inappropriate expressions through the choice of clothing, such as gang colors; to help identify a youth, such as requiring all youth in a particular unit to wear the same color tee shirt; and to eliminate theft or trading of clothing items. During intake, youth are issued uniform clothing that is clean and that fits properly. Youth should not be required to wear shabby or damaged clothing. A youth also receives basic hygiene items and is informed of the facility’s system for replenishing those items.

Screening and Assessment

Although the juvenile correctional facility usually has information on a committed youth in advance of his or her arrival, it is important to conduct an initial screening or assessment on all youth for consistency and to have a baseline from which to establish service and treatment plans. Screening is a relatively brief effort conducted, as described by Grisso and Underwood, to obtain information indicating the need for immediate attention.[21] Initial screening usually occurs before a youth is committed to a juvenile correctional facility, and the facility should focus on the need for subsequent assessments. These may include suicide assessments; drug and alcohol assessments; current medical and dental assessments; updated mental health assessments; vocational interests, if appropriate; educational assessment; religious background and interests; recreational interests; and other assessments as needed.[22] In addition, a PREA Screening and Assessment must be completed on all newly admitted youth.[23]

Classification and Housing Assignment

Similar to a juvenile detention facility, a juvenile correctional facility must make classification and housing assignments based on each youth’s treatment and safety needs and on the facility’s specialized programs. Typically, facilities have a written classification plan or policy that contains detailed procedures to aid in decision-making related to a youth’s placement within the facility. These may include but are not limited to:

  • Method of determining level of risk presented by the youth.
  • Type of housing required.
  • Criteria for youth participation in facility and community programs.
  • Criteria for changing the status of the juveniles with procedural safeguards when there is an increase in custody level or transfer.
  • Staff authorized to make classification or reclassification decisions.

Institutional classification systems frequently identify factors related to the need to separate specific youth from one another. Classification helps staff make decisions regarding placements of youth in housing units, in beds within these units, or for classroom assignments. Information to be considered would include whether the youth has any known enemies in the facility, whether he or she has any delinquent associates or is affiliated with a gang, whether the youth has family members in the facility, or whether he or she has a history of sexually acting out or victimization.

Facility size is a factor in making housing assignments, as are the levels of security available in the facility. Many juvenile correctional facilities initially assign all new residents to a separate unit for reception and orientation. Youth remain there for a set period of time, often one week to one month, before being assigned elsewhere in the facility. The subsequent placement is determined, at least in part, on the more thorough screening and evaluation that is conducted while the youth is on orientation status. ACA Performance-based Standards recommend that youth be provided with programming, including education, during their reception period, if that orientation occurs in a separate location or lasts more than one day. Written orientation materials should be provided in the youth’s own language; a translation should be provided, as needed. If a literacy problem exists, a staff member should assist the youth in understanding written material.[24] Staff should take care to not embarrass youth who may be insecure about their ability to read.

Classification must consider youth and facility safety and security, so efforts must be made to separate violent youth from nonviolent youth. A juvenile correctional facility has more time than a detention facility does to review factors related to a youth’s potential for violence or vulnerability to being victimized. Reliance on relatively superficial factors such as the commitment offense, without other evaluative tools, should not occur. In addition to the completion of screening and assessment by juvenile correctional facility staff and mental health providers, classification decisions should consider such things as:

  • Information about a youth’s prior sexual victimization or abusiveness.
  • Any gender nonconforming appearance or manner or self-identification as lesbian, gay, bisexual, transgender, or intersex.
  • Behavioral reports and summaries from prior placements.
  • Prior offense history.
  • Information from probation officer or caseworkers.
  • Prior offense history.
  • Status of gang membership.
  • Physical indicators of violence (scars from fights or gunshots).[25]

Of course, a primary factor in making classification decisions is gender. If a facility is coeducational, male and female residents should be housed separately, and programming must be gender sensitive.

ACA standards recommend that “living areas are primarily designed for single-occupancy sleeping rooms; multiple-occupancy rooms do not exceed 20% of the bed capacity of the unit.”[26] It is recommended that juvenile correctional facilities have single-occupancy rooms available for certain, identified youth, even if the facility also has multi-occupancy rooms or open dorm housing. At the least, single-occupancy rooms should be provided for:

  • Youth with serious medical disabilities.
  • Youth suffering from severe mental illness.
  • Youth with physical disabilities that impair functioning as defined in Americans With Disabilities Act (ADA) standards.
  • Youth who represent threats to the safety of others, self, or the facility, including sexual predators, youth who engage in self-harm and seriously aggressive or assaultive youth.
  • Youth likely to be exploited or victimized by others.

The admission and intake event can positively impact the youth’s attitude towards his entire stay at the facility. The process should be conducted professionally but sensitively. It is the first opportunity that the staff has to establish a healthy and constructive relationship with the youth and, done well, it can produce information that can assist the staff in addressing the youth’s needs and treatment issues effectively.

Admission and Intake to an Adult Jail—An Event and Process

The admission of youth to adult jails is an exception to typical practice; juveniles are normally placed in juvenile detention facilities. The ACA’s Core Jail Standards prohibit the “confinement of juveniles under the age of eighteen [to an adult jail] unless a court finds that it is in the best interest of justice and public safety that a juvenile awaiting trial or other legal process be treated as an adult for the purposes of prosecution, or unless convicted as an adult and required by statute to be confined in an adult facility.”[27] However, all states have laws that allow for the use of confinement in adult jails for young people who are otherwise statutorily or chronologically considered juveniles. Young people end up in adult corrections systems in three basic ways: age of jurisdiction laws, transfer laws, and blended sentencing laws.[28] (See Ch. 2: Types of Facilities)

Age of jurisdiction laws establish the age at which a youth is automatically under the jurisdiction of the adult court. Those laws vary among the states, but trend reports in the first decade of the 21st century indicate an increase in that age. Data from 2012 indicate that 38 states set the maximum age for juvenile court jurisdiction at 17. Ten other states set the age at 16; two states set that age at 15. New York is one such state, where youth aged 16 and 17 are automatically tried in the adult system. Still, the 2012 numbers indicate a recent trend in a growing number of states toward keeping more youth in the juvenile system.[29]

Transfer laws allow a young person below the age of adult jurisdiction to be transferred, waived, or certified to the adult court system. That transfer may occur through a judicial waiver or decision, through prosecutorial discretion, or by categorical exclusion from the juvenile system based on the offense. In some jurisdictions, waiver to adult court will occur “if a youth engages in a crime while involved in a gang or some other behavior, that makes the case eligible for transfer to the adult court.”[30]

Blended sentences are allowed in some jurisdictions where a juvenile disposition may be imposed on a youth but, if that youth does not succeed, he or she may be transferred to the adult corrections system on that same conviction.[31]

The Juvenile Justice and Delinquency Prevention Act (JJDPA) seeks to limit the incarceration of juveniles in adult jails. And, when juveniles are held in adult facilities, the JJDPA rules prohibit their contact with adult inmates. However, those regulations do not extend to young people transferred to the adult court.[32] Juveniles who are admitted to adult jails must be separated from adult inmates at all times by sight and sound. However, if that same young person has been certified for processing as an adult, sight and sound separation is not mandatory unless state law or other regulations require this. Nevertheless, many jurisdictions offer similar protections for transferred youth held in adult jails as they do for youth still considered to be juveniles under the law.[33] These protections often begin at the time of admission and intake.

Decision to Admit and Legal Authority

As with juvenile detention, admission to an adult jail is an event that involves the act of taking physical and legal custody of a juvenile on the basis of the statutory authority of a particular state. The adult jail must ensure that the youth meets the legal requirements for admission, either as a youth transferred or certified to the adult court or as a juvenile charged as an adult under state statute. Generally, the jail is notified that a juvenile will be transferred subsequent to the filing of charges in adult court or based on a court order of certification. Youth who are below the state’s age of adult jurisdiction and who are subsequently certified or who are charged as adults may be placed in a juvenile detention facility first, pending legal action. They may also be booked directly into jail when charged with specific, serious offenses. When a youth is delivered to an adult jail for admission, that jail must confirm the youth’s status and ensure that the necessary legal paperwork is in order, either before or at the time of admission.

Preliminary Safety and Security

Although safety and security are critical components of any confinement facility, there are unique aspects of those concerns in dealing with youth. For example, newly admitted youth should be “separated from the general population during the admission process.”[34] Conducting an immediate frisk search will ensure that a detainee has no weapons or contraband, which could be used to harm himself or others. The transporting officer may have already completed a frisk search, but the jail staff must also do so. As discussed in the previous sections on admission to juvenile detention and juvenile correctional facilities, any kind of search is invasive and has the potential for violating the youth’s sense of well-being. Feelings of violation may be mitigated by continuously orienting a youth to the intake process and explaining to that youth what is going to happen next. This technique reduces fear and anxiety, while placing the admitting staff member in a nonthreatening and helpful role during an important security function. The jail staff must consider the youth’s emotional maturity during the booking process and, particularly, while conducting the search. Staff should conduct searches calmly and professionally to mitigate a youth’s heightened anxiety.

Property Inventory, Showers, and Searches

Inventory. As with juvenile facilities, the property inventory is an essential part of the jail admission process. Explaining clearly how the facility will safeguard the youth’s property helps establish the booking officer and the jail as being trustworthy. The youth’s personal items are also removed and inventoried at that time. The jail staff must document any items that the youth has in his or her possession at admission, including the youth’s clothing, when that youth changes into facility clothing. The youth should be asked to sign the inventory form and should receive a copy of it. Securing and storing the inventory in the presence of the youth will increase the youth’s trust.

Showers. Youth admitted to jail should be required to shower before being placed in the housing unit to ensure the hygiene and health of the new youth as well as other youth in the facility. The shower should include the youth thoroughly shampooing his or her hair. Some facilities require that all youth use head lice shampoo during their admission shower. Although that may be a good precaution, head lice shampoo does not guarantee that the youth will be free of lice or nits. In either case, a medically trained professional should follow up with a thorough examination for head lice.

After the youth showers, he or she should dress in facility clothing. A youth also receives basic hygiene items and is informed of the facility’s system for replenishing those items.

Searches. Searches are a legitimate part of the admission process, because they ensure safety and order in the jail by controlling access to contraband. As in juvenile facilities, several types of searches are used in adult jails, including inventory search, frisk search, strip search, body-cavity search, and cell search. The first two searches are always part of the admission and intake process. The other types of searches are conducted in jails as required and authorized by state statute, applicable case law, and facility policy.

The frisk search, or clothed-body search, is a thorough pat-down of a youth’s body and outer clothing. The frisk search does not require a youth to remove any clothing, except outer clothing such as a coat or jacket and, sometimes, shoes. A frisk search may also be accompanied by a wand search using a metal detecting, hand-held device. As part of the frisk search, the booking staff member should have the youth remove coats and outer clothing and remove anything from pockets, to be inventoried and secured. An additional precaution often includes requiring the youth to remove shoes, and allowing the youth to leave on shirt, pants, undergarments, and socks.[35]

The strip search and the body-cavity search are much more invasive and are subject to closer legal and professional scrutiny. However, federal statute and, often, state statute and agency policy place limitations on strip searches, particularly searches of juveniles. Admissions officers in adult jails must be familiar with and comply with relevant case law, statutory requirements, and agency policy regarding strip searches and body-cavity searches.

Strip search. When authorized to conduct a strip search, the admission staff should observe these guidelines for the protection of both the staff and the youth:

  • Only specifically-trained staff may conduct a strip search. That training should address issues related to a youth’s age, maturity, and vulnerability.
  • Only same gender staff may conduct strip searches. Policy may require that two staff members be present for all strip searches. That practice serves as a protection for the youth against undue invasion of privacy and for the staff against false accusations.
  • Strip searches must be conducted in a private area of the jail.
  • Staff must maintain a professional demeanor throughout the process.
  • Youth should be asked to remove all of their clothing, and staff should refrain from inappropriate comments and staring.
  • Staff must not touch a youth during a normal strip search.
  • Strip searches must be documented as required by agency policy, including the justification for the search, such as reasonable suspicion. Documentation may note unusual bruises, cuts, marks, or other concerns that could indicate abuse and that should be examined by a medical professional.

Body-cavity search. If a body-cavity search is to be conducted, staff should follow these guidelines, which policy and procedure should indicate:

  • Only a licensed healthcare provider with authorization from the responsible physician and facility administrator should ever conduct a body-cavity search.
  • Body-cavity searches must only be allowed if there is reasonable suspicion that contraband will be found.
  • Body-cavity searches may only be performed by same gender medical staff and must be conducted in private. It is generally advisable that two staff members be present during a body-cavity search.
  • The primary role of facility healthcare staff is to serve the health needs of their patients. Conducting body-cavity searches for contraband can create an ethical conflict. Therefore, some agencies’ policies require that body-cavity searches be conducted by outside professionals or someone on the facility staff who is properly trained but not involved in a therapeutic relationship with the juvenile.[36]
  • Body-cavity searches must be documented as required by agency policy, including the justification for the search, such as reasonable suspicion.

Information Gathering, Orientation, and Paperwork

As is the case when admitting a youth to a juvenile detention facility, jail staff responsible for the admission and intake process should focus attention immediately on the youth to establish contact and to determine his or her physical and mental condition. Documentation should be as thorough and detailed as possible. Staff should also use the transporting officer as a source of information. As part of the transfer of custody, jail staff should inquire of the officer if there is any vital information about the youth that the jail staff should know about or that would impact the youth’s immediate safety.

Adult jails face situations at intake that present significant challenges when admitting youth. Although a youth may be facing adult criminal charges, that youth is still—chronologically, emotionally, and developmentally—an adolescent. Jail staff must consider that fact in effectively obtaining the information necessary to book the youth and make classification, housing and programming plans. Because youth are usually transferred from a juvenile facility, the jail will often receive some basic information that is not available for inmates arrested and brought directly to the jail.

As with juvenile detention facilities, the information gathering process is equally important as the event itself. A jail generally will ensure that the youth does not co-mingle with adult inmates during this process. Depending on the size of the jail, there may be one employee responsible for obtaining most intake information, or there may be several.

Medical and mental health staff may be available to get health history and mental health history and evaluate the youth’s current state of mind. That process helps in determining immediate placement upon completion of the intake process.

Court services personnel may interview a youth regarding school, employment, and housing status. Normally, court services personnel determine whether persons would qualify for release on their own recognizance. However, a youth typically would not qualify for this type of release.

Booking and jail services personnel will verify information on the police report or probable cause statement provided at the time of the arrest or intake. These staff will also verify demographic information such as date of birth and address and request other information such as emergency contacts. Jail staff should offer an orientation to the youth, including an explanation of his or her rights, such as the grievance procedure, visitation, mail, telephone access, access to medical and mental healthcare, and available services and programs. Information should be provided about sexual abuse and any related services offered. The orientation should address the rules of the facility and sanctions for violating those rules. It is recommended that the youth read these rights and rules and sign an acknowledgement of having done so. Again, it is important for jail staff to consider the youth’s age and level of maturity while gathering information and providing an explanation of expectations. Staff should consider the youth’s literacy level and should verbally describe any written material as well. If the youth does not speak or read English, the orientation information should be available in a written translation. Regardless of language, staff should verbally review the orientation materials with each youth to make sure youth understand the content.

It is recommended that adult jail staff use the same techniques in interviewing youth as described for youth being admitted into a juvenile detention facility. Using positive patterns of responding will encourage the youth to behave more cooperatively and to be more truthful and forthcoming with information.

The booking personnel will also fingerprint and photograph each admitted youth, as required by local policies.

Admission Screening and Assessment

Youth admitted to adult jails undergo screening and assessment similar to youth entering a juvenile detention facility. This may occur during the booking process and be completed by the same officer who completes the legal admission. Or, specialized staff members may do the screening and assessment. As with juvenile detention, in addition to the facility’s basic admission or intake form, other screening and assessment paperwork must be completed as part of the admission process. Screening and assessment instruments are used to aid in making classification and housing assignments.

Targeted screening and assessment. Again, as Grisso and Underwood describe, screening is “a relatively brief process designed to identify youth who are at increased risk of having disorders that warrant immediate attention, intervention or more comprehensive evaluation.”[37] All youth admitted to an adult jail should be screened.[38]

Assessment is “a more comprehensive and individualized examination of the psychosocial needs and problems identified during the initial screening…and includes recommendations for treatment intervention.”[39] Assessment is more time consuming and expensive and requires the expertise of a mental health professional. Assessment is usually reserved for just a subset of screened youth.

Suicide screening. All youth must be screened for suicide potential as part of the jail admission and classification process. A booking officer usually does initial suicide screening, unless mental health staff are available at all times for that purpose. Suicide screening policies must include referral for further mental health assessment as needed.

Drug and alcohol screening. A drug and alcohol use screening is important for all youth upon admission. The interviewer and staff need to be alert to possible withdrawal symptoms or other drug-related effects. The effort extended in establishing rapport with the youth will pay off greatly at this point if the youth is honest during this screening.

Initial medical screening form. Comprehensive jail intake also includes an initial medical screening that gathers basic, preliminary information such as recent hospitalization or other medical care, recent injuries or illnesses, current medications, allergies and the name of the youth’s primary healthcare provider. This screening is designed to be completed by a non-medically trained staff member. The information is then provided to the medical staff for further assessment.

Other specialized forms of screening for issues like substance abuse, symptoms of disorders, problems/strengths/needs, and cognitive abilities may be conducted to determine a youth’s needs and to ensure youth and facility safety and security

PREA screening. PREA requires intake screening for a jail inmate’s potential as a perpetrator or a victim of sexual abuse. PREA Standard 115.41 states:

  1. All inmates shall be assessed during an intake screening and upon transfer to another facility for their risk of being sexually abused by other inmates or sexually abusive towards other inmates.
  2. Intake screening shall ordinarily take place within 72 hours of arrival at the facility.
  3. Such assessments shall be conducted using an objective screening instrument.
  4. The intake screening shall consider, at a minimum, the following criteria to assess inmates for risk of sexual victimization:
    1. Prior sexual victimization or abusiveness;
    2. Whether the inmate has a mental, physical, or developmental disability;
    3. The physical build of the inmate;
    4. Whether the inmate has previously been incarcerated;
    5. Whether the inmate’s criminal history is exclusively nonviolent;
    6. Whether the inmate has prior convictions for sex offenses against an adult or child;
    7. Whether the inmate is or is perceived to be gay, lesbian, bisexual, transgender, intersex, or gender nonconforming;
    8. Whether the inmate has previously experienced sexual victimization;
    9. The inmates’ own perception of vulnerability;
    10. Whether the inmate is detained solely for civil immigration purposes.
  5. The initial screening shall consider prior acts of sexual abuse, prior convictions for violent offenses, and history of prior institutional violence or sexual abuse, as known to the agency, in assessing inmates for risk of being sexually abusive.

In addition to the requirement that each youth admitted to an adult jail be screened during intake, PREA Standard 115.42 requires:

The agency shall use all information from the risk screening required by §115.41 to inform housing, bed, work, education, and program assignments for residents with the goal of keeping separate those inmates at high risk of being sexually victimized from the those at high risk of being sexually abusive.[40]

A validated instrument should be used for the PREA assessment. The adult jail should use the critical period of admission to obtain at least initial self-report evidence regarding a youth’s potential risk or vulnerability. The full screening must then be completed as expeditiously as possible to ensure appropriate classification and housing as well as to offer essential services. The PREA screening is part of the admission process and must be completed within 72 hours. Other detention screening can and usually does occur within 24 hours.

Classification and Housing

Similar to juvenile detention, “classification refers to the process of determining at what level of custody an offender should be assigned.”[41] Information acquired during preliminary screening, and possible subsequent assessment, is used to make initial housing and programming decisions. A jail often has an inmate management unit that ensures that classification determinations are made at admission. That unit will then reassess at predetermined intervals and confirm or reconsider a youth’s classification.

The jail’s classification system should consider objective factors such as gender, age, violence tendencies, and vulnerability.

At admission, the first classification decisions are related to housing or group. Just as with juvenile detention, in medium or large jails that have more than one housing unit and various program groups, classification usually involves the following issues: 1) separation of violent from nonviolent detainees, 2) separation of male from female detainees, and 3) separation of detainees based on level of sophistication or on some arbitrary assessment of age, size, and mental maturity. Additional classification decisions may be based on the number and range of programs offered. However, due to the relatively small proportion of youth inmates, most jails are only able to separate them from adults without being able to separate sub-groups of youth inmates.

Special Concerns and Challenges

Sight and sound separation of juveniles. JJDPA requires that states establish “rules on ‘sight and sound’ regulations in managing juveniles in jails.”[42] However, those “rules around the management of juveniles who might end up in jail do not extend to youth who may be transferred to the adult court, and tried in the adult justice system.”[43] Nevertheless, with the advent of PREA, most jails make every reasonable effort to keep youth separated from adult inmates. PREA Standard 115.48 addresses that issue:

Inmates at high risk for sexual victimization shall not be placed in involuntary segregated housing unless an assessment of all available alternatives has been made, and a determination has been made that there is no available alternative means of separation from likely abusers. If a facility cannot conduct such an assessment immediately, the facility may hold the inmate in involuntary segregated housing less than 24 hours while completing the assessment.[44]

Safely keeping youth separated from adult inmates while upholding their right to not be segregated involuntarily under this PREA rule creates a particular challenge for jails. Even large jails usually have only a small number of youth inmates. It is not cost-effective to have entire housing units dedicated to this small group. Some jails have implemented procedures to ensure the safety of youth without segregation. For example, the Washoe County Jail (Nevada) provides “24-hour direct supervision to maintain reasonable separation between juveniles and adults; the tier time (free time out of cell) schedule dictates that at no time will adult inmates be out with the juvenile inmates; and meal services are directly supervised by the unit deputies.”[45] Physically isolating youth may have a detrimental emotional impact and heighten a youth’s potential for self-harm.[46]

Gang affiliations. Many juvenile inmates housed in adult jails are affiliated with gangs in the community. Youth gang members are especially susceptible to social pressure to maintain a hardened persona while incarcerated and may succumb to expectations to act out in violent ways. It may be necessary to house juvenile members of rival gangs separately from each other, in addition to separating youth from adult inmates.

Transportation. Best practice is to transport youth separately from adult inmates. Transporting youth to and from court hearings or other outside appointments can present scheduling and staffing challenges for jails and their parent agencies.

Education and other programming. Ensuring that youth in adult jails have access to programs equivalent to those available to adult inmates can be difficult. Youth should be able to participate in any and all activities, unless those programs are clearly inappropriate for an adolescent. Youth should be able to participate in religious programming and meet with the jail chaplain or other clergy. Youth should be able to access the jail library, television, and any other free-time opportunities. Juveniles must have comparable access to visitation including, if possible, contact visits. Most important, given their age, youth must have access to comprehensive educational programming. These programs and how youth may take advantage of them must be explained during the admission process.

Depression and suicidal behavior. As with youth who are admitted to a juvenile detention facility, those admitted to an adult jail are at heightened risk for suicide. It is important for jail staff to be aware of a youth’s affect and behavior and note any signs that may indicate the risk of self-inflicted injury. As discussed previously, all youth must be screened for suicide potential during the intake process, “immediately upon confinement and housing assignment.”[47] The facility must have policies and procedures in place that ensure a more in-depth assessment by a mental health professional when the initial suicide screening indicates a suicide risk, or if the staff learn that a youth has tried to hurt him or herself or if staff have any related concerns. If suicide screening indicates that the youth is at risk for self-harm, the youth should be observed constantly until he or she is assessed by a mental health professional. (See Ch. 11: Mental Health)

During the admission and intake process, staff can help to establish a sense of safety for the youth and communicate the facility’s expectations. Completed competently, the process can minimize behavior problems and can enhance the jail’s overall programs for youth inmates.

Admission and Intake to an Adult Prison—An Event and a Process

Admission and intake of youth to adult prisons varies greatly across the country, based on statutory and policy differences among individual states and between states and federal prison systems. These variations include state laws that determine the age of adult jurisdiction. In addition, state and federal prison agencies take different approaches for philosophical or practical reasons, often subsequent to research on adolescent brain development, “showing that brain maturation is a process that continues through adolescence and into early adulthood.”[48] Specifically, research verifies three aspects of adolescent brain development that create challenges for adult prisons. (See Ch. 6: Adolescent Development)

  • Short-sighted decision-making. Research confirms that adolescents have a less developed sense of future consequences of their actions.
  • Poor impulse control. Research also tells us that “adolescents are both less sensitive to risk and more sensitive to rewards—an attitude that can lead to greater risk-taking.”[49]
  • Vulnerability to peer pressure. Here, research indicates that susceptibility to peer influence lessens as the young person ages.

Research on brain development seems to verify what veteran practitioners have long known: Younger offenders comprise a very small proportion of the population in adult prisons, but they present significant and unique challenges. Corrections systems often lack age-appropriate services and supports. Youth have less access to rehabilitation and to the family support that is so important to their success upon release. Youth may be negatively influenced by the stigmatization or labeling effects of being a convicted felon. Youth often have a sense of resentment and injustice when tried in adult court. And, youth are susceptible to “peer deviance training”—learning criminal mores and behavior while incarcerated with adults.[50] All of these factors should be considered in the decision-making process that occurs during admission and intake of a juvenile to an adult prison. Although juvenile and adult corrections professionals have generally opposed the placement of minors in the adult corrections system,[51] all states and the federal government currently allow this placement to occur in some fashion. (See Ch. 2: Types of Facilities)

Decision to Confine and Legal Authority

The decision to admit a youth to an adult prison is similar to that of a juvenile correctional facility. The youth is tried and convicted in adult court, and the court commits that youth for a period of time to an adult corrections facility. Typically, the court commits the youth to the state’s department of corrections or the federal Bureau of Prisons (BOP), and that agency makes the decision regarding placement. A youth is then placed in a particular institution and to an assigned unit within that institution. Some jurisdictions separate inmates by age using designated facilities for younger inmates. Some jurisdictions have units designated for youth within larger facilities. In general, the state department of corrections or the BOP makes the decision to admit a youth to the prison, subsequent to the court’s order. The admission staff needs to verify that each new admission is legally committed to the adult correctional system by court order, statue, or compact agreement. The prison must accept the youth, but prison administrators must often make housing decisions within constraints, such as available beds.

Some states have entirely separate facilities designated for youthful inmates, although how they define their populations may vary. Often those facilities house inmates up to age 25. Most adult prisons are large enough to designate separate housing units for juveniles to adhere to federal mandates that there be sight and sound separation. Level of security may also be a factor in making housing assignments. Many adult correctional facilities initially assign all new residents to a separate unit for reception and orientation. Youth remain there for a set period of time, often one week to one month, before being assigned elsewhere in the facility. That subsequent placement is determined, at least in part, by the more thorough screening and evaluation that is conducted while the youth is on orientation status. Youth are generally provided with programming, including education, during their reception period if that orientation occurs in a separate location or lasts for more than a few days. Written orientation materials should be provided in the youth’s own language or should be translated. If a literacy problem exists, a staff member should assist the youth in understanding written material.

Information Gathering and Paperwork

To make effective decisions regarding placement and services for youth in an adult prison, comprehensive information must be obtained. Techniques that work with youth admitted to juvenile confinement facilities are equally effective in acquiring necessary, reliable information from a youth entering a prison. Although the youth is in an adult corrections environment and has been convicted of an offense in the adult court system, that youth is still emotionally and developmentally an adolescent. That youth may have feelings of fear, apprehension, and hostility similar to those that a youth entering a juvenile facility for the first time might have. Using the positive patterns of responding described earlier in this chapter can be useful in the information-gathering phase in a prison setting as well.

Youth who are prosecuted in the adult criminal justice system are usually confined for lengthy periods prior to conviction and sentencing, and they are accustomed to confinement. However, a youth sentenced to prison knows that he or she may be among adult felons and will be justifiably apprehensive and uncertain. That anxiety can be lessened when staff members are knowledgeable about such issues as adolescent development. Just as with the admission process in a juvenile confinement facility, establishing rapport while gathering information can and must be done simultaneously.

Systematic information gathering helps to ensure that the prison provides services that can most effectively meet each youth’s individual needs while also ensuring youth safety and facility security. As indicated above, that process may begin before the youth arrives. Information from the juvenile justice system, the jail where the youth may have been housed, court pre-trial services, or adult probation should be obtained in advance of the youth’s placement, or as soon as possible. At a minimum, the following information should be obtained on each new admission: name; address; social security number; date of birth; height, weight, eye, and hair color; race and ethnic origin; next of kin and emergency contact information; and a listing of scars, tattoos, or other identifying marks.[52]

Preliminary Safety and Security

Similar to the process of admission to a juvenile correctional facility, it is imperative that the admission event includes tasks that will aid in ensuring safety and security. Primary to that goal is the need to keep young offenders separated from the adult population. This may be accomplished through early detection, observation, and escorts.[53] It is particularly important to comply with the PREA Standard requiring the sight and sound separation of youth from the adult population.[54] The sooner the institution is aware that a youth will be placed there, the more prepared that facility can be to meet that youth’s needs. Ideally, the institution will receive some information about the youth in advance; however, that information may not be available until the youth arrives. Placing youth in observation cells where they are directly visible to staff can help to keep a youth inmate safe. And escorting the youth to his or her cell or elsewhere, particularly during the intake and reception process, offers an additional level of safety.

Also critical to ensuring security are searches of the youth and his property. Staff should conduct a frisk search to ensure the youth has no contraband. And, as with other juvenile and adult confinement facilities, the prison officer must always conduct that search, even if the transporting officer states that the youth has been searched. The initial frisk search must be conducted immediately upon entry into the prison and may be accompanied by a search with a hand-held, metal detecting wand. A more invasive strip search will also likely be conducted, in accordance with applicable statute, case law, and agency policy. Body-cavity searches are rarely conducted and must also be done in accordance with applicable statute, case law, and facility policy.

As discussed above, any kind of search is invasive and a potential violation of the youth’s sense of well-being. This can be traumatic when the youth is already feeling a heightened sense of anxiety, vulnerability, and weakness. Being subjected to a strip search or a body-cavity search could intensify a youth’s fears, sense of hopelessness, and potential for self-harm. Any feeling of violation may be mitigated by continuously orienting a youth to the intake process and explaining what is going to happen next. This technique reduces apprehension and anxiety, while placing the admitting staff member in a nonthreatening and helpful role as an important security function is completed.

If a youth admitted to an adult prison has personal property, that property is usually delivered securely and is not in his possession. However, any personal property that a youth arrives with should be inventoried in his presence and stored securely.

Basic Needs

All youth should be required to shower upon admission. The youth may also be required to have a haircut, be photographed and fingerprinted, and have DNA testing, in accordance with statute, case law, and agency policy.

During intake, youth are issued uniform clothing that is clean and that fits. Youth should not be required to wear shabby or damaged clothing. Along with clothing, a youth receives basic hygiene items and is informed of the facility’s system for replenishing those items.

Screening and Assessment

The state department of corrections, the BOP, and the prison to which a juvenile is assigned usually have information on a sentenced youth, similar to what is received by a juvenile correctional facility. However, it is important to conduct initial screening and assessment on all inmates for consistency and to have a baseline from which to establish service and treatment plans. The unique needs of juveniles make this process even more important. Initial screening and assessment has usually already occurred before a youth is committed to an adult prison. The prison should focus on updating any prior information and completing additional assessments particular to the adult prison. Those assessments may include suicide assessment; drug and alcohol assessment; current medical and dental assessments; updated mental health assessment; vocational interests (if appropriate); educational and vocational assessment; religious background and interests; recreational assessment; and other assessments as needed. In addition, a PREA Screening and Assessment must be completed on all newly admitted youth as required.[55]

Screening and assessment in an adult prison is usually completed during a period of orientation and is not part of the initial intake event. That period may last for a few days to a few weeks. Specialized staff members usually do the screening and assessment. The prison’s basic admission paperwork must be completed upon entry, but other screening and assessment paperwork must be completed as part of the admission and orientation process. In many institutions, youth receive the same screening and assessment regimen as adult inmates. In some cases, additional or different tools will be used to focus specifically on the needs of the adolescent inmate.

Targeted screening and assessment. As stated above, screening is concise and identifies immediate concerns or needs that require intervention. All youth admitted to an adult prison should be screened.[56]

Assessment is a more detailed and individualized examination of the psychosocial needs and recommendations for treatment intervention.[57] Assessment is more time consuming and expensive and requires the expertise of a mental health professional. Assessment in a long-term setting such as an adult prison should also occur with each admitted youth.

Mental health screening. In-depth mental health screening and assessment of youth in adult institutions is particularly critical. ACA standards address this issue: All intersystem and intra-system transfers will receive an initial mental health screening at the time of admission to the facility by a trained or qualified mental healthcare professional. The mental health screening includes, but is not limited to:

Inquiry into:

  • whether the offender has a present suicide ideation
  • whether the offender has a history of suicidal behavior
  • whether the offender is presently prescribed psychotropic medication
  • whether the offender has a current mental health complaint
  • whether the offender is being treated for mental health problems
  • whether the offender has a history of inpatient and outpatient psychiatric treatment
  • whether the offender has a history of treatment for substance abuse

Observation of:

  • general appearance and behavior
  • evidence of abuse and/or trauma
  • current symptoms of psychosis, depression, anxiety, and/or aggression

Disposition of offender:

  • to the general population
  • to the general population with appropriate referral to mental healthcare service
  • referral to appropriate mental healthcare service for emergency treatment.”

Mental health screening and assessment is an important aid in making classification and housing assignments. ACA standards also require a mental health appraisal within 14 days of admission that is more detailed and may require input from a psychiatrically and medically trained mental health professional, as this appraisal includes history and need for psychotropic medication.[58]

Drug and alcohol screening. A drug and alcohol use screening is important to determine service and treatment needs.

Initial medical screening form. Comprehensive prison intake also incorporates an initial medical screening that gathers basic, preliminary information such as recent hospitalization or other medical care, recent injuries or illnesses, current medications, allergies, and the name of the youth’s primary healthcare provider. This screening may be completed staff member that is not medically trained, and the information is then passed on to the medical staff for further assessment. More often, a medical professional will complete medical screening in a prison.

Other specialized forms or screening instruments may be used to determine a youth’s needs and ensure youth and facility safety and security. These instruments can effectively and efficiently screen for issues such as substance abuse, symptoms of disorders, problems/strengths/needs and cognitive abilities.

PREA screening. The same PREA Standards that apply to adult jails are also applicable to adult prisons. Adult prisons must screen all inmates in accordance to PREA Standards 115.41 and 115.42 as discussed above. Therefore, “All inmates shall be assessed during an intake screening and upon transfer to another facility for their risk of being sexually abused by other inmates or sexually abusive towards other inmates.” And, “Intake screening shall ordinarily take place within 72 hours of arrival at the facility.”[59]

A validated instrument should be used for the PREA assessment. It is important for the prison to use the critical period of intake to obtain at least initial self-report evidence regarding a youth’s potential risk or vulnerability. The full screening must then be completed as expeditiously as possible to ensure appropriate classification and housing as well as to offer essential services. The PREA screening is part of the admission process and must be completed within 72 hours. Other detention screening can and usually does occur within 24 hours.

Orientation, Classification, and Housing Assignment

Some states place new offenders in a separate facility or a separate unit for reception and orientation. That placement may last anywhere from a few days to a few weeks. In addition to the screening and assessment described above, this time is used to orient the youth and to make classification decisions and housing assignments.

Prison staff should offer an orientation to the youth, including an explanation of his or her rights, including the grievance procedure, visitation, mail, telephone access, access to medical and mental healthcare, and other available services and programs. Information should be provided about sexual abuse and any related services offered. The orientation should also address the rules of the facility and sanctions for violating those rules. It is recommended that the youth read these rights and rules and sign an acknowledgement. Again, it is important for prison staff to consider the youth’s age and level of maturity while gathering information and providing an explanation of expectations. Staff should consider the youth’s literacy level and should verbally describe any written material as well. If the youth does not speak or read English, the orientation information should be translated.

National standards establish requirements for the housing of youth inmates. PREA Standards are discussed above and mandate sight and sound separation. The ACA standards also address the housing of this population. “If youthful offenders are housed in the facility, written policy, procedure, and practice provide that they are housed in a specialized unit for youthful offenders except when:

  • a violent, predatory youthful offender poses an undue risk of harm to others within the specialized unit; and/or
  • a qualified medical or mental-health specialist documents that the youthful offender would benefit from placement outside the unit.

Written policy, procedure, and practice provide for the preparation of a written statement of the specific reasons for housing a youthful offender outside the specialized unit and a case-management plan specifying what behaviors need to be modified and how the youthful offender may return to the unit.”[60]

Because only a small proportion of a prison’s population is comprised of youth, implementing a comprehensive classification system is challenging. Nevertheless, the adult prison must address the particular needs of youth in making classification decisions. ACA standards require that the institution establish “classification plans for youth that determine level of risk and program needs developmentally appropriate for adolescents. Classification plans shall include consideration of physical, mental, social, and educational maturity of the youthful offender.”[61] These plans are based on the entirety of information obtained on the youth at the time of commitment, and the screening and assessment information that is acquired after admission.

Strip Searches on Youth in Juvenile and Adult Facilities

Fundamental Differences between Juveniles and Adults

The U.S. Supreme Court and federal statute have established that youth are different from adults; juvenile detention and corrections facilities and adult jails and prisons must account for these differences when deciding to conduct strip searches on the youth in their custody.

Over the past several years, a series of U.S. Supreme Court cases has changed the constitutional landscape and established that the fundamental differences between youth and adults should translate into youth being treated differently than adults in the juvenile and criminal justice context. In J.D.B. v. North Carolina, the Court found that, when determining whether a youth can knowingly waive Miranda rights, law enforcement officials must consider a youth’s age, “because childhood yields objective conclusions” that allow law enforcement to take the child’s age into account.[62] The Court also established that youth are constitutionally different from adults in the sentencing context,[63] noting the developmental differences between youth and adults, including that youth have a lack of maturity, are more vulnerable to outside influences, and do not have as well formed character or personality as adults.[64]

In addition, several federal statutes—including PREA and the JJDPA—have recognized that youth are different than adults and have created separate standards for youth who are placed in juvenile detention facilities and for those in adult jails and prisons.

Strip searches for youth have been addressed in various contexts, such as schools, juvenile detention and correctional facilities, and adult jails and prisons. As a federal district court noted, this case law reflects a “constitutional spectrum” under which “the standard for analyzing strip searches of children at [a juvenile detention facility] falls somewhere between the standards that govern searches of adult prison inmates and searches of school children.”[65] It follows that the idea of a “constitutional spectrum” would also apply to children placed in adult jails and prisons.

Strip Searches in Juvenile Detention Centers

Case Law

In Bell v. Wolfish, the United States Supreme Court evaluated 4th Amendment claims regarding searches involving prisoners. The court noted that the test of reasonableness under the 4th Amendment is not capable of precise definition or mechanical application, but rather requires balancing the need for the particular search against the invasion of personal rights that the search entails. It is also necessary for courts to consider the scope of the particular intrusion, the manner in which it is conducted, the justification for initiating it, and the place in which it is conducted.[66]

Although the U.S. Supreme Court has not ruled on a standard for strip searches in juvenile detention facilities, several lower courts have addressed this issue and recognized the differences between youth and adults. For example, when the court in Mashburn noted that the standards for juvenile facility strip searches fell on a “constitutional spectrum,” it took into account that children have a more acute vulnerability to the intrusiveness of a strip search. The court explained that strip searches of children raise unique concerns, because youth “is a time and condition of life when a person may be most susceptible to influence and to psychological damage.”[67]

Two district courts have found that strip searches were unreasonable or conducted without reasonable suspicion. In Moyle v. County of Contra Costa, the district court in Northern California found that a detention center’s blanket policy to perform strip and visual body-cavity searches without having a reasonable suspicion that such searches would produce contraband or weapons was unconstitutional.[68] Instead, the court required that reasonable suspicion to search a youth “depends on the facts known at the time of the strip search.”[69] A similar blanket strip search policy was rejected in T.S. v. Gabbard, where the detention center stated that the purpose of the search was “not to discover contraband,” but, “to document any obvious signs of injury, illness, infection or abuse,” even if the detention staff did not have reasonable suspicion that the youth may have an underlying medical condition or injury.[70] The court found no evidence to justify the extensive scope of and serious invasion of personal privacy and that less intrusive alternatives should meet the facility’s legitimate interests.[71]

However, other courts have upheld strip searches of youth in juvenile detention facilities if those searches are based on a reasonable suspicion that a strip search was necessary. In Justice v. City of Peachtree City, the Eleventh Circuit court held that “law enforcement officers may conduct a strip search of a juvenile in custody, even for a minor offense, based upon reasonable suspicion to believe that the juvenile is concealing weapons or contraband.”[72] The Second Circuit court held that a strip search performed upon a juvenile’s initial admission into a detention center was reasonable under the 4th Amendment, but that subsequent searches (in this case the juveniles had been strip searched eight additional times)—absent any reasonable suspicion that the juveniles had acquired contraband—were unreasonable.[73]

Several other courts have also addressed the intrusiveness of the strip search. In Smook v. Minnehaha County, the Eighth Circuit held that a juvenile detention center policy of requiring partial removal of clothing during searches of juvenile detainees, regardless of the seriousness of the charged offense or the existence of suspicion was reasonable under the 4th Amendment and that the defendants were entitled to qualified immunity.[74] Similarly, in Mashburn, the court held that strip searches can be conducted without reasonable suspicion, but the “scope of the detention facility’s strip search must account both for the need that justifies the search and the acute vulnerability of the searched child. Although general institutional security concerns may justify a brief strip search to inspect for contraband that would be hidden by a child’s underwear, a greater showing of need is required to justify keeping a child undressed to conduct an extensive search of areas that can be searched while the child is partially or fully clothed.”[75]

Standards

Beyond case law, both national and state standards exist with regard to strip searches on juveniles in juvenile detention centers. At the national level, the Juvenile Federal Performance-Based Detention Standards Handbook explains that juvenile detention facilities can conduct strip searches that are “conducted in a manner that preserves constitutional rights[, and t]he searches and the contraband found are documented.”[76] However, body-cavity searches are “only conducted by qualified health care personnel outside of the facility, authorized by the facility director, and followed up with an incident report.”[77]

In addition, the federal PREA Standards provide guidance on strip searches of youth in juvenile detention facilities. The PREA Standards prohibit “cross-gender strip searches and visual body cavity searches except in exigent circumstances or when performed by medical practitioners.”[78] The juvenile standards also specifically “prohibit cross-gender pat-down searches of both female and male residents except in exigent circumstances.”[79] Any cross-gender pat-down, strip, or body search must be documented.[80] The PREA Standards also specifically address searches of transgender or intersex youth by prohibiting staff from “searching or physically examining a transgender or intersex inmate for the sole purpose of determining the inmate’s genital status.”[81] Finally, the state agency must train facility staff on “how to conduct cross-gender pat-down searches and searches of transgender and intersex residents in a professional and respectful manner, and in the least intrusive manner possible, consistent with security needs.”[82]

Each state also has standards that deal with strip searches on youth in juvenile detention facilities. Many states require juvenile detention centers to have written procedures to address intake searches and searches performed on juveniles returning from activities outside of the facility. For example, California, Oregon, and several other states require facilities to have written procedures that discuss the use of strip searches in the facility.[83] Other state standards permit blanket strip searches of youth when they are admitted and after returning to the facility from off grounds, but all other strip searches must be based on reasonable suspicion or belief that the youth is carrying contraband or other prohibited material.[84] Another common provision in state standards is that the search on a juvenile must be conducted by a staff member of the same sex.[85]

Juveniles in Adult Facilities

Each year, an estimated 250,000 youth in the U.S. under age 18 come into contact with the adult criminal justice system.[86] Youth can be held in adult jails and prisons under several circumstances, including if their case is prosecuted in adult court under state or federal transfer law,[87] under very limited conditions while their case is pending in juvenile court,[88] or if the youth reaches the age of the state’s majority, but still falls under the extended jurisdiction of the juvenile court.[89]

Related research on youth in adult jails and prisons shows that the “inherently harmful, humiliating, and degrading”[90] nature of strip searches may affect youth more than adults and that youth are uniquely vulnerable while they are held in these facilities. First, youth in adult jails and prisons face a high likelihood of physical and sexual assault;[91] a vulnerability that lasts throughout the youth’s sentence if they are placed in an adult prison before reaching the age of 18.[92] The very thought of youth standing naked and vulnerable in front of a group of adults offends the conscience; however, for youth in adult jails and prisons who have been transferred to adult court, the strip search process is the first time that they may be seen by adults with whom they will be spending months, if not years, housed together. A strip search may further increase the youth’s sexual vulnerability and feelings of weakness, perhaps heightening the youth’s fear of entering the facility. Second, youth in adult jails and prisons are much more likely to commit suicide when compared to the general population[93] and have some of the highest mental health needs.[94] Being subjected to a strip search could increase a youth’s feelings of despair or hopelessness.

Case Law

In Florence v. Board of Chosen Freeholders, the U.S. Supreme Court addressed the constitutionality of strip searches in adult jails, finding that “security imperatives involved in jail supervision” allow jail officials to strip search detainees absent a reasonable suspicion of the existence of contraband.[95]

However, the Florence decision is not likely to apply to youth in adult jails or prisons for two reasons. First, in Florence, the Court made clear that its support of a blanket strip search policy was limited to circumstances in which the individual would be placed directly into the jail’s general population following the search and did not address “the types of searches that would be reasonable in instances where, for example, a detainee will be held without assignment to the general jail population.”[96] This distinction is important for youth, as both the JJDPA and PREA require the separation of youth from the general population in adult jails and prisons. For youth who are under the jurisdiction of the juvenile court for a delinquency offense, the JJDPA requires that youth can only be placed in adult jails under very limited circumstances under six hours for processing or up to 48 hours for youth in rural areas awaiting an initial court hearing).[97] Even in these limited circumstances, youth must be sight and sound separated from adults in adult jails.[98] For youth who are under the age of 18 and under adult court jurisdiction, PREA Standards require that youth cannot be placed in a housing unit in an adult prison, jail, or lockup where the youth will have contact with adults in common spaces, shower areas, or sleeping quarters.[99] When not in housing units (for example, in a cafeteria or recreation room), youth must be “sight and sound” separated from adults unless they are directly supervised by staff.[100] Therefore, youth in adult jails and prisons will rarely be placed in the general population of jails and prisons and will be instead placed in isolation or a smaller, youth-specific unit.

Second, Florence is particularly distinguishable with regard to youth in adult prisons. The essential operational and population differences between jails and prisons make the immediate safety concerns pertaining to strip searches in the jail setting less relevant in the prison setting. When compared to adult prisons, adult jails have a much higher population turnover and a significantly shorter intake and evaluation process.[101] Jails also serve as a buffer to the adult prison system and typically deal with individuals who are being brought in directly from the street with issues such as “possible drug ingestion prior to entering jail.”[102] Given these differences, the concerns raised in the jail context—many of which center around the original intake of the individual into the facility—are not applicable in prisons.

Since the Florence decision, a district court directly addressed the issue of strip searches of youth in adult jails. In Trujillo v. City of Newton, Kansas, the federal district court of Kansas held that the strip search of a juvenile booked at an adult detention center was constitutionally permissible, because “the strip search was sufficiently based upon the reasonable suspicion that Plaintiff had concealed drugs on her person.”[103] Therefore, the Trujillo court utilized a higher standard—reasonable suspicion—for a youth in an adult jail than Florence, which would have permitted the strip search of an adult held in the same facility, even without reasonable suspicion of contraband.[104]

Standards

A review of state standards found no statutes that clearly delineate between strip searches on youth in juvenile and adult facilities. However, with adult jails and prisons, this information may be addressed in a facility’s internal policies, which can be difficult, if not impossible, to access publicly and may vary even within a jurisdiction (different jails within a state or even within a county could have different policies). This lack of information and transparency can lead to inconsistent treatment and potential harm for youth in adult jails and prisons during the strip search process.

Conclusion

The final statement about the admission process is a very simple one. Staff in either juvenile or adult facilities, for the short or long term, are working with human beings who need the same things that juvenile and adult corrections professionals would want if they were locked up in a strange place—compassion and respect. To the extent that facility policies are designed to emphasize the use of kindness and humanity, and to the extent that facility staff members are taught to handle youth with empathy and understanding, according to the guidelines in this chapter, the intake event and the admission process will be successful.

 

 

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Campaign for Youth Justice. 2007. Jailing Juveniles: The Dangers of Incarcerating Juveniles in Adult Jails in America. Washington, DC: Author

Campaign for Youth Justice. 2013. “Fact Sheet - No Excuses: The Prison Rape Elimination Act (PREA).” http://www.campaignforyouthjustice.org/documents/prea%20fact%20sheetfinal2013.pdf.

Crawford, Randy. Information provided regarding Admission and Intake, Indiana Department of Corrections, September 3, 2013.

Dickson, Maggie. 2013. “Juvenile Incarceration Procedure,” Information provided regarding Classification and Intake, Washoe (NV) County Jail, August 21, 2013.

Goemann, Melissa, Tracey Evans, Eileen Geller, and Ross Harington. 2007. Children Being Tried as Adults: Pre-Trial Detention Law in the U.S., Washington, DC: Campaign for Youth Justice. http://www.campaignforyouthjustice.org/documents/ChildrenBeing.pdf.

Graham v. Florida, 560 U.S. 48, 130 S.Ct. 2011, 176 L.Ed.2d 825 (2010).

Griffin, Patrick, Sean Addie, Benjamin Adams, and Kathy Firestine. 2011. Trying Juveniles as Adults: An Analysis of State Transfer Laws and Reporting. Washington, DC: Office of Juvenile Justice and Delinquency Prevention. https://www.ncjrs.gov/pdffiles1/ojjdp/232434.pdf.

Grisso, Thomas, and L.A. Underwood. 2004. Screening and Assessing Mental Health and Substance Use Disorders Among Youth in the Juvenile Justice System, A Resource Guide for Practitioners. Washington, DC: Office of Juvenile Justice and Delinquency Prevention.

Hall, Daron. “Commentary: Jails vs. Prisons.”Commentary

Hayes, Lindsay M. 2009. Juvenile Suicide in Confinement: A National Survey. NCJ 213691. Washington, DC: Office of Juvenile Justice and Delinquency Prevention. https://www.ncjrs.gov/pdffiles1/ojjdp/213691.pdf.

J.D.B. v. North Carolina, 564 U.S. ___,131 S.Ct. 2394 (2011).

Justice v. City of Peachtree City, 961 F.2d 188 (11th Cir. 1992).

Juvenile Justice and Delinquency Prevention Act. Washington, DC: Office of Juvenile Justice and Delinquency Prevention. https://www.ojjdp.gov/about/jjdpa2002titlev.pdf.

MacArthur Foundation Research Network Adolescent Development and Juvenile Justice. 2007. “Less Guilty by Reason of Adolescence, Issue Brief 3.” Models for Change: Systems Reform in Juvenile Justice." https://adjj.org/.

Mahr, Ryan, Warden, Nebraska Correctional Youth Facility. “Admission of Youthful Offenders to Adult Correctional Facilities.” Document provided electronically in response for request. September 11, 2013.

Mashburn v. Yamhill County, 698 F. Supp. 2d 1233, 1238 (D. Or. 2010).

Miller v. Alabama, U.S., 132 S.Ct. 245, 183 L.Ed.2d 407 (2012).

Missouri Juvenile Justice Association. “Missouri Law Enforcement; Juvenile Justice Guidelines and Recommended Practices.” https://dps.mo.gov/dir/programs/jj/documents/le-manual-final.pdf.

Moyle v. County of Contra Costa, 2007 WL 4287315 *8, N.D. Cal., (2007).

Murrie, Daniel C., Craig E. Henderson, Gina M. Vincent, Jennifer L. Rockett, and Cynthia Mundt. 2009. “Psychiatric Symptoms Among Juveniles Incarcerated in Adult Prison.” Psychiatric Services 60: 8.

N.G. v. State of Conn., 382 F.3d 225 (2nd Cir. 2004).

National Commission on Correctional Health Care. 2011. Standards for Health Services in Juvenile Detention and Confinement Facilities, Chicago, IL: Author.

National Juvenile Detention Association (currently NPJS). “Definition of Juvenile Detention.” https://www.ojp.gov/ncjrs/virtual-library/abstracts/juvenile-detention-nationally-recognized-definition#:~:text=The%20definition%20states%20that%20juvenile,protection%20while%20awaiting%20legal%20action..

Office of Juvenile Justice and Delinquency Prevention. 2010. “Guidance Manual for Monitoring Facilities Under the Juvenile Justice and Delinquency Prevention Act of 2002.”

Roper v. Simmons, 543 U.S. 551, 125 S.Ct. 1183, 161 L.Ed.2d 1 (2005).

Roper, 543 U.S. at 569, quoting Johnson v. Texas, 509 U.S. 350, 367 (1993).

Smook v. Minnehaha County, 457 F.3d 806 (8th Cir. 2006).

Steinhard, David. 2006. Juvenile Detention Risk Assessment: A Practice Guide to Juvenile Detention Reform. Juvenile Detention Alternatives Initiative. Baltimore, MD: Annie E. Casey Foundation.

T.S. v. Gabbard, 860 F.Supp.2d 384, 392 (E.D.Ky. 2012).

Tandy, Kim, Erin Davis, and Morgan Quigley. 2013. “Strip Searches on Youth in Juvenile and Adult Facilities.” documents prepared September 16, 2013.

Trujillo v. City of Newton, Kan., No. 12-2380-JAR (D. Kan. July 2, 2013).

U.S. Department of Health and Human Services. 2013. “Summary of the HIPAA Privacy Rule.” https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html.

U.S. Department of Justice. 2011. “Juvenile Federal Performance-Based Detention Standards Handbook.” Section C.2. https://www.justice.gov/archive/ofdt/juvenile.pdf.

U.S. Department of Justice. 2012. “National Standards to Prevent, Detect, and Respond to Prison Rape Under the Prison Rape Elimination Act (PREA), Juvenile Facility Standards.” https://www.prearesourcecenter.org/sites/default/files/content/preafinal....

Washington State Department of Social and Health Services. Juvenile Rehabilitation Administration. 2009. “Sexually Aggressive/Vulnerable Youth Assessment—SAVY.” https://www.dcyf.wa.gov/sites/default/files/pdf/jr-policies/Policy3.20.pdf.

Zeidenberg, Jason. 2011. You’re an Adult Now: Youth in Adult Criminal Justice Systems. Washington, DC: National Institute of Corrections. https://nicic.gov/youre-adult-now-youth-adult-criminal-justice-systems.

 

Endnotes


[1] National Juvenile Detention Association, “Definition of Juvenile Detention,” Revised October 14, 2007.

[2] American Correctional Association, Standards for Juvenile Detention Facilities, 3rd Edition, (1991:97) Based on Standard 3–JDF–5A–02.

[3] David Steinhard, “Juvenile Detention Risk Assessment: A Practice Guide to Juvenile Detention Reform,” Juvenile Detention Alternatives Initiative, (Baltimore, MD: Annie E. Casey Foundation, 2006): 7.

[4] For examples of screening and assessment instruments, see T. Grisso and L.A. Underwood, “Screening and Assessing Mental Health and Substance Use Disorders Among Youth in the Juvenile Justice System, A Resource Guide for Practitioners,” (Washington, DC: Office of Juvenile Justice and Delinquency Prevention, December 2004): 16–18.

[5] American Correctional Association, Guidelines for the Development of Policies and Procedures: Juvenile Detention Facilities,” (January,1992a,) (Laurel, MD: 1992): 56.

[6] Ibid., 57.

[7] U.S. Department of Health and Human Services, “Summary of the HIPAA Privacy Rule.”

[8] T. Grisso and L.A. Underwood, “Screening and Assessing Mental Health and Substance Use Disorders Among Youth in the Juvenile Justice System, A Resource Guide for Practitioners,” (Washington, DC: Office of Juvenile Justice and Delinquency Prevention, December 2004): 2.

[9] Ibid., 16–18.

[10] Ibid., 2.

[11] Lindsay M. Hayes, Juvenile Suicide in Confinement: A National Survey, (Washington, DC: Office of Juvenile Justice and Delinquency Prevention, 2009): 30.

[12] U.S. Department of Justice, “National Standards to Prevent, Detect, and Respond to Prison Rape Under the Prison Rape Elimination Act (PREA), Juvenile Facility Standards,” May 17, 2012.

[13] Ibid.

[14] See for example, Washington State Department of Social and Health Services, Juvenile Rehabilitation Administration, “Sexually Aggressive/Vulnerable Youth Assessment—SAVY,” 2009.

[15] James Austin, Kelly Dedel Johnson, and Ronald Weitzer, Alternatives to the Secure Detention and Confinement of Juveniles, (Washington, DC: Office of Juvenile Justice and Delinquency Prevention, 2005).

[16] Kim Tandy, Erin Davis, and Morgan Quigley, “Strip Searches on Youth in Juvenile and Adult Facilities,” documents prepared September 16, 2013.

[17] National Commission on Correctional Health Care, Standards for Health Services in Juvenile Detention and Confinement Facilities, (Chicago, IL: 2011): 137–138.

[18] Hayes, Juvenile Suicide in Confinement, 30.

[19] American Correctional Association, Performance-Based Standards for Juvenile Correctional Facilities, 4th Edition, (Alexandria, VA: Author, 2009): 122, Based on Standard 4–JCF–5A–01.

[20] Tandy, Davis, and Quigley, “Strip Searches on Youth,” 1–2.

[21] Grisso and Underwood, “Screening and Assessing Mental Health and Substance Use Disorders,” 2.

[22] American Correctional Association, Performance-Based Standards for Juvenile Correctional Facilities, 123, Standard 4-JTC-5A-02.

[23] U.S. Department of Justice, “National Standards to Prevent, Detect, and Respond to Prison Rape Under the Prison Rape Elimination Act (PREA), Juvenile Facility Standards,” May 17, 2012, 115.341 and 115.42.

[24] American Correctional Association, Performance-Based Standards for Juvenile Correctional Facilities 123, Standard 4-JTC-5A-03.

[25] American Correctional Association, Performance-Based Standards for Juvenile Correctional Facilities 123, Standard 4-JTC-5A-02.

[26] American Correctional Association, Standards for Juvenile Training Schools, 3rd Edition, (Lanham, MD: January 1991) 38, Standard 8-JTS-2C-01.

[27] American Correctional Association, Core Jail Standards, Standard 1-CORE-2a-19, (Alexandria, VA: 2010): 17.

[28] Jason Zeidenberg, “You’re An Adult Now: Youth in Adult Criminal Justice Systems,” (Washington, DC: National Institute of Corrections, December 2011): 3.

[29] Sarah Alice Brown, “Trends in Juvenile Justice State Legislation: 2001-2011,” (Denver, CO: National Conference of State Legislatures, June 2012) 4.

[30] Zeidenberg, “You’re An Adult Now,” 3.

[31] Ibid.

[32] Ibid., 9–10.

[33] Melissa Goemann, Tracey Evans, Eileen Geller, and Ross Harington, “Children Being Tried as Adults: Pre-Trial Detention Law in the U.S.,” (Washington, DC: Campaign for Youth Justice, 2007): 13–19.

[34] American Correctional Association, Performance-Based Standards for Adult Local Detention Facilities, 20.

[35] Maggie Dickson, “Juvenile Incarceration Procedure,” 2013.

[36] National Commission on Correctional Health Care, Standards for Health Services in Juvenile Detention and Confinement Facilities, (Chicago, IL: Author, 2011): 137–138, Standard Y-l-03.

[37] Grisso and Underwood, “Screening and Assessing Mental Health and Substance Use Disorders,” 2.

[38] Ibid., 16–18.

[39] Ibid., 2.

[40] U.S. Department of Justice, “National Standards to Prevent, Detect, and Respond to Prison Rape,” 115.41 and 115.42.

[41] Austin, Johnson, and Weitzer, Alternatives to the Secure Detention and Confinement of Juveniles.

[42] Zeidenberg, “You’re An Adult Now,” 9.

[43] Ibid., 10.

[44] U.S. Department of Justice, “National Standards to Prevent, Detect, and Respond to Prison Rape,” 115.43.

[45] Dickson, “Juvenile Incarceration Procedure.”

[46] American Civil Liberties Union and Human Rights Watch, Growing Up Locked Down: Youth in Solitary Confinement in Jails and Prisons in the United States.

[47] Hayes, Juvenile Suicide in Confinement, 30.

[48] MacArthur Foundation Research Network Adolescent Development and Juvenile Justice, “Less Guilty by Reason of Adolescence, Issue Brief 3,” Models for Change: Systems Reform in Juvenile Justice: 3.

[49] Ibid.

[50] Zeidenberg, “You’re An Adult Now,” 19.

[51] American Corrections Association, “Public Correctional Policy on Youthful Offenders Transferred to Adult Criminal Jurisdiction” states: “The American Correctional Association supports separate housing and special programming for youths under the age of majority who are transferred or sentenced to adult criminal jurisdiction.”

[52] Ryan Mahr, Warden, Nebraska Correctional Youth Facility, “Admission of Youthful Offenders to Adult Correctional Facilities,” 2013.

[53] Randy Crawford, Information provided regarding Admission and Intake, Indiana Department of Corrections, 2013.

[54] U.S. Department of Justice, “National Standards to Prevent, Detect, and Respond to Prison Rape Under the Prison Rape Elimination Act (PREA), Juvenile Facility Standards,” 115.14(a).

[55] U.S. Department of Justice, “National Standards to Prevent, Detect, and Respond to Prison Rape Under the Prison Rape Elimination Act (PREA), Juvenile Facility Standards,” 115.341 and 115.42.

[56] Ibid., 16–18.

[57] Ibid., 2.

[58] American Correctional Association, Standards for Adult Correctional Institutions, 4-ACI-4-4371.

[59] U.S. Department of Justice, “National Standards to Prevent, Detect, and Respond to Prison Rape Under the Prison Rape Elimination Act (PREA), Juvenile Facility Standards,” 115.41 and 115.42.

[60] American Correctional Association, Standards for Adult Correctional Institutions, 4-ACI–4-4307.

[61] American Correctional Association, Standards for Adult Correctional Institutions, 4-ACI-4-4309.

[62] J.D.B. v. North Carolina, 131 S.Ct. 2394 (2011).

[63] See generally Miller v. Alabama, __ U.S. __, 132 S.Ct. 245, 183 L.Ed.2d 407 (2012) (holding that youth under 18 cannot be sentenced to mandatory life without the possibility of parole); Roper v. Simmons, 543 U.S. 551, 125 S.Ct. 1183, 161 L.Ed.2d 1 (2005) (finding the death penalty unconstitutional for youth under 18); and Graham v. Florida, 560 U.S. 48, 130 S.Ct. 2011, 176 L.Ed.2d 825 (2010) (prohibiting youth from receiving life without parole sentences for non-homicide offenses).

[64] Roper, 543 U.S. at 569 (quoting Johnson v. Texas, 509 U.S. 350, 367 (1993)).

[65] Mashburn v. Yamhill County, 698 F. Supp. 2d 1233, 1238 (D. Or. 2010).

[66] Bell v. Wolfish, 441 U.S. 520, 599 (1979).

[67] Mashburn v. Yamhill County, 698 F.Supp.2d 1233, at 1242.

[68] Moyle v. County of Contra Costa, 2007 WL 4287315 *8, N.D. Cal., (Dec. 5, 2007).

[69] Ibid., at *8.

[70] T.S. v. Gabbard, 860 F.Supp.2d 384, 392 (E.D.Ky. 2012), pending final decision in the Sixth Circuit Court of Appeals.

[71] Ibid.

[72] Justice v. City of Peachtree City, 961 F.2d 188 (11th Cir. 1992).

[73] N.G. v. State of Conn., 382 F.3d 225 (2nd Cir. 2004).

[74] Smook v. Minnehaha County, 457 F.3d 806 (8th Cir. 2006).

[75] Mashburn at p. 1245 (D. Or. 2010).

[76] U.S. Department of Justice, Juvenile Federal Performance-Based Detention Standards Handbook, Section C.2 (2011).

[77] Ibid.

[78] U.S. Department of Justice, “National Standards to Prevent, Detect, 115.315(a).

[79] Ibid., at (b).

[80] Ibid., at (c).

[81] Ibid., at (e).

[82] Ibid., at (f).

[83] Title 15, Minimum Standards for Juvenile Facilities, Division 1, Chapter 1, Subchapter 5 (2007 Regulations), (also states that “searches shall not be conducted for harassment or as a form of discipline”), https://www.bscc.ca.gov/wp-content/uploads/Juvenile-Title-15-Effective-2019-1-1.pdf; See also, “Oregon Juvenile Detention Facility Guidelines” – 4th Edition; February 2012, Section 5: Youth Rights – “Protection from Harm,” ORS 169.760 (“Juvenile detention facilities shall have established comprehensive written policies providing for the least restrictive alternative consistent with the safety and security of the facility…”), https://library.state.or.us/repository/2012/201202091528374/index.pdf.

[84] See, Social Services; Juvenile Justice: New Mexico Juvenile Detention Standards – Title 8; Chapter 14; Part 14. 8.14.14.14, Security, Staffing, and Control, https://164.64.110.239/nmac/parts/title08/08.014.0014.htm.; Kentucky Administrative Regulations; Title 505; Justice and Public Safety Cabinet Department of Juvenile Justice, 505 KAR 2:060. Security and Control, Section 1 (18) (a), https://apps.legislature.ky.gov/law/kar/titles/505/002/060/.; Indiana, Security and Control: 210 IAC 6-3-3.142, http://www.youthlawteam.org/files/Indiana%20Juvenile%20Detention%20Standards%202003.pdf.

[85] Missouri Law Enforcement; Juvenile Justice Guidelines and Recommended Practices – Revised 2012, Chapter 2 – Delinquent Offenses Recommended Practices: Issues Relating to Custody, https://dps.mo.gov/dir/programs/jj/documents/le-manual-final.pdf, accessed February 25, 2014; See also, Social Services; Juvenile Justice: New Mexico Juvenile Detention Standards, 8.14.14.14 (C); and, Kentucky Administrative Regulations; 505 KAR 2:060 (1) (18) (c).

[86] Zeidenberg, “You’re An Adult Now,” 2.

[87] Patrick Griffin, Sean Addie, Benjamin Adams, and Kathy Firestine, Trying Juveniles as Adults: An Analysis of State Transfer Laws and Reporting, (Washington, DC: Office of Juvenile Justice and Delinquency Prevention, 2011).

[88] Juvenile Justice and Delinquency Prevention Act, Washington, DC: Office of Juvenile Justice and Delinquency Prevention, 42 U.S.C. 5633(a)(13).

[89] For example, Ohio law provides that youth may be subject to juvenile court jurisdiction until the youth turns 21. However, a youth who has a juvenile court disposition that lasts beyond the youth’s 18th birthday can be placed in an adult jail once a youth turns 18 for violating the terms of their disposition.

[90] Florence v. Board of Chosen Freeholders, 132 S. Ct. 1510, 1526 (2012).

[91] Campaign for Youth Justice, Jailing Juveniles, (Washington, DC: November, 2007): 13.

[92] Allen Beck and Candace Johnson, National Former Prisoner Survey, 2008: Sexual Victimization Reported by Former State Prisoners, 2008, (Washington, DC: Bureau of Justice Statistics, 2012)

[93] 28 CFR Part 115, p. 48 (2012), https://www.ojp.gov/programs/pdfs/prea_final_rule.pdf.

[94] Daniel C. Murrie, Craig E. Henderson, Gina M. Vincent, Jennifer L. Rockett, and Cynthia Mundt, “Psychiatric Symptoms Among Juveniles Incarcerated in Adult Prison,” (Psychiatric Services 60, no. 8., 2009).

[95] Florence at 1512.

[96] Ibid., 1523–1524.

[97] OJJDP, Guidance Manual for Monitoring Facilities Under the Juvenile Justice and Delinquency Prevention Act of 2002, (Washington, DC: October, 2010): 13–16.

[98] Ibid., 23–24.

[99] 28 CFR Part 115 (2012), see also U.S. Department of Justice, National Standards to Prevent, Detect, and Respond to Prison Rape: Executive Summary, 4–5, https://www.ojp.gov/programs/pdfs/prea_executive_summary.pdf.; Campaign for Youth Justice, Fact Sheet - No Excuses: The Prison Rape Elimination Act (PREA).

[100] Ibid.

[101] Daron Hall (Sheriff, Davidson County), Commentary: Jails vs. Prisons.

[102] Ibid.

[103] Trujillo v. City of Newton, Kan., No. 12-2380-JAR (D. Kan. July 2, 2013) (emphasis added).

[104] Compare Trujillo v. City of Newton, Kan., No. 12-2380-JAR (D. Kan. July 2, 2013) (“[T]he strip search was sufficiently based upon . . . reasonable suspicion that Plaintiff had concealed drugs . . . .”), with Justice v. City of Peachtree City, 961 F.2d 188, 193 (11th Cir. 1992) (“[O]fficers may conduct a strip search of a juvenile in custody . . . based upon reasonable suspicion to believe that the juvenile is concealing weapons or contraband.”).

Ch.10 Effective Programs and Services

Ch.10 Effective Programs and Services web_admin Thu, 12/23/2021 - 16:44

Author: Wayne Liddell, Pam Clark, MSW, LSW, CYC-P, and Kathy Starkovich

Beyond ensuring public safety, the intent of the juvenile justice system has historically been to rehabilitate youth engaged in delinquent behavior. It can be argued that for many youth the issue is one of habilitation rather than rehabilitation. Many justice-involved youth never had the nurturing and direction needed by all children and youth, and so the purpose with these youth is to provide them with access to positive, pro-social experiences and opportunities to develop new skills.

Rehabilitation or habilitation is considered to be so significant a goal that the Juvenile Justice and Delinquency Prevention Act (JJDPA) urges state advisory groups and state agencies to provide funding for “programs for positive youth development that assist delinquent and other at-risk youth in obtaining: (i) a sense of safety and structure; (ii) a sense of belonging and membership; (iii) a sense of self-worth and social contribution; (iv) a sense of independence and control over one’s life; (v) a sense of closeness in interpersonal relationships.”[1]

In the Coalition for Juvenile Justice report entitled, Positive Youth Justice: Framing Justice Interventions Using the Concepts of Positive Youth Development, Jeffrey Butts, Gordon Bazemore, and Aundra Meroe agree. They say that positive youth development (PYD) is an approach that recognizes the need for young people to have access to appropriate supports and opportunities through which they may develop the knowledge and skills they need to become positive and productive members of society and that “the concepts and principles of positive youth development (PYD) [articulated in the Title II of the JJDPA] offer valuable guidance for the design of interventions for youthful offenders.”[2]

In addition, programs and program activities—particularly those that successfully promote PYD—have been linked to improved conditions of confinement, reduced problems in crowded facilities, improved resident and staff safety, and increased resistance to liability.[3]

Rationale for Programming

Youth in confinement bring with them considerable anxiety and hostility. Some are withdrawn, while others are extremely aggressive. Some are so disturbed that they do not dare show their true feelings. They are upset, and confinement can make them more upset. Many carry with them feelings of hostility toward adults, authority, and society in general. Others have experienced trauma and adverse childhood experiences that contribute to many of these overt behaviors. Some have a strong identification with older delinquents and antisocial goals. Putting an anxious and angry youth in a group of other anxious and angry youth—or with adults in the case of youth being charged and prosecuted as adults—can only serve to compound problems unless proper measures are taken.

Confinement facilities that serve youth have the obligation to hold youth, curb their impulsive behaviors, and work to mend their social ills. This mending partially consists of controlling behavior so that youth do not harm themselves or others. It also involves assisting youth in changing distorted views of themselves and their situation and in developing worthwhile goals.

Programming for youth is an effective and productive approach to accomplishing the many goals of confinement. Even unexceptional and limited programs serve to reduce the number of problems youth experience in confinement. The following benefits of programming (articulated in the original Desktop Guide for Good Practice in Juvenile Detention, 1996), continue to be benefits of programming today, regardless of the type of facility in which youth are confined.

  • Good programs keep confined youth so busy that they do not have time to think of ways to negatively vent hostility. Youth give less thought to harming themselves, others, the building, and equipment and more thought to the positive outcomes of the program.
  • Through programs, youth are placed in many social situations that serve to alter their distorted views of themselves and their situation. Youth with issues of self-control should be identified early. The more aggressive and impulsive behavior of youth is controlled partly by the rules and expectations of the program activity, partly by the close supervision of staff, and—when they are confined in juvenile detention or correction facilities—partly by the opinion of their peers.
  • A variety of situations give more opportunity for a quick evaluation of a youth’s strengths and shortcomings. Programs provide for interaction among the youth and staff. Without interaction, it would be difficult to spot the withdrawn youth. Many times, a certain activity allows the staff to penetrate a youth’s wall of hostility toward adults. Any activity may be the start of a rehabilitative process for a withdrawn youth. Although not all facilities that confine youth (specifically juvenile detention and adult jails) may be geared to rehabilitate youth, they can be the place where the rehabilitation process begins.
  • Confined against their wishes and afraid of their surroundings, their associates, and their future, many youth experience increasing tension. Good programs provide an array of activities and opportunities for the release of emotional and physical tensions.
  • Delinquent youth often have little regard for their ability and worth and lack confidence in themselves. Good programs can help them discover hidden abilities, develop new skills, learn basic facts, and develop new feelings about their ability and responsibility to improve. They can come to a more positive and realistic appraisal of themselves and their capabilities.
  • The success of staff working in a confinement facility is greatly dependent on their ability to effectively engage in a genuine and caring relationship with youth. It cannot be overemphasized that programs are one of the best means available for establishing such a relationship.
  • A direct, overly assertive approach by a staff member causes distrustful youth to back away and set up a barrier between him or herself and the adult. When a staff member “comes in the back door” by being a teammate in a recreational activity, giving reassurance during a craft project or school work, or helping members of the group to achieve a common goal, he or she is able to share good feelings with the youth. The youth and staff member are working together and doing what is appropriate, before either one realizes it. Effective and positive staff–youth relationships are critical.
  • One of the greatest benefits of high-quality programs may be that they help the staff member see confined youth for who they are rather than for what they have done.

In sum, there are both ethical and practical reasons to implement programs and activities for youth in confinement. Not only does putting a group of youth together with little or nothing to occupy their time serve as a recipe for a host of problems, it also represents a lost opportunity to achieve the overall goal of the juvenile justice system—to rehabilitate delinquent youth.

Goals for Programming

According to a National Institute of Mental Health publication entitled, The Teen Brain: Still Under Construction, research in the area of adolescent brain development tells us the human brain is not fully developed until youth are in their early twenties.[4] This means that adolescence is an opportune time, developmentally, to invest in strategies that are consistent with the principles of PYD. (See Ch. 4: Developing and Maintaining a Professional Workforce;Ch. 6: Adolescent Development)

To ensure healthy development and support positive outcomes for youth, program activities must be goal oriented. For every type of activity, physical or nonphysical, a number of goals should be established that participating youth can achieve. Such goals should be inherent in almost every activity that staff and youth engage in. If they are not, the purpose of the activity is questionable. The goals are:

  • Providing for a release of emotional tension.
  • Creating a constructive outlet for physical energy.
  • Teaching fundamentals of recreational and other activities.
  • Giving the youth self-confidence in healthy pursuits.
  • Teaching fair play, rule following, and teamwork.
  • Providing a socially acceptable outlet for hostility.
  • Giving the youth a better understanding of himself or herself.
  • Developing new interests and skills to be continued after release.
  • Keeping the youth busy by providing a structure for the day.
  • Developing good health habits and a healthy physique.
  • Breaking down resistance to adults and adult standards and expectations.
  • Permitting observation of the youth’s behavior, which aids in social diagnosis.

The following serves as a more comprehensive explanation of the goals and their meaning to everyday work with youth in a confinement setting. Review each of the goals of any activity, whether recreational, instructional, or skill building, and see if the activity will answer the following questions in a positive manner.

  • Are the youth involved both emotionally as well as physically? Are the youth really enjoying the activity? Are they involved to the extent that they have forgotten temporarily about their problems and anxieties?
  • Are staff challenging youth physically? Are the youth exhausting their physical energies in the activity?
  • Are the abilities of individual youth being evaluated? Are youth learning the fundamental skills of the game or activity? Are they being taught and coached in the correct methods of play? Are staff able to identify handicaps the youth might have while considering the individual’s lack of knowledge or skills?
  • Are staff supporting youth in building self-confidence? Are the youth being encouraged to learn and improve and become more confident of their abilities? Are the youth experiencing a feeling of accomplishment? Do staff praise the youth for their efforts as well as their achievements?
  • Are the rules of each game being taught? Are the youth being shown (and do they understand) how the game can be better when the rules are followed? Do youth see the importance of working as a team and what is lost when they are playing as individuals? Do staff explain and set examples, guiding youth toward fair play? Do youth witness a cooperative relationship among staff?
  • Does the activity allow for a release of aggressive feelings? Do staff avoid creating resentment toward the activity by not putting youth in positions that are embarrassing or humiliating?
  • Do youth see themselves as being successful in the activity? Are staff providing proper levels of competition that increase confidence and eliminate feelings of insecurity?
  • Are the youth being taught new forms of recreation? Are youth developing good attitudes toward various skills and activities? Have staff developed the skills and created interest among youth that will encourage continued participation upon release?
  • Do staff keep the youth so busy that they do not have time to think of ways to vent their hostilities on staff, equipment, or each other? Is there a balance of both active and inactive recreation to keep youth either physically or mentally involved throughout the day?
  • Are youth experiencing a feeling of well-being, and do they understand it to be the result of fitness and abilities acquired through the program? Do staff impose realistic standards and expectations to avoid any potential physical harm to the youth?
  • Through actions and interactions with youth, do staff gain the respect of youth and will this lead to respect for other adults? Do staff follow the same rules and regulations the youth are expected to follow—win, lose, or draw? Do youth see staff members as part of their team, trying to help and cheering for them to win, rather than as uninterested adults carrying out their duties? During leisure time, class sessions, or competition, do staff convey the feeling they are interested in the youth? Can youth rely on staff to “always be fair” rather than “always be right?”
  • Are staff observant of a youth’s change of attitude and interest throughout the day? Do staff notice and record the comparative levels of skill and knowledge in each activity? Are staff sensitive to changes in peer relationships? Do staff engage in varying youth-adult interaction and notice how this variety alters youth–adult relationships? Is there enough stimulation and freedom in activities for the above characteristics to reveal themselves?

Engaging in goal-oriented activity is a natural part of the work that staff do. However, staff must be alert and attentive and engage in active processing with youth of what they have learned from any programmatic activity. David A. Kolb, an American psychologist and educational theorist, wrote a book entitled, Experiential Learning: Experience as The Source of Learning and Development, in which he first presented a theory for experiential learning.[5] The diagram below provides a visual depiction of Kolb’s model of experiential learning, demonstrating how it might be applied to the processing of activities with youth. The diagram is followed by descriptions of each step of this processing.

 

EXPERIENTIAL LEARNING MODEL

Experience Learning Model: Activity and Experience, Observe and Share, Process, Generalize, Apply, and repeat

 

Activity. Staff decide upon an activity for engaging youth, decide on what goals youth are expected to meet or achieve by participating in the activity, and youth participate in the activity or exercise.

Observation. Staff observe how youth engage with one another during the activity. Youth will naturally observe one another. Staff allow youth to share their experience and observations. Staff share their observations.

Process. Upon completion of the activity, staff intentionally, either formally or informally, process with youth what happened during the activity (e.g., How did you/everyone do, get along? Did you accomplish your goal or complete the activity? How did you or why weren’t you able to accomplish your goal or complete the activity? What worked or didn’t work? What was easy or difficult about what you just did, etc.? What, if anything, did members of the group do contribute to the success or lack of success in completing the activity?)

Generalize. Staff discuss with youth what they learned from the experience. This is an opportunity to help youth identify and develop important life skills such as teamwork, communication, goal setting, and coping with frustration. In connection with the activity, staff discuss with youth what happened and what skills they used or might have used to be successful.

Apply. Staff ask youth what they learned from the activity and how this could help them achieve other goals or be successful in other areas of their lives. Did they learn a new skill? How can they use what they learned in other experiences in their lives?

The first two steps of this Experiential Learning Model—Activity and Observation—are naturally occurring as the participants decide on and engage in the activity. The last three steps—Process, Generalize, and Apply—should be part of the schedule and plan for most any of the activities facilitated by staff, not just an after thought. For example, if there is one hour in which to conduct an activity, 15–20 minutes of that hour should be set aside for these last three steps.

There are a number of resources available to assist staff in better understanding the different ways to process learning from an activity.[6] In addition, a variety of training tools, such as the Debriefing Thumball and Debriefing Wheelies, may be used by facilitators to assist them in asking appropriate debriefing questions. These tools can serve to keep the debriefing process from becoming boring and routine for both the program staff and the youth. These resources can be found at any number of training supply websites and warehouses.

Programming grounded in experiential learning and a PYD approach does not require a specific curriculum, and it is not complicated. However, it does require that staff be intentional in planning activities and experiences for youth, establishing goals for what youth will learn from the experience or activity, and then processing youth learning upon completion of that activity.

Evidence-Based and Best Practice

In recent years, a great deal of emphasis has been placed on the use of evidence-based practice in the development and implementation of justice-system interventions and programs. However, there are many different definitions used for this term. In addition, evidence-based practice and best practice are terms that are often used interchangeably but that have two distinct meanings.

The Austin/Travis County Reentry Roundtable, Evidence-Based Practice Committee, in its “Frequently Asked Questions: Evidence-Based Practices in Criminal Justice Settings” offers the following comparison:[7]

Evidence-Based Practices

  • Emphasis on empirical research
  • Control of confounding variables through random assignment
  • Consistency of findings
  • Cross-site replication

Best Practices

  • Conventional wisdom
  • Repeatable procedures that have proven themselves over time
  • Not necessarily proven through rigorous research

 

In other words, evidence-based practice has been subjected to research that is grounded in scientific methods such as the use of control or comparison groups, conducted on multiple programs across various sites and evaluated over an extended period of time. Best practice is based on ideas that are generally accepted to be true by experts in the field but may not have been proven through research.

The National Institute of Corrections (NIC), as part of its project on “Reducing Offender Risk,” highlights eight principles for effective interventions, which are summarized below.

  1. Assess Risk/Needs. Assessing offenders' risk and needs (focusing on dynamic and static risk factors and criminogenic needs) is essential for implementing the principles of best practice.
  2. Enhance Motivation. Research strongly suggests that "motivational interviewing" techniques, rather than persuasion tactics, effectively enhance motivation for initiating and maintaining behavior changes.
  3. Target Interventions
    1. Risk Principle. Prioritize supervision and treatment resources for higher risk offenders.
    2. Need Principle. Target interventions to criminogenic needs (needs causing or likely to cause or lead to criminal behavior).
    3. Responsivity Principle. Be responsive to temperament, learning style, motivation, gender, and culture when assigning offenders to programs.
    4. Dosage. Structure 40% to 70% of high-risk offenders' time for 3 to 9 months.
    5. Treatment Principle. Integrate treatment into full sentence/sanctions requirements.
  4. Skill Train with Directed Practice. Provide evidence-based programming that emphasizes cognitive-behavior strategies and is delivered by well-trained staff.
  5. Increase Positive Reinforcement. Apply four positive reinforcements [rewards] for every negative reinforcement [punisher] to support behavior change.
  6. Engage Ongoing Support in Natural Communities. Realign and actively engage pro-social support for offenders in their communities for positive reinforcement of desired new behaviors.
  7. Measure Relevant Processes/Practices. An accurate and detailed documentation of case information and staff performance, along with a formal and valid mechanism for measuring outcomes, is the foundation of evidence-based practice.
  8. Provide Measurement Feedback. Providing feedback builds accountability and maintains integrity, ultimately improving outcomes.

https://nicic.gov/theprinciplesofeffectiveinterventions

Evidence-informed practice, which may be considered a mixture of evidence-based and best practice, involves using the best available research combined with theory and practical knowledge. This approach to practice is based on an understanding that existing research may not be specific to practice with all individuals or groups or in all contexts or settings and that appropriate adjustments may need to be made based on these unique factors.

Both evidence-based and evidence-informed practice require a theory of change that describes the specific interventions to be used in bringing about is the desired outcome(s); both will have or be in the process of developing a program or procedural manual and training materials specific to the program components and protocol. Evidence-informed programs and practices, as those that are evidence based, should be involved in ongoing evaluation and continuous improvement activities for the purpose of building evidence of effectiveness.[8]

Both evidence-based and evidence-informed practice are approaches that are also being applied to criminal justice decision-making. In June, 2008, the NIC entered into a partnership with the Center for Effective Public Policy for the purpose of building a system-wide framework for evidence-based decision making for local criminal justice systems. “A Framework for Evidence-Based Decision-Making in Local Criminal Justice Systems” is in its third edition and available at the NIC website.[9]

Program Fidelity

As greater emphasis is placed on the use of evidence-based practice and programs, fidelity is a term used more frequently with juvenile justice interventions.

“Fidelity,” as defined in the Merriam-Webster Dictionary, is “the degree to which something matches or copies something else.[10] The OJJDP, in its Model Programs Guide Glossary of Terms, says that fidelity is “the degree to which a program's core services, components, and procedures are implemented as originally designed. Programs replicated with a high degree of fidelity are more likely to achieve consistent results.”[11]

James Bell Associates in its “Evaluation Brief: Measuring Implementation Fidelity” identifies five dimensions, briefly summarized below, that should be considered when assessing the fidelity of program implementation.[12]

  1. Adherence. The extent to which program components are delivered as specified by the program model, including such things as program content and activities and delivery methods.
  2. Exposure. The amount of the program delivered in relation to the amount prescribed by the program model. This includes things such as the number of sessions or contacts, the progression, frequency, and duration of sessions, and participant attendance.
  3. Quality of delivery. The manner in which a program is delivered. This includes things such as provider enthusiasm, confidence, and respectfulness, and the ability to respond to questions and communicate clearly. Provider training and preparedness also impact quality of delivery.
  4. Participant responsiveness. The engagement of participants in the program, e.g., level of interest, perceptions about the relevance and usefulness of program content, the level of enthusiasm, and willingness of participants to join in discussions and activities.
  5. Program differentiation. This refers to the process of identifying the components of the program that are essential for producing positive, desired outcomes.

The Brief also identifies a number of ways in which fidelity may be assessed. These include:

  • Self-reports of providers and participants.
  • Participant surveys.
  • Observations of program delivery.
  • Data collection.
  • Fidelity assessment provided by the program developer.[13]

Although fidelity is important, it does not mean that a program or curriculum cannot in some ways be adapted or modified. However, adaptations should be well thought out and intentional, as not all adaptations are good ones, and no adaptations should be made to the core components of any program. To effectively determine the impacts and outcomes of any intervention—regardless of whether it is evidence based—fidelity of implementation should be a consideration, and a plan for monitoring fidelity should be a part of program development or adoption.

Types of Program Adaptations

  • Acceptable adaptations
    • Changing language—Translating or modifying vocabulary.
    • Replacing images to show youth and families that look like the target audience.
    • Replacing cultural references.
    • Modifying some aspects of activities such as physical contact.
    • Adding relevant, evidence‐based content to make the program more appealing to participants.
  • Risky or unacceptable adaptations
    • Reducing the number or length of sessions or how long participants are involved.
    • Lowering the level of participant engagement.
    • Eliminating key messages or skills learned.
    • Removing topics.
    • Changing the theoretical approach.
    • Using staff or volunteers who are not adequately trained or qualified.
    • Using fewer staff members than recommended.[14]

Types of Programs

Cognitive Behavioral Interventions

The application of evidence-based principles elevates the role of staff working in a confinement setting to include responsibility for facilitating pro-social change in youth. For many, this is a significant departure from prior expectations that focused heavily on the importance of safety, security, and the use of strategies based on punishment. The use of evidence-based principles moves staff beyond simply meeting a youth’s basic needs and offers them the opportunity to build relationships with youth, teach and enhance skills, and manage youth behavior in a safer, more effective manner. The most effective programming combines behavior management systems and cognitive behavioral interventions to improve facility safety and influence pro-social change.

Cognitive behavioral interventions come from two separate psychological theories. Cognitive theory holds that the way a person thinks determines his or her behavior. Behavioral theory says that the environment in which a person finds him or herself also affects the behavior. This blending of cognitive and behavioral theory in working with delinquent youth is based on the belief that much of the behavior that gets youth in trouble stems from a combination of faulty thinking and limited pro-social skills. An individual’s thinking in a situation is triggered by what is happening in the environment combined with the person’s assumptions, attitudes, and beliefs. That thinking then drives a person’s feelings, behavior choices, and consequences. The cognitive behavioral practitioner believes offenders are responsible for their behavior choices, and their thinking is learned and has been reinforced throughout their life. Staff that use a cognitive behavioral approach work to assist youth in identifying unhelpful thinking and the things that trigger that thinking, as well as teaching alternative thinking to support the individual’s ability to respond in a pro-social manner.

The term “cognitive behavioral intervention” does not refer to a specific product or brand of intervention. It is grounded in the simple belief that our thoughts determine our behavior. The emphasis for detention programs with a cognitive foundation is to take daily interactions with youth and use them as teaching opportunities—opportunities to teach youth new skills, raise awareness around antisocial thinking, and provide a way for them to substitute more rational thoughts through which to understand their situation.

There are two distinct types of cognitive programs: cognitive skill training and restructuring of cognitive events. The two are complimentary, and in developing programs for youth in confinement there is value in incorporating both. Harvey Milkman and Kenneth Wanberg assert that “the two approaches are built on two pathways of reinforcement: (1) strengthening the thoughts that lead to positive behaviors and (2) strengthening behavior due to the positive consequence of that behavior. The former has its roots in cognitive therapy, the latter in behavioral therapy.”[15] The authors agree that both of these approaches are necessary to form the foundation of a cognitive behavioral approach.

Cognitive Restructuring

The cognitive model focuses on the belief that the way someone interprets and thinks about a situation influences his or her behavior choices. Therefore, if detention staff want to change behavior, the focus should be on looking beyond the acting-out behavior a youth demonstrates and on assisting the youth in examining his or her thoughts prior to the behavior. The use of cognitive restructuring in detention involves staff teaching youth to identify the thoughts that occur prior to the problematic behavior. Once those are identified, the priority is to coach the youth to develop more appropriate and realistic thoughts and practice these when similar situations arise. Interventions in cognitive restructuring are based on the notion that youth have learned patterns of thinking that are not helpful and that place them at risk for criminal behavior. A simple tool staff can use to understand and teach this concept is the “thinking chain.” The text in below represents the concept that thinking, feeling, and behavior are connected and sequential; the thoughts we have in a situation determine our feelings, which determine our behavior choices, and then ultimately produce consequences.

Situation ---> Thinking---> Feeling ---> Behavior---> Consequences

Referenced above is the thinking chain taught in the Rational Behavior Training (RBT) program used in DuPage County, Illinois, and replicated in numerous detention facilities across the U.S. Following the chain, behavior originates from thinking that is specific to whatever the situation is or what Aaron Beck referred to as “automatic.” The danger of automatic thinking is that it is often unconscious, accepted as reality, and therefore goes unchallenged by the person.[16] Behavior, according to Beck, is also influenced by a person’s core beliefs—those more deeply-held attitudes shaped over a lifetime. Core beliefs are patterns of general beliefs about the world, how people believe they should be treated and treat others. These core beliefs influence the way a person handles a situation. When youth experience negative consequences, the behavior management program should require staff to review the thinking chain with the youth. Often, discrepancies between behavior and core beliefs exist.

In facilities that use this approach, the main teaching tool used by staff is called a thinking report or, in the case of the DuPage County program, a Rational Self Analysis (RSA). The RSA has sections to help the youth outline the current situation, thinking, and behavior, as well as future alternatives that would result in better outcomes.

Reviewing an RSA or a thinking report is a joint process where staff and the youth work together. The role of the staff member is to facilitate the discussion and assist the youth in identifying errors in thinking; the young person completes most of the work in this process. A youth taking responsibility for thoughts and the behavior choices that are a consequence of those thoughts is the desired outcome of the process. The discussion involves three parts (Note: the RSA reflects two separate thinking chains). The first is the situation as it happened (sections A-C3) and then how this changes when the thinking is replaced with more helpful alternatives (sections D3-E3).

  1. First, reviewing the situation as it occurred and encouraging a review of events that set the behavior chain into motion. This involves identifying a list of at least five thoughts that occurred in the situation, labeling the feelings that resulted from those thoughts, and discussing the behavior choices and consequences.
  2. Next, identifying the “hot thoughts,” those that most strongly influenced the behavior (automatic thoughts) and helping the youth determine if those thoughts were helpful or harmful to the outcome (section D2).
  3. Finally, staff coaching the youth to come up with more helpful and realistic thoughts to use in a similar situation in the future. Staff work with the youth to “restructure” or change his or her thinking to include more helpful alternatives. As a result, the alternative thoughts create a new chain of events focused more on healthier feelings, different behavior choices, and the more likely positive outcomes.

This approach assumes that behavior is rooted in thinking and helps to illuminate the possible distortions in the way we may see or understand situations. These distorted views affect one’s ability to appropriately respond to situations. It is the responsibility of confinement staff to help youth see beyond their behavior and examine the thinking that occurs prior to that behavior.

Cognitive Skill Building

The second type of cognitive behavioral intervention involves the staff member teaching, modeling, and reinforcing social and problem-solving skills. The skills lacking among youth in confinement settings range from basic communication to more advanced anger management and problem solving. A good behavior program has positive expectations and rewards youth as they demonstrate appropriate behavior. As a part of cognitive restructuring, staff want the “self-talk” of the youth to focus on desirable outcomes instead of on what to avoid. For example, instead of “don’t swear” a program should teach youth how to talk with others appropriately (e.g., voice tone, eye contact, positive word choice).

An important consideration is the baseline skill level a youth may bring to this process. Youth come from diverse families and backgrounds, many of which may not support what others believe to be appropriate societal expectations. Given the range of youth experience, programs should not expect youth to demonstrate skills they do not have. Effective programs consistently review expectations, teach the desired skills, and provide reinforcement when youth demonstrate these skills to increase the frequency of this behavior. This can be done on an individual basis or within a group setting. It may be helpful to have youth with more time and experience in the program teach or demonstrate the desired behaviors to youth that are new to program.

The Boys Town curriculum, Teaching Social Skills to Youth, is focused on behavior and provides several models for teaching skills and correcting skill deficits.[17] The curriculum provides a structure for teaching both individually and in a group setting. It emphasizes the relationship between a youth and his or her environment and cites the Antecedent–Behavior–Consequence model. This model stresses that no behavior occurs in a vacuum. If a behavior or skill re-occurs, it is because it has been reinforced. In other words, people do what they do because it makes sense to them. As professionals, we may not understand the behavior a youth chooses, but the youth gets something from it or the behavior has previously produced the desired results for them. Using this more developmental approach in a confinement setting requires a focus on what is rewarding to the individual about his or her behavior and attempting to meet this need through more pro-social means.

Reinforcing social skills requires an approach that accomplishes two things. It rewards positive skills and corrects misbehavior. The correction of misbehavior should be consistent with well-established principles of behavior modification. A consistent and immediate response from staff is far more important than the heavy handedness of a punishment. Confinement facility programs should create environments where positive behavior choices are both acknowledged and encouraged. The use of verbal praise and other incentives are powerful tools to influence positive behavior choices. (See Ch. 14: Behavior Management)

Programs should have multiple means to reward appropriate behavior. Rewards should include immediate, short-, and long-term incentives. The goal is not to pamper youth; it is to help them change this behavior. To be effective in encouraging positive behavior requires that staff immediately link positive consequences to desired behaviors and not dismiss these behaviors as simply what is expected. Bernard Glos Ph.D., former Superintendent at the DuPage County Juvenile Detention Center, consistently reinforced this message in his training of new detention staff with the saying, “Never take any positive behavior for granted.” This shift in thinking assists staff in recognizing that reinforcing positive behavior always has priority over correcting negative behavior. This does not mean that inappropriate choices should be overlooked or not have consequences; however, recognizing positive behavior is consistent with what we know about reinforcement. The behaviors we acknowledge are repeated.

A cognitive behavioral approach increases the professionalism of confinement staff. The role of staff changes from that of an observer or enforcer to that of an active participant in encouraging positive change. Staff work with youth and challenge them to identify high-risk situations and thinking and to think and behave differently. Staff do not accept problematic behavior or make value judgments about youth, but challenge youth to do better. Staff model pro-social skills, and youth practice them. Encouraging positive skills until these become internalized and automatic is the priority. Programming (teaching thinking–behavior connections) and behavior management systems (reinforcing behavior) can be combined to meet the goals of improved facility safety and to influence pro-social change. The positive behavior change a youth experiences changes the way he or she thinks about a situation.

Perhaps the strongest benefit of cognitive behavioral programming is the shift in staff culture that occurs when staff practice the model. A belief in the basic value of people—that change is possible and that work is meaningful—along with a team orientation, is essential for success. The facility becomes a community based on mutual respect, caring, and responsibility. The values and expectations of staff do not differ from the values and expectations of youth.

Focusing solely on eliminating opportunities for misbehavior does youth a disservice by eliminating the opportunity for them to respond appropriately to difficult situations. Staff cannot foresee and prevent every opportunity for misbehavior. When staff depend only on consequences for negative behavior, the likelihood of problem behavior increases. This approach is reactive and punitive, with a limited focus on teaching. A focus on thinking provides staff the ability to get beyond a youths’ inappropriate act. It enables staff to help youth examine their perceptions and take ownership of their choices. Staff must recognize the importance of empowering youth to use own their thoughts and decisions. When released from the confinement setting, youth are better prepared to make difficult decisions.

Moving from an environment that has previously focused on managing and providing consequences for misbehavior, to one where positive behavior is taught, expected, and reinforced, can be challenging. This change in culture requires a significant commitment from facility staff, as they are the ones in closest contact with the youth. Engaging staff in the process of changing the culture is key and “…starts with showing that you C.A.R.E.[18]

  • Communication. Staff in any organization are often suspicious of change (e.g., what is causing the change?; how long will it last?; what affect will it have on me and on my job?). Engaging direct care staff in the process of decision and choice making related to the change provides them with an opportunity to ask questions, share ideas, and begin to own the process of change. “Informal frontline employees can be great assets in linking their coworkers to the [change in] organizational culture, but only if they feel part of the change and understand how it will benefit them.”
  • Accountability. Facility administrators must consistently hold themselves and others in the facility accountable for behaving in a manner that supports the change in culture. Staff will need time to learn and understand the changes in programming and the behavioral expectations for youth, as will the youth. Coaching for staff as they begin to implement the desired changes will be key.
  • Rewards and Recognition. Another key is to reward and recognize the efforts of staff in supporting this new culture. Although acknowledging that change can be difficult, facility administration should visibly recognize those who are supporting the change, highlighting their specific efforts and publicly thanking them for their investments.
  • Environment of Innovation. Direct care staff will be keenly aware of the struggles that both they and the youth experience as programmatic and other changes are implemented. This situation can provide unique opportunities for innovation. Staff may have valuable suggestions that should be considered about the changes that are being implemented. Feedback from staff (an idea or suggestion box) would allow administration the opportunity to review and consider staff input and acknowledge staff for their ideas and contributions.

Life Skills and Independent Living Programs

Programs that focus on the development and internalization of basic life skills can also be highly beneficial for youth in confinement facilities. These programs serve as a way to assist youth in preparing to return to the community and teach skills that may have a positive impact on a youth’s behavior and progress in the facility. The implementation of life skills programs can occur in a wide range of youth confinement settings that include juvenile detention and corrections, as well as adult correctional facilities. Facilities that place a strong emphasis on a youth’s successful reentry to the community typically invest in the process of teaching basic life skills and related social skills.

The primary goal of life skills programs in confinement facilities is to assist youth in developing specific skills that will provide the basis for a productive life as a contributing citizen in the community. The major areas that may be addressed in life skills programs include the following:

  • Educational skills.
  • Vocational skills.
  • Employment skills.
  • Social skills.
  • Anger management/conflict resolution skills.
  • Cognitive reasoning and personal accountability skills.
  • Daily living skills.

The successful implementation of effective life skills programs in confinement facilities that serve youth is largely dependent upon a number of factors. The impact of the professionalism, knowledge, and commitment of the staff that provide instruction and guidance to youth in life skills programming is critical to the overall success of the program. An enthusiastic, committed, and caring staff member who consistently demonstrates the desire to assist youth in their personal development is more likely to engage youth in the scheduled programs than a staff that merely goes through the motions. In addition, the facility administration needs to consistently support the life skills programs by ensuring that they have adequate resources and by acknowledging and encouraging the staff and youth who participate in the program.

Life skills programs should use an established curriculum that staff should implement in a consistent manner. Program topics should be based in reality with a positive focus to have the maximum positive effect and impact. Youth and staff should be actively involved in the delivery of the program topic, stressing participation and planning strategies that are tied to reentry issues as well as pertinent facility issues. Because youth in confinement settings typically have short attention spans, lectures that do not provide for or encourage youth participation and interaction should be avoided whenever possible. (See Ch. 18: Transition Planning and Reentry)

Life skills programs, like other facility programs, should be evaluated on a regular basis to ensure that the goals and objectives of the program are being achieved. Staff and youth should have input into evaluation of the program. This input can be gathered using structured interviews, surveys, and comment and suggestion forms. Information gathered from the evaluations can be used to improve the program.

Effective life skills programs in confinement facilities can provide youth with valuable tools that may not only assist in their successful reentry to the community but can have a positive impact on their adjustment and degree of progress within the facility.

Independent living programs can be highly beneficial as part of the reentry process for some youth. Independent living programs are primarily designed for older youth who, for any reason, are unable to return to a stable, appropriate home environment. As an alternative, these youth are provided with living accommodations in the community along with ongoing support provided by staff with the correctional jurisdiction or a contract agency. Life skills programming assists them in living independently and successfully in the community. Youth receive instruction and guidance in areas such as securing and maintaining employment, household budgeting and management, education, health and wellness, and accessing community resources.

While in the independent living program, youth typically receive varying degrees of case management services and supervision from the supervising jurisdiction’s reintegration staff (parole, probation, aftercare, reentry). Financial support and other resources may also be provided by the supervising jurisdiction or other entities with the ultimate goal of having the youth attain the skills necessary for self-sufficiency and subsequently transition from the independent living program to release from formal supervision. Failure to meet the expectations or contract provisions of the independent living program can result in a range of consequences for the youth up to, and including, removal from the program and return to the youth confinement facility or other placement.

Family Involvement

Effects of Youth Confinement on Parents

Most often, when people think about the confinement experience and programs in confinement facilities, they immediately focus on the youth who has been confined. The confinement experience can be traumatic for any youth, but especially for those who have not been confined before. Being afraid for personal safety and property, being upset by the separation from home, and having feelings of isolation or failure are common. Through the implementation of effective programs, many of these negative feelings can be dealt with and turned into constructive learning experiences.

However, the confinement experience does not touch only the youth. Often, the youth’s parents will be as unfamiliar with confinement as the youth. Parents worry about their son’s or daughter’s safety, well-being, and property; they wonder how long confinement will last; they have to learn how to make their way through a complex justice system; and they worry if the experience, including the possible cost of confinement, will result in any new economic hardships for the family. Many parents also wonder where they have “gone wrong” when they see their child under lock and key. Some parents throw their hands up in disgust over their child’s conduct, and a few may even abandon their children, hoping that the courts will now provide care for their delinquent child.

A child’s confinement can create a new set of problems for parents and guardians. These problems go beyond the need to hire an attorney, appear in court, and meet with confinement facility staff, probation or aftercare officers, social workers, and psychologists. The youth may be the oldest child in the family with duties and responsibilities in the home that will need to be taken over by younger siblings. In some cases, the youth may have been providing a source of income for the family, and the confinement decision can have an adverse economic impact on the family.

This is an excellent opportunity for staff at the facility to engage in and play a leadership role in working with the parents of the youth. The confinement facility may be the first point of contact between the parent or guardian and the juvenile justice or criminal justice system. Facility staff should be prepared to offer information, assistance, and support not only to the youth, but also to the youth’s family members. (See Ch. 18: Transition Planning and Reentry: The Role of Family Engagement and Visitation)

Programs and Services for Parents

The old saying, “strike while the iron is hot,” is most relevant at this time. When a youth is confined, there is an excellent opportunity to engage the youths’ parents or guardians in any intervention and treatment planning. Parents should be recognized for having the unique historical perspective they have on the youth’s development and experiences and should be viewed as partners in the intervention process. All too often, parents are excluded as potential contributors to an effective treatment intervention for the youth. Parent involvement is also important to successful planning for reentry.

Many parents and guardians recognize that they need to develop new parenting skills and choose to attend parenting education courses and family counseling sessions. Some even seek individual counseling. Appropriately trained facility or other staff may also offer crisis intervention, family counseling, parent self-help groups, and substance abuse programs for the parents of addicted youth.

Group counseling with parents, in which a qualified facilitator meets with several parents for 60 to 90 minutes per week, has been shown to be highly effective in helping parents manage the confinement crisis and strengthen their parenting skills. During these self-help sessions, parents have the opportunity learn from each other and identify approaches that can be applied in their home situations. They may receive guidance from other parents who have successfully handled similar problems. Often, the facilitator does not need to do more than convene the meeting and support the group in discussing whatever issues may be of concern to them. Parents identify with other parents, particularly in this type of crisis situation. As a result, parents may be willing to try new approaches in working with their children.

Parent groups can include the parents of confined youth, as well as those of previously confined youth. Facilitators may also wish to engage probation officers or aftercare workers in the group discussions. In this way, probation or aftercare staff can continue these groups in the community to support those parents whose children remain under formal supervision after release.

Other forms of family group counseling have also been successful. Using the skills of trained substance abuse counselors, parents can be educated on critical issues related to substance abuse. They can learn to identify the signs and symptoms of a substance abuse problem in their children and identify resources available to address the problem. In the process, parents may also realize they have a substance abuse problem of their own and seek help for themselves.

In some cases, crisis intervention counseling and victim awareness can be useful to parents, particularly when the victim is another member of the family or when the parents themselves are the victims. Involving parents in these kinds of group processes can benefit the family.

Although the length of stay for youth in juvenile detention facilities is often short, compared to post dispositional correctional placements, these short-term facilities should still offer programs and services to strengthen families and provide assistance to parents as needed. Parents will respond to an environment of genuine care and help. A nonthreatening, “we care” attitude, combined with a self-help process, may help parents manage their children in a more positive and constructive manner.

Family programming begins with family-friendly visitation policies. Confinement facilities that serve youth should make family visitation available as frequently as possible, preferably not less often than least twice weekly. Family members should be able to make arrangements for special visits when work, childcare, or other unavoidable scheduling conflicts prohibit them from visiting during regularly scheduled visitation times.

The Annie E. Casey Juvenile Detention Alternatives Initiative (JDAI) facility assessment standards recommend the following related to visitation:[19]

  1. Youth may visit with parents/guardians, adult relatives, and family friends. Staff encourages visitation with the youth’s (male or female) own children, and the parent/child relationship is facilitated through phone and mail contact and appropriate visiting space. Younger relatives (siblings or cousins) may visit with approval of the youth’s counselor or probation officer. Written policies clearly describe the approval procedure for special visitors.
  2. Family visiting occurs on several days of the week. Staff posts a schedule of visiting hours and rules.
  3. Families may schedule visits at other times with permission from the facility administrator or designee. Written policies clearly describe procedures for special visits.
  4. Visits are at least one hour in length and are contact visits. Staff imposes noncontact visits only when there is a specific risk to the safety and security of the facility.
  5. Staff does not deprive youth on disciplinary status of visits as a punishment. Youth on disciplinary status may have visits with family members unless such visits would pose an immediate threat to the safety and security of the facility.
  6. Staff may supervise the visiting area, but may not monitor conversations, absent a reasonable suspicion that a crime, escape, or threat to safety or security may occur.
  7. If staff conducts searches following visits, they use the least intrusive measure to protect against the introduction of contraband into the facility. Written policy and procedure clearly describe the facility’s practice.
  8. Written policies, procedures, and actual practices ensure that searches of visitors, beyond routine security such as metal detectors, are limited to cases where there is reasonable suspicion that the person is bringing in contraband. Staff posts the search policies so visitors are aware of the rules.
  9. Visitors are able to ask questions or register complaints about the treatment of youth. Facility staff or administrators promptly reply to such questions or complaints.
  10. There are regular family forums at which families of detained youth may voice issues of concern, offer suggestions for improvement, and obtain needed information about institutional policies and practices.
  11. Transportation arrangements are made available to assist visitors in getting to and from the facility if the facility is not otherwise accessible via public transportation.

Additional Programming

Volunteer and Mentoring Programs

Volunteers and mentors are people who donate their time and effort to enhance the facility’s services, activities, and operations. Volunteers and mentors are selected on the basis of their skills or personal qualities, without regard to disability, race, sex, or national origin.

Some common examples of services that volunteers and mentors can provide are recreation, counseling, education or tutoring, and clerical duties. The following issues are important regarding the use of volunteers and mentors:

  • Volunteers and mentors should be at least 21 years of age and should have appropriate training or licensing, when required.
  • All volunteers and mentors should know and follow the policies and procedures for the facility and for the volunteer and mentor program.
  • Volunteers and mentors should receive some form of identification that designates the individual’s name and status with the agency.
  • Volunteers and mentors should operate under the same insurance and liability rules and regulations as facility employees.
  • A job description for each volunteer and mentor position should be developed, and volunteers and mentors should go through an interview process, similar to that for facility employees.
  • The prospective volunteer or mentor should provide at least three references, one of which is work related, and sign a release of information.
  • Criminal background and child abuse and sex offender registry checks should be conducted before assigning a volunteer or mentor to any program responsibility that involves direct interaction with youth. Follow-up checks should be scheduled along with staff background checks or other inquiries.
  • Once a volunteer or mentor is approved, the facility should create a personnel file and have the volunteer sign a confidentiality statement regarding juvenile information.
  • All volunteers and mentors should receive the same orientation and review of facility policies and procedures as paid staff members and should be encouraged to participate in any training that is regularly offered to employees of the agency, space allowing.
  • The facility administrator should formally recognize and acknowledge the contributions that volunteers and mentors make to the youth and to the facility.
  • All volunteers and mentors should be supervised. Violations by volunteers or mentors of agency policies and procedures should be dealt with in a fair and impartial fashion.
  • Whenever possible, volunteer and mentor services should be included in the annual budget prepared by the facility.

Students working at a facility in a designated internship or practicum should operate under an intern or practicum agreement established between the facility and the educational program or institution, not under the volunteer and mentor program policies and procedures.

A report on volunteer and mentor services should be prepared annually and submitted to the facility director to complete a program evaluation and needs assessment.[20]

Balanced and Restorative Community Justice (BARJ)

Since the mid-1990s, the Balanced and Restorative Justice (BARJ) Model has been a viable alternative to the popular get-tough approach to crime that became prevalent in the late 1980s. Although BARJ constitutes a philosophical structure rather than a specific program, it provides a solid framework or foundation for the development and implementation of effective, helpful programs in confinement facilities that serve youth. By applying the principles of BARJ to program development, facilities can move from a retributive or punitive focus to one of restoration and positive growth.

The basic principles of restorative justice are as follows:

  • Crime is injury.
  • Crime hurts individual victims, communities, and juvenile offenders and creates an obligation to make things right.
  • All parties should be a part of the response to the crime, including the victim (if he or she wishes) the community, and the juvenile offender.
  • The victim’s perspective is central to deciding how to repair the harm caused by the crime.
  • Accountability for the juvenile offender means accepting responsibility and acting to repair the harm done.
  • The community is responsible for the well being of all its members, including both victim and offender.
  • All human beings have dignity and worth.
  • Restoration means repairing the harm and rebuilding relationships in the community and is the primary goal of restorative justice.
  • Results are measured by how much repair was done rather than by how much punishment was inflicted.
  • Crime control cannot be achieved without active involvement of the community.
  • The juvenile justice process is respectful of age, abilities, sexual orientation, family status, and diverse cultures and backgrounds—whether racial, ethnic, geographic, religious, economic, or other—and all are given equal protection and due process.[21]

These principles provide the foundation for the “balanced approach,” which addresses the three main goals of accountability, competency development, and community safety. It is in these three areas that facilities can develop and implement specific programs for youth that are consistent with BARJ. Although the types of programs will differ depending on the pre-adjudication or post-dispositional function of the facility, all facilities can implement effective programs that are consistent with the BARJ philosophy.

The Accountability goal addresses the need for the youth to accept responsibility for his or her behavior and attempt to repair the harm to others or to the community as a result of the behavior. Taking ownership for one’s behavior and making amends to the victim(s), represents restoration as opposed to punishment, which is retributive in nature. Accountability, in BARJ terms, provides a learning opportunity for youth not typically found in the use of punitive sanctions.

Facility administrators that address the goal of accountability should develop and implement programs for youth that focus on their accepting responsibility for the behavior that caused harm and specifically communicating that ownership to those who were harmed. Depending upon the facility structure and environment, accountability-focused programs could include family group conferencing, restitution, face-to-face meetings or mediation, and verbal or written apologies. Engaging victims can be a powerful tool in addressing the accountability goal but needs to be carefully planned and supervised. When developing and implementing programs that engage victims, care must be taken to avoid any further trauma or harm to the victim or the youth. Youth in detention and not yet adjudicated may be provided programs that are generic in nature rather than based upon the specific offense.

The Competency Development goal addresses the need for youth to develop new skills that will enable them to function more effectively and positively in the community. Many facilities implement effective programs that address this goal area. Programs that focus on developing social skills, life skills, anger management, empathy, cognitive behavioral training, communication skills, work or academic skills, or problem solving can be tailored to meet the BARJ competency development expectation. Unlike the accountability goal, both pre-adjudicated and post-dispositional youth can benefit from effective competency development programs.

The Community Safety goal addresses the need for youth to return to the community after accepting responsibility for the harm they have done and developing new competencies to prevent further harmful behavior to individuals or the community at large. Rather than focusing on removing the youth from the community and imposing punishment to achieve community safety, BARJ focuses on strengths-based approaches and graduated sanctions designed to assist youth in becoming more responsible citizens. Facilities should initiate the reentry process at the very beginning of the youth’s stay and integrate BARJ focused programs with an individualized reentry plan throughout his or her placement as part of the overall treatment and service plan. The goal of community safety can be achieved through the development and implementation of effective BARJ programs for youth.

Community Service Programs

Community service is most often referred to in the context of a sentence following disposition or adjudication of guilt. Community service is frequently used as a substitute for restitution.

When a youth has been found guilty, a judge will often impose a specific number of hours of community service in lieu of confining the youth. In these cases, the community service usually benefits governmental or nonprofit agencies in the community. In most cases, the person providing a community service is under probation or other appropriate juvenile justice staff supervision.

What makes community service for youth in confinement facilities unique is that the youth remain in secure care throughout the period of community service unless the court or jurisdictional authority determines otherwise. Therefore, projects that can occur inside of facilities should be considered over projects that require the youth to be transported elsewhere. The fact that youth are in secure care should not be a barrier that will keep them from doing community service work during their period of incarceration.

Some examples of community service that can be accomplished within secure confinement facilities are the following:

  • Helping civic and nonprofit groups with mass mailings. Youth in confinement can fold and stuff envelopes as a community service project. The facility should not allow youth to be involved in political campaigns or work for political candidates, because this would constitute a conflict of interest. The facility administrator and staff should be aware of potential conflicts and disclose them whenever possible.
  • Becoming certified in cardiopulmonary resuscitation (CPR) and first aid. Although this is not a direct community service project, knowledge of these skills can be of help to the community later on.
  • Creating artwork and crafts projects for senior citizen centers, nursing homes, and municipal buildings. Many young people in confinement are very talented. However, they need to be encouraged to use and demonstrate these talents. By sharing works of art with people in nursing homes, hospitals, and senior citizen centers, youth can feel they are enhancing the quality of life for others. Municipal buildings—such as county buildings, city halls, and libraries—often welcome artwork done by youth. The artwork can be displayed as a separate project or as part of a larger exhibit, with recognition that the contributions came from justice-involved youth. Through this approach, the public may begin to understand that many youth caught in the web of juvenile delinquency or criminal behavior are also very talented, capable, and worthy of investments made in them.
  • Participating in seasonal activities to provide support to needy families and children. These types of activities can be accomplished in cooperation with the giving campaigns of civic organizations.

Youth in confinement facilities can make positive and useful contributions to their community even while in secure care. The recognition of their talents and their willingness to give can raise the youth’s self-esteem and increase the public’s understanding of these youth. Creativity and innovation are all that is needed to develop a strong community service program in a facility. Community service is a low-cost program with great potential benefit for the community, the facility and the youth.

Religious Services

ACA standards provide clear direction related to religious services. Guaranteed by the U.S. Constitution, access to religious services must be available to confined youth. The ACA standards provide definitions of services and information on access to religious services by the youth, and the requirements for staff.[22] They also require written policies and procedures that govern the institution’s religious services programs.

Although the ACA standards highlight the importance of a religious services program, they do not discuss the specific nature or content of such a program.

What is the purpose of religious services for youth?

  • To offer culturally-neutral values that may enhance human growth and offer a perspective that looks beyond cultural materialism, while acknowledging the disparity of justice in our world and society.
  • To meet adults who bridge the gap between social control demands and the youth’s need for affirmation as a human—adults who “walk their talk.”
  • To instill the challenge of “living all we are intended to be” rather than “settling for what we can get away with.”
  • To encourage youth to explore their spiritual capacity for growth and change.
  • To provide opportunities for youth to articulate or ritualize their faith.
  • To teach youth to pray and to create opportunities for prayerful moments.
  • To provide for the spiritual needs of the residents as an integral component of holistic treatment.
  • To provide encouragement and support at a time when youth are in trouble.

What benefits, if any, do youth receive from participation in religious services?

  • It provides youth with comfort.
  • It may provide youth with interaction with volunteers of diverse religious backgrounds. Detained youth are accustomed to broken promises, especially from people who do things because they get paid. Volunteers come because they want to come, and even if the visit comes only once per month, it is predictable.
  • It provides youth with a nurturing of spirituality.
  • It provides youth with a general emotional catharsis, which may be useful from an institutional management standpoint that if instigated by detention staff, might be questionable from an ethical standpoint.
  • It gives youth ideas and messages to ponder.
  • It provides youth with the opportunity of choice (to attend or not to attend).

Who is most effective in sharing religious thought with youth?

  • Someone who obviously likes people, and youth in particular.
  • Someone who is nonjudgmental.
  • Someone who seriously cares for youth and will continue to visit even when the response is less than desired.
  • Someone who listens first, who “walks with” second, and who proclaims last.
  • Someone of faith who lives what he or she professes; youth can spot hypocrisy.
  • Someone who is open to youth’s spiritual needs and does not try to convert them or threaten them with “fire and brimstone.”
  • Someone who shares faith and who tries to build a relationship first—which takes time and patience.
  • Someone who is comfortable with “unfinished products.”
  • Someone who is comfortable being an adult in a youth setting, not being a “buddy.”
  • Someone who can say “no” without rancor, accusation, or challenge and who speaks from a sense of self-limits that are rooted in values rather than rules.
  • Someone who is consistent in sharing his or her faith and who comes as scheduled.
  • Someone who respects the youth, such as campus ministers, clergy, or volunteers.

What are the most effective ways of sharing religious thought with youth?

  • Through careful sharing in small groups, seldom through large groups.
  • Through experiential learning exercises.
  • Through the words of their culture’s spiritual leaders.
  • Through offering the choice not to participate.
  • Through a time for personal prayer.
  • Through religious education formats that address youth issues and teach youth faith skills.
  • Through role playing that helps youth learn how to put spiritual principles into practice in their lives.
  • Through song. Youth who have the talent or the yearning to share their voice in song can be deeply affected by having the chance to sing.

What is the most effective way of developing spiritual growth in youth?

  • Modeling spiritual principles without being “syrupy” or offensive.
  • Offering meaningful and participatory worship experiences, scriptural study that relates to life issues, involvement in service projects (serving at soup kitchens or building wheel chair ramps), and retreats.

In some facilities, the person responsible for religious services is called the chaplain. In larger institutions, the chaplain may hold a full-time paid position funded by the institution or by the local religious community. For example, Youth for Christ organizations frequently include local juvenile facilities in their ministry. In smaller facilities, religious services may be provided by one or more members of the local clergy who commit their time and services on a voluntary basis. The Reverend Ken Ponds’ questions also addressed the role of the chaplain in the facility.

What should be the relationship of the chaplain to the administration of the facility?

  • There should be a tension present, which is obvious to all and which is respectful. The chaplain should not seek to obstruct or be a tool for institutional management. The integrity of the chaplain has only a fleeting chance in the eyes of the youth; the chaplain must be perceived as being his or her own person.
  • The best situation would have several denominations assist with the compensation of the chaplain to remind both the chaplain and the institution that the chaplain truly serves.

What role does the chaplain play for youth and for the staff who serve those youth?

  • Support and an opportunity to vent for all.
  • Reinforcement to treat one another humanely.

According to Jeong Woong Cheon and Edward Canda, “Adolescence is a particularly intense period of ideological hunger, a striving for meaning and purpose, and desire for relationship and connectedness…In particular, youth spirituality is regarded as young people’s developmental search engine for connectedness, meaning, and being in touch with what is most vital to one’s life…”[23] For many youth in confinement, access to religious and spiritual services and programs may serve to address this striving and meet these needs.

Recreation Programs

One critical aspect of programming is that it must provide a means for the constructive channeling of energy (physical activity). There is a special need for involvement in noncompetitive sports and activities that allow for differences in strength, dexterity, and size. Recreation has the potential for raising a youth’s self-esteem and for supporting the establishment of positive relationships between staff and youth. Handled poorly, it may also have a negative effect in these relationships.

Noncompetitive Activities

Even though most juvenile delinquents are risk-takers, for a variety of reasons, they are generally not involved in organized sports or athletic programs. Because most confinement facilities have a gym and most juvenile offenders have had experience playing basketball, basketball frequently becomes the predominant form of recreation. In addition to sometimes excluding female youth, basketball becomes a convenient recreation strategy that requires minimal involvement and planning on the part of staff.

If the primary goal is maximum involvement of youth in a recreation program, youth must be encouraged to participate. One very effective way to increase participation is through the use of noncompetitive games. These activities are highly inclusive and nonthreatening. They provide staff with numerous opportunities encourage and praise youth. As youth become more trusting and confident, they are more likely to cooperate with others, follow the guidance and direction of staff, and engage in more vigorous physical activities. If approached gradually, noncompetitive games can lead youth into more demanding or challenging recreational activities, such as physical fitness and aerobics.

The New Games movement, which promotes the use of noncompetitive games, began in the late 1960s. These types of games can and have been used successfully with youth in confinement settings.[24] Noncompetitive sports and activities allow for differences in strength, dexterity, and size, encouraging all participants to engage in play. (See Ch. 14: Behavior Management)

Physical Fitness

It is almost impossible to enjoy good health and achieve optimum physical fitness without a planned program of regular exercise. Therefore, physical fitness in youth confinement facilities should include a planned and supervised program designed to maintain a healthy and appropriate body weight and keep a youth's muscles well toned. Proper daily exercise is important to better health, a longer life, and a greatly improved quality of life. Exercise has also been proven to alleviate depression and decrease anxiety.[25]

Facility staff can initiate and develop a recreation program to fit the facility’s philosophy and mission. A recreation program that works well combines old-fashioned physical fitness (calisthenics, running, and weight training) with a variety of sports and games.

A physical fitness program should be approached sequentially. Youth should have an opportunity to work up to vigorous and strenuous exercise routines. At every opportunity along the way, staff should encourage and reinforce participation, effort, accomplishment, and the healthy feelings associated with physical exercise. The sequential nature of a program should include stretching exercises, calisthenics, aerobics, running or jogging programs, and weight training (stationary machines as opposed to free weights). A staff member trained in exercise physiology or physical education should supervise physical fitness programs.

Vigorous exercise is an important component of a good recreation program. The difference between a vigorous therapeutic recreation component and a military style boot camp is not the level of hard work or the expenditure of energy on exercising and physical fitness. Therapeutic recreation programs are not intended to demean, humiliate, or degrade youth by having a staff member yell at and harass them in a stereotypical drill-sergeant fashion. It is not within the legitimate role of youth confinement facilities to attempt to add to the pain and suffering inherent in being forcibly separated from home and society.

A physical fitness program should include a planned program of resistance training for everyone. Staff should make it enjoyable and never talk negatively about anyone’s physical condition or appearance. An overweight youth should be given exercises with high repetitions to help burn fat. A walking and jogging program is also recommended. In addition, staff should advise youth about the advantages of maintaining a healthy diet versus eating junk food and fast food.

As important as good physical fitness is, youth should never be forced to participate in an exercise program, but should be encouraged to become involved. The effort is most important. Encouragement and praise are always needed, especially for youth with a poor self image. Most youth respond in a positive way to physical activity, and their behaviors often improve in other parts of the program. Continued participation should be contingent on positive behavior in all areas of the daily program. As structured team games, sports can provide numerous learning experiences for youth. Sports, sports, and more sports should be offered to all youth in a comprehensive recreation program—which means there should be variety in the activities available to youth. By offering as many types of sports as possible, there is a greater chance that each youth will find one suited to his or her interests and abilities.

Before engaging in any sports, staff should teach youth the rules and work on the basic fundamentals for that particular sport. Sports in which youth may participate include basketball, football, floor hockey, softball, volleyball, weightlifting, running, aerobics, golf, handball, and soccer. Protective gear, flexible equipment, and special foam balls make many of these sports safe for a wide range of youth, usable in co-educational situations, and appropriate for play indoors in a gym, recreation room, or large dayroom.

Leisure Time

Youth in confinement facilities are typically high-risk youth who need structure. However, leisure time is an important component in all confinement programs. How and when leisure time is scheduled and used is important. Many facilities run a very structured program schedule that allows youth little free time. Others subject youth to excessive hours of television or card playing because of insufficient staff and other resources, overcrowding, or a belief that programs reward youth for their delinquent behavior. This latter approach does not qualify as constructive leisure time activity.

Staff must understand their responsibilities for programming and must adequately supervise youth at all times. High-quality programming also requires adequate space and equipment

Leisure-time activities should be chosen with thought and care and scheduled for a specific time within the daily schedule. Facilities may schedule leisure-time activities in the afternoon or evenings during the week and anytime during waking hours on the weekends. Such activities might include watching television or videos, listening to music, playing video games, reading books or magazines, writing letters, studying, playing board, table, or card games. Staff should be vigilant to ensure that card games do not involve any form of gambling.

Some facilities have a game room, which may provide access to additional leisure time activities for youth. Game rooms provide an opportunity for youth who do not enjoy sports to engage in other types of recreation, such as ping-pong, foosball, pinball, and air hockey. Many facilities also have media libraries where youth may access books for recreational reading and computers for listening to music or for playing instructional games or solving puzzles. The resources available in media centers or libraries, while recreational, also serve to complement the facility’s education program.

Staff interactions with youth during leisure time should be ongoing. It may take place in the dayroom, gymnasium or game room, or it may involve a simple talk about the youth’s day. Regardless, staff involvement in leisure time activities with youth can contribute to improved levels of mutual respect and positive working relationships.

Infrastructure to Ensure Successful and Sustainable Programs

Regardless of the type, size, or budget of the facility, it is imperative that facility administrators provide a solid foundation and support for the development and implementation of quality programs for youth in confinement. This includes ensuring that staff are well trained and prepared to deliver programming and that there are adequate resources (space, equipment, supplies) to support those programs. Local churches, service clubs—such as Kiwanis, Rotary and Lions Clubs—volunteer groups, and local philanthropic organizations are often willing to provide financial and other forms of support for youth programs wherever they are delivered. Active leadership and ongoing commitment shown by facility administration can demonstrate to staff and youth that these programs are a priority and will be supported in the future.

To be viewed as a legitimate organizational priority, programming should be articulated in the facility mission, vision, and guiding principles. In addition, programming should be included and fully described in the facility policy and procedure manual. Program manuals, lesson plans, and other materials should be regularly reviewed and updated; they should be consistently available to staff for them to effectively implement the program. Administrators should evaluate and hold staff accountable. Failure to do so can send the message to staff and youth that programs are really not a priority, which can negatively impact the level of commitment, success, and sustainability of programs for youth. Quality programs foster positive changes in youth and contribute to a more productive and positive environment for both youth and staff.

Reentry

The vast majority of youth released from confinement facilities will return home. The process of reentry is focused on ensuring that young people making this return home have access to the supervision, services, and supports they may need to be successful. In a Juvenile and Family Court Journal article entitled, “Reentry and Removal: Implications for Juvenile Confinement Facilities,” authors David Roush, James Moeser, and Timothy Walsh say that “JOR [Juvenile Offender Reentry] encourages citizens, government agencies, social services organizations, and community-based organizations, such as faith-based organizations, to make reentry the highest priority in programs and services to youths in juvenile confinement facilities.”[26] The authors go on to say that “a systematic involvement of community-based programs throughout incarceration enhances the likelihood of successful community reintegration. The public knows and trusts these community-based programs, and their involvement with the juvenile confinement facility enhances the public's cooperation with reentry programs.”[27]

Reentry planning should be part of the overall intervention planning for youth in confinement and as such should begin at the point of placement in any type of confinement facility. The key word in this statement is “planning,” as release from confinement does not by itself ensure the successful reentry of youth into those communities. The ultimate goal of all reentry planning and service delivery is total reintegration of the youth into their families, schools, and workplaces. Successful reintegration includes achievement of positive youth outcomes (e.g., educational achievements, employment, civic involvement) and increased public safety (e.g., reductions in recidivism). (See Ch. 18: Transition Planning and Reentry)

According to Shay Bilchik, there are five key areas emerging in youth reentry policy and practice:

  1. Integrating the science of adolescent brain development into the design of reentry initiatives.
  2. Ensuring that reentry initiatives build on youths’ strengths and assets to promote pro-social development.
  3. Engaging families and community members in a meaningful manner throughout the reentry process.
  4. Prioritizing education and employment as essential elements of a reentry plan.
  5. Providing a stable, well-supported transition to adulthood that helps to create lifelong connections.[28]

Each of these elements is a critical area for consideration by those individuals and organizations planning for reentry and services for youth.

Since 1987, OJJDP has been funding activities, evaluation, and research specific to the development of aftercare programming for juvenile justice-involved youth. The result of these investments has been the development of an Intensive Aftercare Program (IAP) model.[29] The IAP model identifies the following five principles for reentry program development.

  1. Preparing juveniles for progressively increased responsibility and freedom in the community.
  2. Facilitating interaction and involvement between juveniles and the community.
  3. Working with offenders and targeted community support systems (families, peers, schools, employers) on those qualities needed for constructive interactions that advance the juveniles’ reintegration into the community.
  4. Developing new resources and support services as needed.
  5. Monitoring and testing the capacity of juvenile offenders to receive—and the community to provide—services and support.

These principles can be used to guide justice system personnel and community service providers—either of which may provide reentry and aftercare programs—in the development of services for youth as they transition to the community.

In addition to this Guide, there are many resources available for use in planning reentry programs.

  • The Office of Juvenile Justice and Delinquency Prevention’s (OJJDP’s) Model Programs Guide (MPG) contains information about evidence-based juvenile justice and youth prevention, intervention, and reentry programs. It is a resource for practitioners and communities about what works, what is promising, and what does not work in juvenile justice, delinquency prevention, and child protection and safety.[30]
  • The National Reentry Resource Center provides education, training, and technical assistance to states, tribes, territories, local governments, service providers, nonprofit organizations, and corrections institutions working on offender reentry.[31]

Conclusion

Youth in confinement facilities are some of the nation’s most troubled and troublesome youth. The time they spend in confinement and what they do during this time are crucial. For many of these youth, their belief in themselves has been shattered and distorted. They are confined against their will, and the earlier supportive relations in the home and community are altered or severed as they pass beyond locked doors.

Programs may be structured differently from one facility to another, depending on such things as the facility size and purpose, the availability of financial and other resources—including staff—and any number of other factors. Whatever the structure or format, programming is critical to the ability of staff to effectively manage the behavior of youth. Programming provides youth with constructive activities and staff with opportunities to engage with youth, to help them learn new skills, and to feel better about themselves and their abilities.

Programming must be available to all youth at the facility, and confinement facility staff must see as their mission addressing youth and public protection and affording youth maximum opportunities for individual growth and change.

 

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OJJDP. Model Program Guide Glossary of Terms, “fidelity.” https://www.ojjdp.gov/mpg/Resource/Glossary.

Parent, Dale G., Valerie Leiter, Stephen Kennedy, Lisa Livens, Daniel Wentworth, and Sarah Wilcox. 1994. Conditions of Confinement: Juvenile Detention and Correctional Facilities (Research Report). Washington, DC: Office of Juvenile Justice and Delinquency Prevention. https://www.ojp.gov/pdffiles1/Digitization/141873NCJRS.pdf.

Pranis, Kay. 1998. Guide for Implementing Balanced and Restorative Justice. Washington, DC: Office of Juvenile Justice and Delinquency Prevention. https://www.ncjrs.gov/pdffiles/167887.pdf.

Roush, David W. 1996. Desktop Guide to Good Juvenile Detention Practice: Research Report. 161408. Washington, DC: Office of Juvenile Justice and Delinquency Prevention. https://www.ncjrs.gov/pdffiles/desktop.pdf.

Roush, David W. 2008. "Cognitive Behavioral Intervention with Serious and Violent Juvenile Offenders: Some Historical Perspective." Federal Probation 72, no. 3: 30–36.

Roush, David W., J.K. Christner, L.K. Lee, and M.B. Stelma. 1993. “Implementation of Social Skills Training in a Juvenile Detention Center.” Journal for Juvenile Justice and Detention Services 8, no. 1: 32–50.

Roush, David W., James Moeser, and Timothy Walsh. 2009. “Reentry and Removal: Implications for Juvenile Confinement Facilities.” Juvenile and Family Court Journal 56, no. 2: 1–13.

Simpson, Steven, Dan Miller, and Buzz Bocher. 2006. The Processing Pinnacle: An Educator's Guide To Better Processing. Bethany, OK: Wood ‘N’ Barnes.

 

 

Bibliography

Fleugelman, Andrew. 1976. The New Games Book. New Games Foundation.

Fleugelman, Andrew. 1981. More New Games. Main Street Books.

Le Fevre, Dale. 2012. Best New Games. Champaign, IL: Human Kinetics.

Martin, Gerry, and Joseph Pear. 1996. Behavior Modification: What it is and How to Do It . Upper Saddle River, NJ: Prentice Hall.

 

Endnotes


[1] Juvenile Justice and Delinquency Prevention Act of 1974. 2010. 42 U.S.C. 5633 [Sec. 223.].

[2] Jeffrey A. Butts, Gordon Bazemore, and Aundra Saa Meroe, Positive Youth Justice: Framing Justice Interventions Using the Concepts of Positive Youth Development, (Washington, DC: Coalition for Juvenile Justice, 2010): 7.

[3] Dale G. Parent, Valerie Leiter, Stephen Kennedy, Lisa Livens, Daniel Wentworth, and Sarah Wilcox, Conditions of Confinement: Juvenile Detention and Correctional Facilities (Research Report), (Washington, DC: Office of Juvenile Justice and Delinquency Prevention, 1994).; David W. Roush, J.K. Christner, L.K. Lee, and M.B. Stelma, “Implementation of Social Skills Training in a Juvenile Detention Center.” Journal for Juvenile Justice and Detention Services 8, no. 1(1993): 32–50.; Jeffrey Butts, Gordon Bazemore, and Aundra Saa Meroe, Positive Youth Justice: Framing Justice Interventions Using the Concepts of Positive Youth Development, (Washington, DC: Coalition for Juvenile Justice, 2010).

[4] National Institute of Mental Health, The Teen Brain: Still Under Construction, (Washington, DC: U.S. Department of Health Human Services, 2011).

[5] David A. Kolb, Experiential Learning: Experience as The Source of Learning and Development, (Upper Saddle River, NJ: Prentice Hall, 1984).

[6] Michelle Cummings, James Cain, and Jennifer Stanchfield, A Teachable Moment: A Facilitator’s Guide to Activities for Processing, Debriefing, Reviewing and Reflection, (Dubuque, IA: Kendall Hunt, 2012).; Micah Jacobson, and Mari Ruddy, Open To Outcome: A Practical Guide For Facilitating and Teaching Experiential Reflection, (Bethany, OK: Wood ‘N’ Barnes, 2004).; Steven Simpson, Dan Miller, and Buzz Bocher, The Processing Pinnacle: An Educator's Guide To Better Processing, (Bethany, OK: Wood ‘N’ Barnes, 2006).

[7] Austin/Travis County Reentry Roundtable, Evidence-Based Practice Committee, “Frequently Asked Questions: Evidence-Based Practices in Criminal Justice Settings.”

[8] FRIENDS National Resource Center for CBCAP, Evidence-Based & Evidence-Informed Programs: Prevention Program Descriptions Classified by CBCAP Evidence-Based and Evidence-Informed Categories, (Chapel Hill, NC: Author).

[9] Center for Effective Public Policy, A Framework for Evidence-Based Decision Making in Local Criminal Justice Systems, 3rd ed., (Washington, DC: National Institute of Corrections, 2010).

[10] Merriam-Webster, n. “fidelity.”

[11] OJJDP. Glossary, https://www.ojjdp.gov/mpg/Resource/Glossary.

[12] James Bell Associates, “Evaluation Brief: Measuring Implementation Fidelity,” (Arlington, VA: Author, 2009).

[13] More detailed information on steps to measure fidelity may be found at <a ">http://www.jbassoc.com/ReportsPublications/Evaluation%20Brief%20-%20Meas....

[14] Cailin O’Connor, Stephen A. Small, and Siobhan M. Cooney, “Program Fidelity and Adaptation: Meeting Local Needs Without Compromising Program Effectiveness,” (Madison, WI: University of Wisconsin–Madison/Extension, 2007).;

[15] As quoted in David W. Roush, "Cognitive Behavioral Intervention with Serious and Violent Juvenile Offenders: Some Historical Perspective," Federal Probation, 72 (3): 30–36.

[16] Beck Institute, “History of Cognitive Therapy.”

[17] Dowd, Tom, and Jeff Tierney, Teaching Social Skills to Youth: A Curriculum for Child Care Providers. Boys Town, NE: The Boys Town Press, 1992.

[18] K. Baird, Show You C.A.R.E.—Engaging Frontline Employees in Organizational Culture,” (Baird Group, 2009).

[19] Annie E. Casey Foundation, Juvenile Detention Facility Assessment: 2014 Update, (Baltimore, MD: Author, 2014): 129–130.

[20] David W. Roush, Desktop Guide to Good Juvenile Detention Practice: Research Report, 161408, (Washington, DC: Office of Juvenile Justice and Delinquency Prevention, 1996).

[21] K. Pranis, Guide for Implementing Balanced and Restorative Justice, (Washington, DC: Office of Juvenile Justice and Delinquency Prevention, 1998).

[22] ACA, Standards for Juvenile Detention Facilities, 3rd ed. (Alexandria, VA: Author, 1991).; ACA, Standards for Adult Correctional Institutions, 4th ed. (Alexandria, VA: Author, 2004).; ACA, Performance-Based Standards for Juvenile Correctional Facilities, 4th ed. (Alexandria, VA: Author, 2009).; ACA, Core Jail Standards, (Alexandria, VA: Author, 2010).

[23] Jeong Woong Cheon and Edward Canda, “The Meaning and Engagement of Spirituality for Positive Youth Development in Social Work,” Families in Society 91, no. 2 (2009): 123.

[24] David Roush, J.K. Christner, L.K. Lee, and M.B. Stelma, “Implementation of Social Skills Training in a Juvenile Detention Center,” Journal for Juvenile Justice and Detention Services 8, no. 1 (1993): 32–50.

[25] A. Byrne and D.G. Byrne, “The Effect of Exercise on Depression, Anxiety and Other Mood States: A Review,” Journal of Psychosomatic Research 37, no. 6 (1993): 565–574.

[26] David W. Roush, James Moeser, and Timothy Walsh, “Reentry and Removal: Implications for Juvenile Confinement Facilities,” Juvenile and Family Court Journal 56, no. 2 (2009): 2.

[27] Ibid, 3.

[28] Shay Bilchik, “Five Emerging Practices in Juvenile Reentry,” (Justice Center, The Council of State Governments, 2011).

[29] David M. Altschuler, Troy L. Armstrong, and Doris L. MacKenzie, Reintegration, Supervised Release, and Intensive Aftercare, Juvenile Justice Bulletin, (Washington, DC: Office of Juvenile Justice and Delinquency Prevention, 1999).

Ch.11 Mental Health

Ch.11 Mental Health web_admin Mon, 12/27/2021 - 10:55

Author: Lisa Boesky, PhD.

"Something is wrong with this kid. I don’t know what it is, but he’s definitely going to have a hard time being locked-up here."

Juvenile Correctional Officer

Youth with mental health disorders continue to enter and remain in juvenile detention, corrections, and adult jails and prisons. Some of these youth are mildly disturbed; others have a serious mental illness. Their ability to function in a facility can be compromised by:

  • Severe attention and concentration problems.
  • Serious mood disorders.
  • Histories of repeated trauma.
  • Unusual and bizarre thinking.
  • Self-destructive behavior.
  • Low intellectual functioning.
  • Issues related to alcohol or other drug use.
  • Aggression and violence.

Youth in custody with mental health disorders are a mixed group. Within the same week, staff may work with youth who have ADHD and struggle with rigid rules and stimulating living units, youth who hear voices, those who smear their feces on walls, and those who try to take their own lives.

The numbers of incarcerated youth are decreasing, dramatically in some states. The remaining population of juveniles in custody tends to be the most 1) violent, 2) criminal, 3) mentally ill, and 4) challenging to treat. This is a difficult and potentially dangerous combination, and one of the biggest challenges currently facing facilities that house juveniles.

How Many Youth in Custody Have a Mental Health Disorder?

The exact number of juveniles in custody with mental health disorders is currently unknown, however, research consistently shows that incarcerated youth suffer from significantly more mental illness than youth in the general population. Studies of youth in custody have found 63% to 92% met formal criteria for a mental health or substance use disorder.[1] When one of the studies removed conduct disorder and substance use disorders, almost half of youth still met criteria for a mental health disorder. The need is great for large-scale, standardized studies on incarcerated youth with mental health and substance use disorders to identify exactly how many are suffering and the nature of their conditions.

Suicide thoughts and attempts are more frequent among youth in custody; extreme levels of irritability and aggression are common, and self-injury is not unusual.[2] Gang members have high rates of mental health disorders, and youth with learning disorders are three times more likely to become gang members.[3] Many incarcerated youth have been exposed to serious, sometimes life-threatening trauma during childhood and adolescence.

Participation in outpatient mental health therapy is common among this population, and close to one-fifth has been hospitalized in inpatient mental-health facilities—with some youth requiring multiple hospitalizations.[4] Youth in correctional facilities and youth in psychiatric hospitals share more similarities than differences, and juvenile justice staff may often feel as if they are working at a mental health facility.[5]

Juvenile Justice Facilities Are the New Default “Mental Health” Facilities

Accessing quality mental healthcare has become increasingly difficult for adolescents, especially those from low-income communities or those who exhibit delinquent or aggressive behavior. Residential “treatment” options for youth with serious mental health disorders have shrunk; many psychiatric hospital programs for adolescents have closed. Of those remaining, many are hesitant to accept youth with criminal or violent histories—some refusing outright to admit them. Even when juveniles are admitted, brief inpatient stays are the norm.

Long waiting lists and ineffective outpatient treatment is typical. When their mental health deteriorates, mentally ill youth frequently engage in behaviors—some minor, some serious—that bring them to the attention of law enforcement. The juvenile justice system has become the default placement for many youth with mental health disorders who do not receive appropriate psychological and psychiatric treatment in the community. This is particularly true for minority youth who are over-represented in the juvenile justice system and under-represented in the mental health system. A government report found that “the unnecessary detention of youth who are waiting for mental health treatment is a serious national problem.”[6] When families of youth with mental health disorders were surveyed, over one-third reported that their children were placed in juvenile justice facilities because needed services were unavailable.[7] In addition, “zero-tolerance” school policies and an increase in school resource officers have resulted in more youth with mental health disorders being referred to the juvenile justice system for behaviors that in the past were handled by teachers and school administrators.[8]

Common Mental Health Disorders Among Incarcerated Youth

Following are the most common mental health disorders seen among youth in custody. See the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) for detailed descriptions of each condition;[9] subsequent sections explain how each mental health disorder specifically manifests among incarcerated youth.[10]

  • Attention-Deficit/Hyperactivity Disorder (ADHD)
  • Posttraumatic Stress Disorder (PTSD)
  • Oppositional Defiant Disorder (ODD)
  • Conduct Disorder
  • Major Depression
  • Persistent Depressive Disorder or Dysthymia
  • Disruptive Mood Dysregulation Disorder (DMDD)
  • Bipolar Disorder
  • Specific Learning Disorders (Learning Disabilities)
  • Intellectual Disability (previously known as Mental Retardation)
  • Fetal Alcohol Syndrome (FAS)

Youth can become psychotic (e.g., lose touch with reality; have difficulty differentiating fantasy from reality) if suffering from schizophrenia, bipolar, depression, or substance use disorders.

Most incarcerated youth with mental health disorders suffer from two or more impairing conditions simultaneously. The assessment and treatment of these juveniles becomes more clinically complex with each additional disorder. Plus, having co-morbid mental health disorders during adolescence can also raise juvenile offenders’ risk of recidivism during young adulthood.[11]

Because of intense suffering or problems functioning in day-to-day activities, some incarcerated youth require specialized mental health services, despite not meeting criteria for a formal mental health disorder, according to the DSM. Use of the DSM is the main way, but not the only way, to determine which juveniles suffer from psychopathology. The National Institutes of Mental Health (NIMH) has moved away from DSM categories and is developing a new classification system of mental disorders that is potentially very relevant to the mental health struggles seen among incarcerated youth.

Substance Use and Co-Occurring Disorders

Studies of youth in custody have found rates of substance use disorders ranging from 37%–86%.[12] Therefore, a significant number of youth require formal treatment for their problematic use of alcohol or other drugs. Co-occurring disorders refers to the simultaneous presence of both a mental health and a substance use disorder. One study found that one in ten incarcerated youth had depression, bipolar, or schizophrenia and a substance use disorder;[13] rates of substance use disorders co-occurring with conduct disorder and ADHD are likely even higher. The assessment, treatment, and management needs of juveniles with co-occurring disorders are different and more complex than those who suffer from only one condition. Individuals with co-occurring disorders have been shown to have:[14]

  • Higher rates of future criminal behavior.
  • Relationship problems.
  • Higher rates of depression.
  • Poor compliance with psychotropic medication.
  • Higher rates of hospitalization.
  • A lower likelihood of successfully completing treatment.

Juveniles with co-occurring disorders are also at increased risk of dying by suicide.[15]

Head Injury and Brain Trauma

Many incarcerated juveniles have had experiences in which damage to their brain could have occurred: physical fights, car accidents, a blow to the head as a child, being shaken as a baby, falling from trees or down stairs, excessive drug use, being beat up, jumped by gang members, and others.

Some incarcerated youth experienced trauma to their brain before birth; during pregnancy, their mother:

  • Used alcohol or other drugs.
  • Did not receive appropriate prenatal care.
  • Was malnourished.
  • Was infected with an illness.
  • Gave birth prematurely before the youth’s brain was fully developed.
  • Experienced birth complications (e.g., decreased oxygen to baby’s brain).

Studies show that one in four to almost one in five incarcerated youth suffer from traumatic brain injury.[16] Most of these injuries are unidentified.

Incarcerated juveniles with damage to the front part of the brain, where the “executive” functions reside, typically have difficulty:

  • Planning ahead.
  • Accurately judging situations.
  • Controlling their emotions.
  • Prioritizing what to pay attention to.
  • Controlling their behavior.

Therefore, these youth have a hard time:

  • Following rules or directives.
  • Delaying immediate gratification.
  • Behaving appropriately when obstacles and challenges are present.
  • Keeping their emotions under control.
  • Learning from consequences or past mistakes.

In response to their negative behavior, youth in custody with head trauma frequently lose privileges and spend time in isolation. Some are restrained; many end up in the adult system. Decision-makers are typically unaware of juveniles’ brain damage, therefore, the misguided perception that these are “bad” kids making “bad” choices drives placement and programming decisions.

Comprehensive neuropsychological assessments are rarely obtained for incarcerated youth, primarily due to the high financial cost and minimal access to neuropsychologists. A relatively brief neuropsychological screening should be conducted with youth who exhibit persistent aggressive or violent behavior, as well as with impulsive, emotionally unstable youth who cause significant disruption to a living unit or facility. If neuropsychological screening detects an issue, juveniles should be referred for a comprehensive neuropsychological battery. The cost of this type of assessment is high, but less than the physical and financial resources spent unsuccessfully managing these youth.

Trauma Among Youth in Custody

Trauma among incarcerated juveniles is the rule, not the exception. One study found 93% of youth in custody had at least one traumatic incident; over half had experienced trauma six or more times.[17]

The following are common in the history of incarcerated youth:

  • Witnessing someone being badly hurt or killed.
  • Extreme parental or caregiver neglect.
  • Physical, sexual, or emotional abuse.
  • Domestically violent home.
  • Removal from family home.
  • Placement in foster care or residential treatment setting.
  • Raised in filthy home with insects, rotting food, broken windows, no beds, and minimal food.
  • Sleeping in the same room with adults engaging in sexual activity or forced to watch pornography.
  • Victim of sex trafficking or prostituting their bodies.
  • Forced by parents or caregivers to have sex with strangers in exchange for drugs.
  • Locked in closets, cages, cars, or basements.
  • Being shot or stabbed.

Many of these traumas occurred during childhood, when youth did not possess the intellectual or emotional capacity to process frightening, disturbing, or painful events. The adults children depended on for stability, protection, and love were often those who caused the most harm. These adults, as well as others who could have helped youth cope with the aftereffects of traumatic incidents, were frequently struggling with their own issues. Hurt people hurt people.

Interpersonal traumas (e.g., abuse, neglect, witnessing domestic violence, separation from parents) tend to have the most negative impact on young people. Depression, anxiety, PTSD, attention problems, substance abuse, as well as aggressive, delinquent, and violent behavior, are all associated with having experienced traumatic events; and parental or caregiver neglect is at least as damaging as physical and sexual abuse.[18]

Many incarcerated youth have experienced “poly-victimization”—multiple forms of victimization experienced by a single child. The greater the number of traumatic experiences, the more damage to a child or adolescent. Compared to other traumatized youth, those who have experienced numerous different types of traumas are:[19]

  • At double the risk of developing depression.
  • Three times more likely to develop PTSD.
  • Three to five times more likely to abuse alcohol or other drugs.

They are also at higher risk of:

  • Engaging in delinquent behavior.
  • Struggling in school.
  • Running away.
  • Becoming suicidal.

Experiencing multiple types of maltreatment is associated with “reactive aggression” (e.g., impulsive, angry aggression in response to perceived provocation versus aggression to obtain status, power, or material goods).

Posttraumatic Stress Disorder (PTSD) Among Incarcerated Youth

Studies of youth in custody find rates of PTSD ranging from 10%–50%,[20] which is remarkably high, given that the rate of PTSD among youth in the general population ranges from 6%–8%,[21] and the rate of combat-related PTSD among soldiers returning from Iraq or Afghanistan is estimated to range from 4%–17%.[22] Almost all incarcerated youth who suffer from PTSD also suffer from another mental health or substance use disorder, with half suffering from two or more disorders in addition to PTSD.[23] Youth who experience multiple traumas but do not meet the full criteria for PTSD experience similar distress and problems in daily life as those formally diagnosed with PTSD.[24] Therefore, juveniles who experience impairment due to trauma-related symptoms should be referred for treatment, regardless of whether they qualify for a PTSD diagnosis.[25]

The DSM criteria for PTSD fits well with a one-time event that shocks or terrorizes an individual (e.g., rape, car accident, witnessing a murder), rather than the chronic, multiple interpersonal traumas many youth in custody experience. Studies of justice-involved youth have found that 57% experienced four or more traumatic events, and half have experienced six or more traumas.[26]

Because of the limitations of the PTSD diagnosis, modified diagnoses have been proposed—Complex Trauma, Complex PTSD, and Developmental Trauma Disorder—to better account for the impact of multiple, prolonged, inescapable trauma on 1) a youth’s mood, attention, and behavior, 2) his or her brain, and 3) key areas of a youth’s life.[27] Unfortunately, none of these diagnoses were formally listed in the most recent manual of mental disorders (DSM-V); however clinicians and researchers are increasingly integrating Complex Trauma, Complex PTSD, and Developmental Trauma Disorder models when screening, assessing, and treating juveniles with lengthy histories of multiple victimizations to more accurately and effectively meet the needs of this highly victimized group. See the National Child Traumatic Stress Network (NCTSN) for more information on trauma, Complex PTSD, and Developmental Trauma Disorder.

Misdiagnosis of Trauma and PTSD among Youth in Custody

Despite their high rates of trauma, multiple types of victimization, and associated suffering, most youth in custody are not diagnosed with a trauma-related condition or referred for trauma-related treatment. This is due to the following:

  • Trauma is often misdiagnosed as another mental health disorder (e.g., symptoms of trauma can look very similar to symptoms of ADHD, depression, bipolar, personality disorders, psychosis, and conduct disorder).
  • Chronic or heavy alcohol or other drug use to cope with traumatic experiences may be solely diagnosed as a substance use disorder.
  • Screening and assessments often do not ask about traumatic events.
  • Even when asked, incarcerated boys tend to underreport physical and sexual abuse, as well as any suffering related to traumatic experiences.
  • Boys tend to exhibit their distress in anger, irritability, and aggression and so are seen as bad youth versus traumatized or sad youth.

Research has found that one in six boys has been sexually abused, although this may be an underestimate.[28] The rate of sexual abuse among incarcerated boys is unknown, but is likely even higher than estimates for the general population, because many youth in custody were raised in environments that placed them at increased risk (e.g., instability, interpersonal conflict, living with one parent, domestic violence, experiencing additional forms of abuse). According to Holmes and Slap, sexual abuse among boys is “common, underreported, under-recognized, and undertreated”; harmful effects include, depression, anxiety, PTSD, paranoia, physical symptoms, anger, aggression, difficulty in school, running away from home, and delinquency.[29]

Some incarcerated youth have been given three, four, or five mental health and substance use diagnoses due to exhibiting a multitude of problems in multiple areas. Most clinicians do not consider that some or all of these symptoms may stem from an underlying core of trauma.

Trauma Changes the Brain

Early and severe trauma (particularly physical, sexual, and verbal abuse; neglect; domestic violence) can change the brain and central nervous system, as well as cause neuroendocrine abnormalities.[30] Faced with threatening situations (violent families and communities), the body automatically goes into “fight or flight” mode and releases certain chemicals. When these chemical responses in the brain are continually reactivated, it can lead to structural, molecular, and functional changes in a youth’s brain;[31] these negative changes are associated with significant academic, social, and behavior problems.

Repeatedly traumatized youth can become biologically wired for survival—always revved up, tense, and reactive. They constantly scan the environment for signs of a possible threat, and then impulsively respond. Not surprisingly, these youth often see danger, a threat, or an attack when none exists. A basic request from staff is perceived as a challenge. In casual conversations, they hear disrespect when none was intended. Traumatized youth are particularly keyed into non-verbal signals (e.g., inflection and tone of voice, body posture, how close someone is standing to them). These automatic reactions are intensified in facilities when youth feel unsafe with staff or peers. Youth whose brains have been impacted by multiple traumas are difficult to manage because of the following:

  • Unpredictable moods.
  • Difficulty calming down once upset.
  • Angry outbursts that are often out-of-proportion to what initially provoked them.
  • Apparent lack of concern for others.
  • Minimal impact of sanctions and negative consequences.
  • Minimal response to psychotropic medication.

Violence and delinquency are complex, multi-determined behaviors. It is not being suggested that trauma and multiple victimizations caused youth in custody to engage in them. However, the role of complex trauma among youth in juvenile detention, corrections, and adult facilities must be addressed and integrated into screenings, assessments, and interventions—especially among youth at the “deep end” of the system.

Re-traumatization

The combination of irritability, anger, fear of being seen as weak or vulnerable, and impulsivity often results in youth with significant trauma receiving multiple sanctions while in custody due to negative and sometimes dangerous behavior. Youth must be held accountable, including those who have been traumatized; however, staff should be aware that re-traumatization can occur when youth are:

  • Confined and locked in small rooms.
  • Physically restrained, especially by multiple staff members at once.
  • Physically searched, especially when the search is invasive.

The following can also trigger traumatic thoughts and emotions:

  • Being stripped of clothes or put into a safety smock after reporting thoughts of suicide.
  • Being observed by staff or harassed by peers while showering.
  • Witnessing or directly experiencing physical or sexual assaults.
  • Receiving no visits from family or caregivers.
  • Not being told important information.
  • Intrusive room checks in the middle of the night.
  • Intimidating and violent peers.
  • Antagonistic and harsh staff.

These situations can exacerbate feelings of vulnerability and loss of control, which often triggers an automatic, biologically programmed fight or flight survival response. When he or she is re-traumatized, a youth’s belligerent, destructive, or aggressive behavior is likely to escalate in intensity and duration. Not surprisingly, at this point, staff typically respond with more intensive supervision or control, physical restraint, or some form of isolation. This tends to further trigger youth, resulting in even more aggression, belligerence, or destructive behavior, which leads to longer or harsher sanctions. As the cycle continues, both youth and staff are at increased risk of getting hurt.

It is tragically ironic that juvenile justice facilities are one of the most difficult environments for traumatized youth—yet their traumatic histories often play a major role in the delinquent or violent behavior that gets them there.

Mental Health Screening and Assessment

To manage and effectively treat juveniles with mental health and substance use disorders, facilities must be able to identify these youth, their challenges, and their strengths. Doing so increases the likelihood that those who work with these youth will:

  • Refer them to qualified mental health professionals.
  • House them appropriately.
  • Use strategic and effective management strategies.
  • Provide effective clinical treatment.
  • Prescribe psychotropic medication only to youth who truly need it.

Accurately identifying juveniles with mental health and substance use disorders also helps reduce youth aggression, assaults, and suicide. Mental health “screening” and “assessment” are integrally related, but are not the same.

Mental Health Screening

Mental health screening is a brief (30 minutes or less) procedure primarily used to detect youth who may have a mental health disorder and are in need of further evaluation. Conducted early in the process of confinement, screening typically includes an interview and mental health checklists or questionnaires. Screening tools should be simple enough for a variety of professionals (including non-clinical staff) to administer, or for youth to complete on their own. They should be available in different languages, or facilities should have access to someone who can translate them. Every juvenile in custody should receive a mental health screening, regardless of his or her estimated length of stay.

When mental health screening identifies juveniles as possibly having mental health symptoms, youth should receive a more extensive assessment to explore the nature and severity of the symptoms, as well as determine the necessity of specialized treatment services. Mental health screening is not designed to provide a mental health diagnosis and should not be used for that purpose.

All youth in custody should be screened for mental health symptoms 1) upon entry to a facility, 2) each time youth move to a new placement (e.g., detention, correctional facility, work camp, ranch, group home), 3) if youth display dramatic changes in behavior, or 4) if staff suspect mental health symptoms.

At a minimum, mental health screening should include questions about:

  • Current or past mental health symptoms, self-injury, suicidal thoughts or behavior.
  • Current or past mental health treatment, psychotropic medication.
  • Current or past use of alcohol or other drugs, substance abuse treatment.
  • Cognitive or intellectual limitations.
  • Recent or past traumatic events.
  • Current or past aggressive or violent thoughts and behavior.
  • Current support system.
  • Strengths and resiliencies or protective factors.
  • Degree of insight regarding need for treatment.
  • Observation of juveniles’ behavior (e.g., appearance, attitude, speech, mood).

If a youth is overtly intoxicated or extremely agitated, staff should delay mental health screening until they can elicit compliance and obtain reliable results. Youth should not be placed in general population until the screening is completed.

Professionals conducting the screening should know about 1) mental health symptoms, 2) normal adolescent development, 3) the stress of incarceration, and 4) signs of intoxication and withdrawal. Juvenile justice professionals who administer a brief mental-health screening tool at intake do not need to have the same mental health knowledge as psychologists, but their knowledge and training must be appropriate to the task at hand. (See Ch. 9: Admission and Intake)

Referrals to Mental Health Professionals

Staff should refer youth to a qualified mental health professional (QMHP) within the facility if 1) “red-flags” are identified on screening tools, 2) youth exhibit moods or behaviors of concern, 3) they ask to speak with a QMHP, or 4) their parents or caregivers request it.

All facility staff should have access to the mental health referral process, as they are valuable observers of youth behavior. Requiring supervisors to sign-off on formal mental health referral slips submitted by staff helps them remain informed regarding a youth’s struggles.

According to the National Commission on Correctional Health Care (NCCHC), QMHP include psychiatrists, psychologists, psychiatric social workers, psychiatric nurses, and others who by virtue of their education, credentials, and experience are permitted by law to evaluate and care for the mental health needs of patients.[32]

Mental Health Assessment

Mental health assessments typically occur after youth have been identified in the screening process as having a possible mental health disorder. More comprehensive than screening, assessments often take hours to complete, and results provide the foundation for treatment planning within the facility and as youth prepare for transition back to the community. Assessments go into more depth on issues covered in the mental health screening; they explore additional key areas of a youth’s life. Youth are queried about their thoughts, feelings, and behavior.

Clinicians should assess a youth’s level of functioning—psychologically, intellectually, emotionally, and socially—to better understand the areas of challenge and success.

Specific diagnostic criteria from the DSM are used to establish whether a youth has a mental health disorder; if so, clinicians determine the scope and severity. Carrying a mental health diagnosis has major ramifications; therefore, clinicians who assign diagnoses to youth should have formal training in the 1) screening and assessment of mental health disorders among youth and 2) provision of mental health diagnoses among youth. Mental health diagnoses should only be assigned after a comprehensive and thorough mental health assessment.

Mental health assessments should include:

  • A clinical interview with youth.
  • Tests of cognitive and intellectual functioning.
  • Personality tests.
  • Rating scales and checklists regarding youth moods and behavior.
  • Information from individuals familiar with a youth's functioning, including family members.
  • Behavioral observations.

Short stays in detention facilities typically do not provide enough time for comprehensive mental health assessments that include psychological testing and the provision of a diagnosis. In these situations, QMHPs should spend as much time as is feasible assessing a youth’s mental health, developing plans that address immediate issues that may impede his or her success in the temporary setting, and communicating key information to individuals who supervise and interact with youth.

Mental health, substance use, and trauma should not be assessed in isolation because the three are highly interrelated, with overlapping symptoms. When youth have co-occurring mental health and substance use disorders, clinicians should examine how the two conditions interact. Because of the significant trauma histories among incarcerated youth, clinicians should evaluate the effect trauma plays in a youth's moods and behavior before assigning a mental health diagnosis.[33] Situational factors should also be taken into account before diagnoses are made; youth who react to a temporary stressor must be distinguished from those with true mental health disorders.

Mental health diagnoses are of little value to staff without detailed recommendations. Therefore, assessment results should be summarized in written form and integrated into daily programming, treatment, and transition plans. Clinicians should write in terms understandable to a youth’s family and professionals in various disciplines and should provide face-to-face feedback to youth regarding key findings.

Mental Health Reassessment

Youth with mental health disorders need periodic reassessments to determine whether their diagnosis (or lack thereof) and current treatment plan remain accurate. Serious mental health disorders may increase in severity as youth move into late adolescence; in contrast, a youth’s depressed mood, anxiety, or suicidal thoughts may disappear after a major stressor is removed. Reassessment is typically necessary if mentally ill youth exhibit a dramatic change in mood or behavior or experience major stress, or when there is reason to believe a previous mental health evaluation was unreliable or invalid.

Strength-Based Mental Health Screening and Assessment

Many confined youth have experienced tragedy, trauma, and crisis. Their strength and resiliency is often one of the primary reasons they survived—physically and emotionally—and these assets should be identified and explored. Rather than asking only about problems, difficulties, and areas in which youth struggle, mental health screening and assessment should also ask about areas in which juveniles have achieved or excelled. Questions about behaviors youth may be embarrassed or ashamed about should be balanced with questions about hobbies, interests, and areas that make them proud. Youth with mental health disorders are more than their pathology, diagnosis, or label. A strength-based approach does not entail overlooking criminal behavior or ways youth have harmed others; it strives for a more balanced approach. Taking a broader view of juveniles with mental health disorders demonstrates to them that adults are interested in knowing about each of them as a whole person.

Culturally-Sensitive Mental Health Assessment

Professionals who conduct mental health screenings and assessments with youth from various minority groups must be alert to cultural issues. Clinicians can misinterpret youth responses as signs of mental illness if unfamiliar with their background. For example, having visions of deceased relatives during periods of grieving is an accepted experience in some cultures and not viewed as hallucinations. Fearful youth exclaiming “they’re all after me” can be perceived as paranoid when rival gang members or others in the facility may truly be threatening them. By the same token, clinicians who rely on stereotypes of youth who are different than they are (e.g., culture, race, gender, sexual orientation) can overlook or automatically dismiss mental health symptoms, assuming they are just part of youth culture.

Youth from various racial and ethnic backgrounds can manifest mental health symptoms differently. Some mental health instruments have been developed for middle-class Caucasian males, so results may not be valid when assessing youth of other races, backgrounds, or another gender. In addition, parents or caregivers have often sought assistance for their mentally ill children from clergy, extended family, tribal healers, or curanderos; therefore, screening and assessment should broaden questions about previous treatment beyond outpatient or inpatient psychotherapy.

Which Screening and Assessment Instruments Are Best?

Using the same or similar screening and assessment tools throughout an entire juvenile justice agency—and within key partnering agencies—can facilitate more efficient and effective communication within and across systems. Standardized (administered the exact same way every time) instruments, with research evidence that demonstrates that they are reliable and valid, should be the first-line tools. Most mental health instruments were not developed for use with incarcerated youth, and some have limited validity for young women or minority youth. Non-research-based standardized screening tools can be used as a supplement; they typically contain questions that directly ask about specific behaviors such as “do you cut yourself to feel better?” or “what medication are you taking?” During all phases of the assessment process—test administration, scoring, interpretation, and reporting of results—individuals who administer mental health screening and assessment tools must take into account the strengths and limitations of the instruments they use and the population for whom they were developed.

See Boesky and Grisso, Vincent, and Seagrave, for a list of standardized mental health instruments used with youth in custody.[34]

Self-Report Information: Can We Believe What Incarcerated Youth Tell Us?

Most incarcerated youth answer honestly if directly asked about mental health symptoms. But they may inadvertently provide inaccurate information if intoxicated, do not have good memories, or have difficulty verbalizing their internal experience. Some youth deliberately minimize or exaggerate mental health symptoms, intentionally manufacture them, or deny them completely. Youth may minimize or deny mental health symptoms to avoid:

  • Being seen as weak, vulnerable, weird, or crazy.
  • Taking psychotropic medication.
  • Placement on a specialized unit or room.
  • Extra monitoring by staff.

Some seriously suicidal youth deny having thoughts of killing themselves so staff will not try to stop them.

Youth in custody may exaggerate or fabricate mental health symptoms because they want to:

  • Talk and spend time with a variety of professionals.
  • Obtain mind-altering psychotropic medication.
  • Be placed on a special unit or in a special room.

A few standardized mental health tools were designed to detect youth who are hiding or faking symptoms. These validity scales are particularly useful when assessing incarcerated youth, as are specialized tools that detect “malingering.”

The screening and assessment of youth with mental health, substance use, co-occurring, and trauma-related disorders is an ongoing process, especially in juvenile detention and adult jails where youth may be admitted with alcohol or other drugs in their system.

Mental Health Treatment

The treatment needs of youth with mental health disorders do not decrease or disappear when they enter juvenile detention, corrections, or an adult facility; on the contrary, their needs may intensify due to the stress of incarceration. Just as juvenile justice provides medical services to youth with external physical injuries, the system must also respond to a youth’s internal mental health symptoms. This responsibility is detailed in national standards[35] and recent class action lawsuits (e.g., incarcerated youth with serious mental health disorders have a constitutional right to mental health treatment).[36]

Correctional facilities are not inpatient psychiatric hospitals, nor should they be treated as such. These settings must be given appropriate funding and resources to provide intensive mental health services when, by default, they are expected to serve that role.

Regardless of the type of correctional setting, the goals of mental health treatment include:

  • Stabilize youth’s emotions and behavior.
  • Maintain safe facilities and orderly living units.
  • Reduce youth suffering and impairment in key areas.
  • Decrease self-destructive behavior.
  • Facilitate opportunities for youth to succeed while incarcerated.
  • Teach youth necessary skills to better control their emotions and behavior.
  • Teach youth necessary skills to function more successfully in the community.

Successful mental health, substance abuse, co-occurring, and trauma-related interventions address all areas of a youth’s life, including family, peers, school, community, or when necessary—youth's physiology (through medication). This mission is more difficult when youth are incarcerated, but the goal remains the same. Providing effective mental health treatment is not only best practice, it also reduces the likelihood of a large lawsuit, something common in recent years.

Except in rare circumstances, mental illness is not an excuse for youth breaking rules or laws. Accountability is essential in facilities—and having a mental health disorder does not change that. However, youth should not be sanctioned or punished for their mental health symptoms. This issue can be complicated when a youth’s mental health symptoms manifest in aggression and harm toward others, which is why mental and corrections staff must work together closely when sanctioning a youth with mental health disorders.

Involving Parents or Caregivers in Mental Health Treatment

Parents or caregivers experience a variety of emotions when their children with mental health disorders are incarcerated. Amidst hope that their children will receive treatment, they also worry that their vulnerable sons or daughters will be victimized while in custody. If they do not believe their children are mentally ill, parents or caregivers may be troubled upon hearing that facility clinicians want to prescribe psychotropic medication or other treatment services. They want to participate in the decisions that affect their children, but may not know how to become involved or have the resources and supports to do so. Time and energy must be devoted to engaging parents or caregivers in the assessment and treatment process to increase their motivation and foster positive treatment outcomes.

If parents or caregivers cannot attend in-person meetings, consider participation by conference call, webcams, Facetime, or another communication option. Efforts should be made to include fathers, even if they are only distantly involved in a youth’s life. Parents or caregivers should be encouraged to call the facility with questions or concerns about the mental health treatment of their children.

Strategies to Engage Youth and Their Parents or Caregivers in Treatment

For youth confined for more than a month, the following strategies can engage parents or caregivers and maintain their involvement as treatment progresses:[37]

  • Clarify what treatment is and what it is not (can differ pre- versus post-adjudication).
  • Set realistic treatment goals that are meaningful to juveniles and their families.
  • Update parents or caregivers regularly regarding the status of their child’s behavior.
  • Provide immediate responses to positive and negative youth behavior.
  • Follow through on all promises made to juveniles and their parents or caregivers.
  • Acknowledge and attempt to address other problems with which youth and their parents or caregivers are concerned.
  • Ensure that all professionals in the facility, regardless of discipline, send a consistent message on critical issues.
  • Treat youth and their parents or caregivers with respect at all times.

Allowing parents or caregivers to ask questions, provide input, and participate in decision-making is empowering and makes it more likely they will support and commit to the treatment process. Parents or caregivers should be educated on the benefits and risks of each treatment option, including psychotropic medication.

Treatment agreements help parents or caregivers understand what treatment will entail and the type of participation the practitioners expect of them. Treatment agreements reduce miscommunication and can be referred to if miscommunication should arise; they should be written and reviewed verbally with all parties. Treatment agreements should include 1) a description of the treatment process, 2) the goals of treatment, 3) limitations of treatment, and 4) information about relapse.[38]

Strength-Based Interactions with Parents or Caregivers

Parents or caregivers of incarcerated youth with mental health disorders have often had professionals point out what they were doing "wrong" raising their children, as well as in their own lives. Acknowledging their positive characteristics and effective parenting choices decreases apprehension and self-protection and increases motivation. Staff should balance questions about youth difficulties with questions about youth success (no matter how small); inquire about parents’ or caregivers’ fears and concerns about their children and what makes them most proud. Avoid language that implies that something is bad, wrong, or a problem and instead use words such as “challenge” and “struggling.” When incarcerated, juveniles and their parents or caregivers frequently feel hopeless about the situation or their child’s future. In such cases, staff might ask how they survived hardships and difficulties in the past. Many have overcome major obstacles, tragedy, and heartbreak, and some continue to cope with significant daily stressors. Staff should recognize and highlight these assets and strengths.

From the start, staff should reinforce participation in treatment with youth and their parents or caregivers; this helps increase the chance of completing treatment, should things become difficult. The following incentives can increase motivation to attend treatment sessions at the facility:

  • Transportation to or from the facility.
  • Food during treatment sessions.
  • Time for youth and their families to visit after sessions are over.
  • Verbal praise and acknowledgment.
  • Certificates of achievement.
  • Rituals for completed tasks or goals.
  • An extra phone call between youth and their parents or caregivers later in the week.

Regardless of their age, size, and strength, most youth in custody appear genuinely moved and touched when receiving praise from their parents or caregivers in response to their efforts or progress. Ask youth and their parents or caregivers what would be most motivating for them.

Informed Consent for Psychotropic Medication

Parents or caregivers should be contacted for their informed consent if youth are prescribed psychotropic medication. They should be told:

  • The mental health conditions youth suffer from.
  • The psychotropic medication to be prescribed.
  • Potential benefits and risks of the prescribed medication.
  • Potential benefits and risks of alternative treatments, including no medication.

Medical staff should ensure that parents or caregivers understand the explanation, have the capacity to give consent, and are not coerced or manipulated into giving permission. Verbal consent can typically suffice when a written signature cannot be obtained; however, a copy of the consent form and information about the medication should be mailed to parents. Most facilities require informed consent for the continuation of psychotropic medication prescribed in the community, although it typically does not have to be acquired immediately upon admission. Youth and their parents or caregivers should be involved in decisions associated with stopping psychotropic medication. Informed consent laws associated with psychotropic medication for incarcerated youth differ by state and locality; mental health and medical staff should familiarize themselves with local laws and be alert to any updates.

Suicide Prevention with Youth In Custody

Suicide is the leading cause of death among youth in confinement[39] and is more common among incarcerated youth than those in the community.[40] Death can seem like the only option to youth in custody who feel hopeless, alone, anxious, or depressed and who want to escape unbearable psychological pain, distressing circumstances, or dire futures. There are two types of staff that work directly with youth in custody: those who have encountered suicidal youth and those who will.

A study of youth in detention found one in ten had thought about killing themselves in the previous 6 months, and a little over one in ten had made an actual suicide attempt at some point in their lives, with many trying to kill themselves more than once. Fewer than half of the youth with recent suicidal thoughts had told anyone about them.[41] Rates are likely even higher among youth who are deeper in the system—those who reside in longer-term juvenile justice facilities.

Who Is Most At Risk for Suicide?

When working with youth who have the risk factors below, line staff should be alert to the possibility of suicidal thoughts or behavior.

  • Previous suicidal behavior.
  • Mental Health Disorders (e.g., depression, bipolar).
  • Substance use disorders.
  • Aggressive or violent behavior.
  • Family factors (e.g., suicide, mental illness, substance use among parents or caregivers; parental absence; lack of support; abuse or neglect; family conflict or domestic violence).
  • Poor social skills or few friends.
  • Stressful life events (e.g., legal or discipline problems; incarceration; isolation from peers in a facility; lengthy time in room or cell; prolonged stay in a juvenile justice facility; discipline or failure at school; break-up of romantic relationship; conflict with parent or other important adult; victim of bullying, harassment, humiliation, or rejection; sexual assault; death of a loved one; believing peers will harm or kill them).
  • Childhood abuse or neglect.
  • Exposure to someone else’s suicide.

Because most incarcerated youth often have three, four, or even all of the listed suicide risk factors, plus the stress of being detained or incarcerated, and restricted access to their typical coping skills (cigarettes, alcohol, other drugs, fighting, sex, running away)—all youth in custody should be viewed as at-risk for killing themselves.

The majority of youth who have died by suicide in juvenile justice facilities were not on any type of suicide precautions at the time of their death.[42] Therefore, we need to be vigilant about suicide among all incarcerated and detained youth—at all times.

Youth in custody are commonly housed alone in rooms with door knobs, handles, large hinges, protrusions on the ceiling, vents, towel racks, bunk beds, toilets, floor drains, clothing hooks, and other secure items to which they can tie a sheet, t-shirt, bra, or torn blanket and asphyxiate themselves. Even toilet paper or plastic trashcan liners can be twisted or braided into strong enough material to strangle oneself. If youth want to die, they can jump off the second tier of a two-story unit, jump in front of a moving vehicle on campus, asphyxiate themselves with hair extensions, or suffocate themselves by putting plastic liners of trash cans over their heads. Despite safe and secure facilities, there is a multitude of ways confined youth can kill themselves.

Protecting Youth in Custody

The best way to prevent suicide in juvenile justice facilities is to prevent youth from becoming suicidal in the first place. Implementing the recommendations and strategies throughout this chapter (e.g., mental health and suicide-specific screening and assessment, developing positive relationships, meaningful programming, education and vocational programs, home-like environments, evidence-based mental health and suicide-specific psychotherapy, a trauma-responsive approach, parent or caregiver engagement, skill-building rather than punishment, strength-based behavior management, a variety of recreation and leisure activities, collaboration between juvenile justice, mental health, medical and education staff) is one of the best ways to reduce the chances that a youth in custody will try to take his or her own life.

Identifying Youth Who Want to Die

Even though most youth in custody are at increased risk for suicide, placing them all on “suicide precautions” or in suicide-resistant rooms is not only impractical and unrealistic, it would likely be psychologically harmful. It is also unnecessary, because, despite having multiple suicide risk factors, the majority of youth in custody do not try to kill themselves.

Currently, there is no failsafe way to predict exactly which youth will try to take their own lives; identifying who is the highest risk for suicide among an already high-risk population is challenging. There is no “typical” suicidal youth. They may 1) be sad and withdrawn, 2) state they want to die, 3) deny suicidal thoughts or intentions, or 4) be angry and aggressive. Therefore, juvenile justice and mental health staff must consider multiple factors when determining degree of suicide risk, including observable behavior, youth history, facility suicide hazards, and youth interview.

Observable Behavior

Staff may not recognize depression among confined youth, as it is often experienced and exhibited as irritability, agitation, or aggression versus a sad mood; when these youth are mistakenly viewed as “bad” and given significant sanctions, their depression is likely to worsen. Suicide-related behavior has also been seen among intensely angry or frustrated youth, even though they are not depressed. All staff should be on the lookout for the following behaviors; exhibiting one of them does not necessarily indicate increased suicide risk, but a combination of them is concerning:

  • Sad or depressed mood.
  • Increased irritability or agitation.
  • Reduced interest or pleasure in activities they used to enjoy.
  • Complaints of having no energy or feeling tired all of the time.
  • Excessive levels of guilt or shame.
  • Difficulty concentrating or making decisions.
  • No emotion or youth seems apathetic.
  • Threatening or aggressive behavior.
  • Restless or agitated behavior.
  • Very slow speech or behavior.
  • Lack of appetite or overeating.
  • Problems falling or staying asleep, or sleeping too much.

Youth History

The more risk factors in a youth’s history, the higher his or her risk for suicide.

  • Previous suicide attempt.
  • Knowledge of or exposure to someone else’s suicide.
  • Past psychiatric hospitalization.
  • Prior or current psychotropic medication.
  • Prior or current mental health disorder (e.g., depression or bipolar).
  • Substance use disorder.
  • Multiple traumas.
  • Irritability or difficulty controlling their anger.
  • Family history of mental illness.
  • Violent behavior.

Facility Suicide Hazards

Potential facility suicide hazards include:

  • Low number of staff per youth requiring supervision.
  • Over-reliance on isolating juveniles.
  • Easily reached protrusions or projections in rooms.
  • Access to psychotropic medication.
  • Unit or cottage layout.
  • Clothing or uniforms with shoelaces, belts, or zippers.
  • Access to toxic materials (e.g., shampoo, cleaning chemicals).
  • Routine and predictable monitoring.

Youth Interview

All staff that work directly with youth in custody must be comfortable asking them about their suicidal thoughts and behavior. A five- to ten-minute private interview is usually enough time to determine whether juveniles are:

  • Potentially suicidal.
  • In need of referral to a QMHP.

Staff should approach youth they are concerned about, convey the specific behaviors that have them worried, and directly ask youth if they have been thinking about killing themselves. Staff should ask how youth would go about killing themselves if they report suicidal thoughts. Differentiating youth with passing thoughts from those seriously considering ending their lives is key. If youth describe a plan, staff should ask questions to assess 1) the specificity, 2) availability, and 3) lethality of the plan. Details, easy access, and plans that could result in death all increase a youth’s risk of suicide.

If time allows, staff should ask youth:

  • If they have made a previous suicide attempt. If so, when and how, and if they were hospitalized.
  • If they ever thought about suicide and did not made an attempt. If so, what they did to cope in that situation.
  • If there is one thing would help them no longer feel suicidal.

Incarcerated youth may not feel comfortable sharing the details of their suicidal thoughts, feelings, or plans with staff; or they may not want staff to interfere with their plan to die. That said, most youth—particularly those in emotional pain—answer honestly when asked about suicidal thoughts and behavior when staff are calm, nonjudgmental, and genuinely caring. Maintaining a conversational tone is much more effective than running down a checklist of questions or treating the interview as an interrogation. Staff should trust their judgment and intuition and talk with a supervisor or QMHP if a youth denies suicidal thoughts, but staff remain concerned about them due to their history, observable behavior, or facility hazards.[43]

There is no way to tell if youth are manipulating or truly want to die; “manipulative” individuals have died by their own hands. Although frustrating and difficult to manage, youth who engage in suicidal behavior solely to solicit attention, facilitate a transfer, or obtain coveted resources can accidentally kill themselves; they should be taken seriously, referred to QMHPs for an evaluation, and be closely monitored. Many “manipulative” youth have underlying mental health, substance use, and trauma-related disorders, as well as other risk factors that raise their suicide risk.

Key Components of a Suicide Prevention Program for Youth in Custody

All juvenile detention, corrections, and adult facilities that house youth must develop and implement comprehensive suicide prevention programs to identify potentially suicidal youth and respond in ways that reduce their suicidal thoughts and behavior. The recommendations below are based on correctional health care standards,[44] though most go further and include best practices.

Policies and Procedures

  • Suicide prevention policies and procedures should be written clearly, concisely, and in language easily understood by staff at all levels.

Suicide Prevention Training

  • Upon hire, every facility staff who comes into contact with or makes key decisions about youth should receive mandatory, practical, up-to-date and interactive training on suicide prevention among youth in custody (8-16 hours); mandatory refresher training (2-4 hours) should occur annually.

Suicide Screening and Referral

  • All youth in custody should be screened for suicide risk, in a private setting, by appropriately trained staff using a standardized form with interview questions and behavioral observations.
  • Youth identified as potentially suicidal should be placed on suicide precautions and immediately referred to a QMHP for an in-depth suicide assessment.
  • Youth should be re-screened for suicide risk at important transition points throughout the system (e.g., change in placement) and whenever indicated by a youth’s statements, behavior, or information coming from other sources.
  • Youth who elicit staff concern related to suicide at any point during their stay should be immediately referred to a QMHP for an in-depth suicide assessment. QMHPs should conduct a face-to-face suicide assessment of youth as soon as possible, but no longer than 24 hours after being contacted. Youth deemed to be a potential high risk for suicide should be continuously observed and monitored while awaiting a clinician’s evaluation.

Suicide Assessment or Evaluation

  • QMHPs should be available on site or by telephone, 24 hours a day, seven days a week.
  • Suicide assessments conducted by QMHPs should determine a youth’s degree of suicide risk, the level of monitoring needed, specific components for a safety plan, and if transfer to a psychiatric hospital is necessary. QMHPs have the license, education, training, and experience to make these decisions.
  • A determination of suicide risk should take into account a youth’s current behavior, history, and issues specific to the facility, in addition to the youth’s statements. Parents or caregivers may be able to provide valuable information related to a youth’s risk of suicide, as well as helpful strategies to support him or her. Youth placed on suicide precautions should be re-assessed in person (not through a door) by a QMHP at least once per day to determine if their suicide status has changed and, if it has, the QMHP takes action to address it (e.g., increase or decrease in the required level of monitoring, transfer to psychiatric hospital, removal from suicide precautions).
  • Each day, QMHPs should gather information about a suicidal youth’s behavior from a variety of staff with whom youth have interacted.

The period following removal from suicide precautions is a high-risk time for some juveniles; therefore, QMHPs should remain in close contact with youth after precautions end, assessing for suicide risk over the next several days. Contact should then be slowly spaced out, with QMHPs periodically assessing suicide risk.

Key Treatment Issues in Suicide Prevention

  • Suicide precautions or suicide watch are different than treatment and should be viewed as such. Staff recognize that restricting youth access to potentially lethal methods and closely observing them helps keep them safe, but often does little to decrease their distress, mental health symptoms, or hopelessness. If isolated from peers, staff, and programming, a suicidal youth’s suffering will likely worsen.
  • Based on a youth’s level of risk, QMHPs should develop individualized safety plans that address any modifications or restrictions to standard programming that are required for a youth’s safety. These should be as least restrictive as safely possible.
  • QMHPs should develop individualized treatment plans for youth on suicide precautions specifically targeting suicidal thoughts or behavior, and secondarily other key issues and needs. Treatment plans should emphasize the development and strengthening of protective factors as much as reducing suicide risk factors. QMHPs should use evidence-based or best practice psychotherapy to reduce suicidal thoughts and behavior and address underlying issues.
  • Psychotropic medication is prescribed only when necessary.
  • QMHPs should provide treatment to suicidal youth during high-risk periods and provide follow-up treatment and monitoring to reduce the risk of relapse after a suicidal crisis is over.
  • Line staff are essential to suicide prevention; they should be encouraged to build positive and supportive relationships with all youth during day-to day interactions and provide extra support to those who are suicidal.

Self-injury (cutting, head banging) is distinguished from suicide in screening, assessment and treatment, yet it is still regarded as a significant risk factor for suicide.

Intensive Monitoring

  • Staff should monitor youth at high risk for suicide in person and on an irregular schedule not to exceed 5 or 10 minutes, depending on a youth’s level of risk.
  • Staff should “continuously” observe (1:1 youth-to-staff ratio, sight and sound, close proximity) actively suicidal youth (threatening or engaging in suicide-related behavior) or transfer them to the hospital.
  • Staff should clearly document all monitoring.
  • Closed-circuit television and other ways of supervising suicidal youth can supplement, but never replace, in-person staff monitoring.
  • Juvenile justice, mental health, and medical professionals should be adequately trained to place potentially suicidal youth on suicide precautions; only QMHPs should be able to lower or take youth off suicide precautions.

Safe Housing of Suicidal Youth

  • Suicidal juveniles should be housed in the least-restrictive manner possible, given the severity of their suicidal behavior.
  • Suicidal youth who can safely participate in standard facility programming should do so with more intensive levels of supervision, monitoring, and documentation. Staff should encourage youth participation.
  • Suicidal youth should have access to the same academic, recreation, and leisure opportunities as their peers, unless these are modified for safety purposes; only QMHPs can implement or remove these modifications, and they must be documented and communicated to all relevant staff.
  • Suicidal youth should not be isolated; if this must be done for safety reasons, the decision should be made in collaboration with a QMHP, and suicidal youth must be continuously monitored.
  • Social interaction is essential to suicide prevention; removing suicidal youth from peers and programming can add to their feelings of alienation and depression. When alone in a cold and empty room, suicidal youth have little to distract them from their problems and a great deal of time to think about ways to kill themselves.
  • Suicidal youth who are unable to remain on their own living unit can be housed in safe rooms on mental health units or a health clinic. Youth should be housed near staff stations, with staff regularly interacting with them.
  • Suicidal youth should remain in regular clothing (except if wearing shoelaces or belts), unless they use their clothing to harm themselves. In those instances, only that piece of clothing should be removed.
  • Safety smocks should not be used, except in rare circumstances where it is indisputably necessary for youth safety and is done in collaboration with a QMHP. Youth should never be made to wear special clothing that signifies their risk of suicide. All rooms or cells that house suicidal juveniles should be suicide resistant (e.g., no secure objects youth can tie something to and asphyxiate themselves, nothing youth can use to suffocate themselves, large viewing windows)

Every facility should have enough suicide resistant rooms to meet the needs of their population.

Communication About Suicidal Youth

  • Juvenile justice, mental health, medical, and educational staff should meet daily to discuss which youth in the facility are on suicide precautions and the most effective strategies to observe and manage them.
  • Juvenile justice staff should communicate from one shift to another about 1) which youth are on suicide precautions, 2) the level of intensive monitoring required, and 3) any specific information needed to help keep these youth safe.
  • Communication about suicidal youth should occur between facility staff and community agencies (e.g., arresting or transporting officer, local court, psychiatric or medical hospitals) when necessary.
  • QMHPs should communicate with juvenile justice and medical staff before removing youth from suicide precautions.
  • Juvenile justice, mental health, and medical staff should document essential information related to which juveniles require more intensive monitoring and why. Documented information from a variety of sources helps juvenile justice staff strategically manage suicidal youth and helps QMHPs evaluate and develop intervention strategies for them. Staff should document factual information (e.g., what staff observed, heard, read) and avoid statements about motivation (e.g., trying to get attention). Behavioral observations related to depressed mood, irritability, or aggression should also be recorded.

Responding to an Active Suicide Attempt

  • Staff must know how to respond to suicide attempts in progress, especially hangings and other forms of asphyxiation, and should be trained in providing first-aid, CPR, an dother life-saving measures.
  • Realistic suicide-intervention drills should be conducted randomly and regularly to help staff practice life-saving strategies in situations where errors could have tragic results.
  • Suicide cut down tools (see Figure A) should be located on every unit, easily accessible to staff, and inventoried every shift.
  • Staff who discover a youth attempting suicide should immediately respond, assess the severity of the emergency, alert other staff to call for medical personnel if needed, and begin life-saving measures.[45]

Staff should never assume youth are dead and should do all they can to keep youth alive until medical professionals take over.[46]

Reporting and Notification of Suicidal Behavior

  • Policies and procedures should be in place for staff to easily document which youth have been identified as a high suicide risk. Staff should use standardized forms to document close observations and intensive monitoring of suicidal youth. Forms should be easy to understand and easy to complete. Staff should follow documentation procedures in the event of a completed suicide.
  • QMHPs should inform parents or caregivers if their child is placed on suicide precautions and inquire about strategies that have previously decreased the youth’s distress.
  • Staff should notify administrators and outside authorities about potential, attempted, and completed suicides, according to policy. If youth are a high risk for suicide close to the time they are returning to the community, staff should enlist the support of parents or caregivers and community mental health providers with regard to continued assessment, monitoring, and treatment.
  • When recently or currently suicidal youth are released, QMHPs should educate parents or caregivers about the danger of guns and other potentially lethal means in the home and encourage them to remove these items.

Review and Debriefing

  • If a tragedy such as a serious suicide attempt or completed suicide occurs, several types of reviews should take place (e.g., administrative, mental health, medical) to better understand exactly what happened, why, and what necessary improvement measures are required, if any. The goal is to gain information and to learn, not to find someone to blame.
  • A psychological autopsy should be conducted within 30 days of a completed suicide by a psychologist or psychiatrist to better understand the specific factors that may have contributed to a youth taking his or her own life.
  • A quality-assurance process should be in place to monitor the components of a facility’s suicide prevention program, with immediate modifications made when indicated.
  • A debriefing (e.g., structured group process to help individuals effectively cope in response to a traumatic loss) should be made available as soon as possible (preferably 24 hours, no longer than 72 hours) after an incident to all staff and youth who may have been impacted by a serious suicide attempt or completed suicide. Staff involved in the incident should not be mandated to immediately return to job duties.
  • Youth should be encouraged to talk with a QMHP about any thoughts and feelings they have in relation to a peer’s suicide or suicide attempt.
  • Staff should be encouraged to seek additional support through the Employee Assistance Program (EAP) or other sources, if needed.

After a Serious Attempt or Completed Suicide

It can be traumatic and painful to work with youth who have made serious suicide attempts or who have died by suicide. Many line staff have intervened with youth they have found hanging or strangling themselves, as well as youth who have seriously cut their wrists or other body parts. Some staff have performed life-saving procedures in situations where youth still died, despite their efforts. Staff are often required to return to work immediately after these types of disturbing incidents to supervise the rest of the other youth on a unit. This should never happen.

Youth are often upset and confused when another resident makes a serious suicide attempt or dies by suicide. This is a particularly high-risk period for other youth in custody to take their own lives; therefore, staff should be vigilant to signs of distress, especially among vulnerable youth.

Intense guilt is common among staff who were unable to prevent a juvenile suicide. They may wonder if they overlooked key warning signs or what would have happened if they had checked on the youth a few moments earlier. Some staff feel guilty when youth kill themselves on a day when they were not present, believing that they may have been able to prevent it had they been on duty.

Working with suicidal youth can have significant emotional and psychological effects on direct care staff. These effects are intensified when staff work with multiple suicidal juveniles throughout their career. Investigations and litigation after a death by suicide can add to already disturbing, stressful, and traumatic situations. Unless there was significant wrongdoing, staff should be given support and patience if they have been involved with seriously suicidal youth.

Self-Injury Among Youth in Custody

Although known by various names—self-injury, self-mutilation, cutting—this type of behavior reflects a youth’s deliberate harming of his or her own body as an attempt to feel better. It affects boys and girls of all racial backgrounds. Self-injury creates a safety risk and is disruptive to the facility environment. Although suicide training is mandatory, most staff receive little to no training in the identification and management of juveniles who self-injure.

Youth intentionally harm themselves most commonly on the forearm, but they can injure anywhere on their bodies, including areas covered by their undergarments. Superficial cuts or scars do not necessarily indicate less distress; all self-injury should be taken seriously.

Self-Injury Versus Suicide

Self-injury and suicide are two very different behaviors. Suicide is related to death, whereas self-injurers often report their harm makes them feel alive and helps them live. Many youth who self-injure report that if they could not hurt themselves, they would be overwhelmed, unable to cope, and potentially suicidal. They usually know where and how deep to cut so they do not accidentally die. Two distinct behaviors—self-injury and suicide—can occur simultaneously, and engaging in self-injury raises a youth’s risk of suicide.[47] When they occur together, the desire to die may resolve once a suicidal crisis is over, but juveniles are likely to continue injuring themselves to cope with everyday emotions and stress.

Items Youth Use to Hurt Themselves

Despite careful and frequent room searches, watchful staff, and minimal access to sharp objects, youth who self-injure can always find ways to hurt themselves. The following items have been used by juveniles in custody:

  • Staples, paper clips, thumbtacks.
  • Pencils, pens.
  • Combs, brushes.
  • Eye glasses.
  • Teeth, fingernails.
  • Forks, knives, broken plastic spoons.
  • Snaps, zippers, belt buckles.
  • Rocks or gravel.
  • Broken DVDs, playing cards.
  • Paint chips, pieces of floor tile.
  • Pull tops from pop can.
  • Metal clasps on ace bandages.
  • Dried peach pits, apple cores, orange peels, or chicken bones.

Cutting, scratching, and carving their skin are the most common ways youth in custody deliberately harm themselves, however some punch themselves, punch walls, bite themselves, pull out their hair, bang their heads against doors, give themselves eraser burns, or interfere with the healing of scabs or wounds.

Some incarcerated youth have engaged in dangerous and severe self-harm—ripped out medical stitches, inserted pens into healing wounds, held drain cleaner in their mouth “to feel the burn,” and inserted pens into their penis. This type of self-injurer typically begins with superficial wounding and needs to make deeper and larger cuts or experience more intense levels of pain to achieve their desired level of release.

Why Do Youth Hurt Themselves?

Self-injury is typically a coping strategy used during times of stress or intense, overwhelming feelings. Hurting themselves helps youth 1) regulate or control their emotions, 2) reduce stress and tension, or 3) get their emotional or relationship needs met. Some youth communicate through self-harm what they cannot say in words; others hurt their bodies in custody because it is something they can control. Although usually driven by emotional reasons at the start, a youth may continue to self-injure because of responses or reactions that the behavior elicits from others (e.g., attention, support, exemption from responsibilities, shocking staff or peers, transfer). For the small group of youth who harm their bodies solely as a strategy to solicit attention, their behavior should still be taken seriously, and they should be referred to a QMHP for evaluation.

Managing Youth in Custody who Self-Injure

Self-injury is typically a symptom of a larger problem; a comprehensive mental health assessment is necessary to identify any psychological issues or disorders and determine what function the behavior serves in the context of the unit. Clinicians should develop individual treatment plans, use evidence-based therapy, and help staff reinforce youth for not engaging in self-harm and for using appropriate coping skills. Staff from all disciplines should provide emotional support and attention before youth self-injure. Unit schedules and staff teams should remain as consistent as possible, and staff should inform youth of any upcoming changes in the routine. Staff should provide extra support during major transitions (e.g., new unit or staff, transfer, release), as these can be high-risk periods for self-harm.

Housing and monitoring decisions should be based on findings from the mental health assessment. Unless their self-injury is severe, most youth can participate in standard facility programming with minor modifications; when programmed, they have little time to think about self-injury—and even less time to do it. Youth may lose certain privileges related to using specific items or participating in certain activities if they are unable to keep themselves safe with those items or activities. In these situations, staff should emphasize safety and security rather than present restrictions as punishment. As soon as youth demonstrate signs of safety, staff should strategically lift restrictions. Secluding or isolating youth who self-injure should be a response of last resort. Removing youth from peers and programming often worsens their distress and intensifies their need to hurt themselves. Plus, youth can still bang their heads, as well as bite or scratch themselves while isolated. Regardless of where youth are housed, staff should be stationed near self-injurious youth and regularly interact with them. This is not suicidal behavior, therefore if intensive monitoring is required, it should be referred to as “safety precautions” or “safety watch.” Facilities without the resources to safely manage severely self-injuring youth should transfer them to a psychiatric hospital or residential treatment facility.

Staff Responses to Youth Who Self-Injure

Feeling frightened or disgusted by self-injury is a natural reaction, especially when wounds are bloody or located on certain parts of the body. Staff should maintain a matter-of-fact attitude and tone when dealing with self-injury; these youth are often ashamed of their behavior and know that it is unusual and strange. If staff appear uncomfortable, upset, or grossed out by injuries or scars, youth will be less likely to talk to them about underlying thoughts and feelings and will keep wounds a secret.

Staff should convey:

  • An understanding that self-injury helps some youth cope.
  • They do not view self-injurious juveniles as crazy or weird.
  • Youth will need to stop hurting themselves in the facility due to safety and security issues.

This approach shows respect for youth, especially when staff communicate their commitment to keeping youth safe and supporting them in learning more acceptable ways of dealing with strong emotions, stressful situations, and challenging personal relationships.

The Move Toward Trauma-Responsive Care

Since the inception of juvenile justice system, the philosophy of how best to respond to delinquent youth has swung back and forth between rehabilitation and punishment. Recently, there have been three major approaches used with youth in custody; each has potential benefits for youth in custody with mental health disorders, as well as potential drawbacks or even harm. Some facilities primarily rely on one approach; others have integrated aspects of two or three. Even within a particular facility, the approach may differ, depending on the unit, the shift, the specific staff, and the individual youth being supervised. Youth benefit most when these three approaches are used together in a strategically balanced and integrated manner.

The following are general descriptions; they are much broader and deeper in actual practice.

Juvenile Corrections Approach

In a juvenile corrections approach, youth are typically seen as intentionally engaging in negative behavior in the facility and community to obtain something for themselves (e.g., power, status, material goods, attention); youth need to “make better choices.” Safety, structure, predictability, and accountability are central to all management strategies. These issues are essential for youth who have mental health disorders; youth will not truly engage in treatment if they do not feel safe. The emphasis on clear and specific behavioral expectations and strength-based behavior management programs is also important for youth success.

Unfortunately, sanctions may be often issued without exploring whether there are potential vulnerabilities or alternative explanations for a youth’s behavior. For example, aggression receives the same penalty whether it is exhibited by a sophisticated gang member carrying out a hit, a traumatized youth trying to protect himself or herself from a perceived attack, or an intellectually disabled youth responding out of intense frustration. This approach encompasses the belief that the discomfort and distress of incarceration and sanctions (e.g., loss of privileges, room confinement) is what motivates youth to engage in pro-social behavior in the future. However, no data exist to support that assumption. Also, some types of responses to negative behavior within this approach (particularly those that are confrontational, harsh, or punitive) can actually escalate the anger, aggression, destructive behavior, or withdrawal of confined youth with mental health, substance use, co-occurring, and trauma-related conditions.

Treatment-Oriented Approach

In a more treatment-oriented approach, youth in custody are typically viewed as having deficits that need to be fixed or treated. The negative behavior of youth is usually seen as related to a mental health or substance use disorder, criminogenic needs, or other underlying issues. According to this approach, if those problems were treated, a youth’s negative, delinquent, or violent behaviors would diminish or completely stop. Accountability remains, but there tends to be more emphasis on comprehensive assessments, individualized treatment plans, and cognitive-behavioral, skill-based therapy to help youth better manage their thoughts and behavior. Youth typically receive mental health, substance use, or co-occurring disorder diagnoses; and many receive psychotropic medication. This approach can be very beneficial when diagnoses are accurate and treatment plans (and the associated treatment provided) target a youth’s key issues. Unfortunately, youth in custody are frequently over-, under-, and misdiagnosed, QMHPs are lacking in many skills, and there can be minimal collaboration between juvenile justice and mental health staff; these issues can lead to inappropriate treatment or treatment that can worsen a youth’s thinking, moods, or behavior.

Trauma-Responsive Approach

A third and more recent approach for youth in custody, is one that is trauma responsive. The assumption is that negative behavior within facilities is not always intentional, but more likely the result of traumatized youth being triggered and overreacting to what they perceive to be a threat.[48] Accountability remains key in a trauma-responsive approach, and youth continue to receive comprehensive assessments and individualized treatment plans, and are taught skills to better manage their thoughts and behavior. However, differences include:

  • An increased focus on traumatic events and trauma-related symptoms during screening and assessment.
  • No mental health diagnoses given to juveniles until clinicians first address the impact of trauma.[49]
  • Symptoms are seen primarily as attempts to cope and survive.
  • Psychotropic medication, if used, is not the first line of treatment and is never used as the sole treatment.
  • All staff use a strength-based approach with youth.
  • Negative behaviors do not necessarily stem from something inside youth (e.g., depression, ADHD, bipolar), but often from youth reacting to events outside themselves.
  • Emphasizes the reduction of trauma triggers in the environment and provides safe places (e.g., comfort room) and tools youth can use to practice self-calming skills.[50]
  • Takes into account research on how trauma negatively impacts the brain.
  • Emphasizes key relationships between youth and supportive adults, such as line staff.

With this approach, youth are not to blame for their victimization and traumatic experiences, but are responsible for learning how to effectively cope and manage their emotions and behavior when their trauma response is triggered. Adults in the facility help youth 1) recognize how they have been impacted by trauma, 2) identify what specifically triggers their trauma-related reactions (e.g., angry outbursts, shutting down, aggression, overreacting, self-injury), and 3) learn more appropriate ways to respond.

Challenges of this approach include the need for significant training, on-the-floor staff coaching, and changes to existing policies and procedures. When management strategies such as isolation and restraint are discouraged, due to potentially re-traumatizing youth, staff may initially feel powerless and unsafe. They may also perceive this approach as excusing negative and dangerous behavior.

Trauma-Responsive Care with Youth in Custody

In trauma-responsive care, conversations shift from “What’s wrong with you?” to “What happened to you?” and “What’s right with you?” Staff interactions with youth focus on “What do you need?” and “How can we support you?”

For example:

Kevin, 15, is repeatedly removed from the classroom for hostile behavior toward the teacher and sent back to his living unit. When placed in his room, he becomes increasingly angry and agitated, kicks the door, and yells provocative comments to staff. When peers return to the unit, he verbally and physically intimidates and threatens some of the smaller and younger boys. It is discovered that Kevin has struggled in school for years due to attention and memory problems. When his teacher in the facility demands he turn in his written assignments before he has finished them, Kevin blows up in anger due to the belief that “this teacher wants me to look stupid and is trying to embarrass me—just like all the other ones.” Alone in his room, Kevin is consumed with humiliation, shame, and feeling “stupid,” so he distracts himself by engaging staff—which is ineffective. To regain a sense of control, empowerment, and success, Kevin terrorizes peers who are more vulnerable than himself.

From a juvenile corrections approach, Kevin would likely receive a variety of sanctions each day his negative behavior occurred. This cycle could continue for days, weeks, or longer—with little to no new learning or change in behavior. From a treatment approach, in addition to cognitive-behavioral group therapy for his criminogenic needs, Kevin may be diagnosed with a learning disorder, ADHD, or depression; he may receive therapy (and possibly psychotropic medication) to treat it. Unfortunately, if he were diagnosed solely with conduct disorder, treatment would be minimal.

With a trauma-responsive approach, Kevin would receive consequences for his negative behavior, plus, he and staff would work together to 1) identify and understand what triggers his reactions and negative behavior and 2) practice new and more appropriate responses when triggered.[51] Safety and self-regulation are key. Staff help youth learn to better control their thoughts and behavior (sometimes in the moment, as problematic behavior is occurring) instead of automatically and reflexively responding in disruptive and sometimes dangerous ways.[52]

A trauma-responsive approach is likely to be effective with most, if not all, youth in custody because of their high rates of multiple types of trauma. It is also likely to be effective with youth who have mental health, substance use, and co-occurring disorders because:

  • Trauma increases a youth’s risk of developing mental health disorders, so youth often have both conditions.
  • Many mental health symptoms overlap with trauma-related symptoms.
  • Some trauma-related symptoms are misdiagnosed as mental health symptoms.
  • Many youth in custody use alcohol or other drugs in response to trauma-related symptoms.

A trauma-responsive approach works well with the treatment approach. Rather than staff exerting control over youth, in both treatment and trauma-responsive approaches, the emphasis is on staff helping youth gain better control over themselves. A key modification is that the impact of trauma on a youth’s mood and behavior is taken into account before youth are viewed as having antisocial attitudes, labeled with mental health or substance use disorders, or prescribed psychotropic medication.

Child-serving systems across the country are moving toward a trauma-responsive model of care, including Florida’s Department of Juvenile Justice (DJJ) and New York’s Office of Child and Family Services (OCFS).

Discovering that a youth experienced a traumatic event at some point in his or her life should not automatically trigger a mental health referral. Facilities do not have the resources to provide treatment to every youth who has experienced trauma, and not every one of them needs it. However, youth should be referred if he or she is currently experiencing trauma-related symptoms and is distressed by trauma-related symptoms, or if trauma-related symptoms interfere with the youth’s ability to do well in school, on the living unit, or in relationships.

Effective Treatment Strategies for Youth in Custody with Mental Health, Substance Use, Co-Occurring, and Trauma-Related Needs

In addition to the recommendations made throughout this chapter, best practices in the treatment of incarcerated youth with mental health, substance use, co-occurring, or trauma-related needs also include:

The Basics

  • Youth feel physically safe (e.g., in the physical structure, with peers, with staff, with themselves if they have a history of self-injury or suicidal behavior). Sufficient numbers of qualified juvenile justice, mental health, and medical staff are available to address youth safety, programming, and treatment needs.
  • Structure, consistency, and predictability are emphasized in all programming and treatment activities; youth receive ample warning about staff and program changes.
  • Staff recognize that youth with mental health disorders are a heterogeneous and resilient group, each possessing different needs, strengths, and challenges.
  • Clear and easy-to-understand rules, expectations, and directions are verbally explained to youth and are written down.
  • Units are more home-like (e.g., youth art on walls, colored walls, carpet or rugs, comfortable furniture, holiday decorations) than correctional or institutional in look and feel.
  • Treatment providers recognize that youth and their parents or caregivers are in various stages of change, assess what stage they are in, engage them, and match treatment to their current stage of recovery.[53]

Formal Mental Health Treatment

  • Staff realize that mental health treatment is often an ongoing, long-term process; relapse is common and should be planned for.
  • Mental health professionals focus on developing and strengthening protective factors, rather than solely reducing mental health symptoms.
  • Individualized treatment plans address specific short- and long-term goals in multiple key areas of a youth’s life, especially for those who exhibit significant mental health symptoms or dangerous, disruptive, or aggressive behavior.
  • Treatment for co-occurring mental health and substance use disorders is integrated and provided by the same treatment provider or by a team of providers who closely communicate and take equal responsibility for intervention goals.
  • Staff ensure that all cognitive-behavioral treatment is appropriate for a youth’s intellectual and developmental level.
  • Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) meetings are available within the facility and are modified for adolescents.

Involvement of Line Staff

  • Staff are alert to unusual youth behaviors, moods, or statements of concern and refer youth to mental health staff for follow-up.
  • Staff are alert to physical complaints (e.g., headaches, stomachaches, fatigue, vague muscle or joint pain, multiple requests to see the nurse or doctor), take them seriously, and communicate them to medical personnel to determine if they are associated with depression, anxiety, trauma, or physical illness.
  • Staff understand that some youth require accommodations or adjustments in programming to be successful in the facility.
  • Staff actively engage youth and develop trusting and empathic relationships. This type of connection is essential to creating positive treatment outcomes among youth with mental health, substance abuse, co-occurring, or trauma related symptoms.
  • Staff recognize that taking time up front to understand youth and their individual needs, strengths, and limitations saves them time and energy in the future (e.g., increased compliance, fewer power struggles, fewer sanctions).
  • As key members of the treatment team, line staff participate in mental health treatment planning. Line staff perceive themselves as central to the treatment process, as do youth and other professionals throughout the facility.

Brain-Related Treatment Issues

In addition to the aforementioned strategies, the following recommendations should be used in the treatment and day-to-day management of youth with brain-related issues:

  • Treatment professionals utilize current brain research to better understand normal adolescent development, trauma, criminal behavior, and aggression; relevant concepts are communicated to juvenile justice and education professionals.
  • Staff hold realistic expectations of youth with cognitive disabilities (including those with suspected or confirmed head injuries or brain damage).
  • Staff speak in clear, short sentences, and provide youth with additional reminders, structure, and supervision, when needed.
  • Because a youth’s response to medication can be affected, professionals who prescribe psychotropic medication investigate the possibility of head injury or brain damage.

Youth who have suffered head injuries or trauma-related brain changes need interventions that focus on:

  • Thinking before acting.
  • Managing anger.
  • Decreasing or discontinuing substance use.
  • Interacting with others in a pro-social manner.
  • Reducing stress.
  • Correctly perceiving social cues (versus suspicious misperceptions).
  • Empathizing with others, especially victims.

Threats of sanctions or punishment do little to modify the behavior of youth with head injuries or brain damage due to their difficulty conceptualizing abstract and future events or consequences.

Trauma-Related Treatment Issues

In addition to the aforementioned strategies, the following recommendations should be used in the treatment and day-to-day management of youth with trauma-related needs (whether or not they are diagnosed with PTSD):

  • Trauma training (e.g., understanding the impact of trauma on thoughts, behavior, and the brain; trauma-responsive management strategies) is provided to all facility staff. Clinical training on trauma-responsive treatment is provided to all treatment providers.
  • Past traumatic events are discussed to better understand and modify current problematic behavior and positively influence future behavior—not to dwell on past pain or victimization.
  • Interdisciplinary treatment teams integrate the impact of trauma into case conceptualizations of youth, individualized treatment plans, interventions, and daily programming. Neutral or strength-based words are used in place of “victim” when talking directly with youth about their past.
  • Youth are educated about the effects of trauma on their thoughts, emotions, behavior, and brain; youth are reassured they are not going crazy.
  • Staff listen and provide support to youth, help them de-escalate when youth are upset, and assist them in developing more adaptive thoughts and behaviors when triggered by people or situations.
  • Staff exhibit patience, creativity, and flexibility in their management and programming of trauma-affected youth.
  • Youth learn practical coping skills to help them manage feelings of anger, shame, guilt, embarrassment, or fear.
  • Staff are diligent about their role as mandated reporters of child abuse and neglect and clearly explain to youth what information remains confidential (if any), what can be released and under which specific circumstances, and who will likely receive information if a report must be made.
  • Evidence-based, gender-specific treatment for trauma, including sexual abuse, is available for girls and boys.
  • Staff assess their own comfort level when youth talk with them about trauma; if uncomfortable, they refer youth to other supportive and trusted professionals in the facility.
  • Due to the demanding, stressful, and potentially traumatic nature of working with incarcerated youth, staff use good self-care strategies on the job and in their personal lives. They obtain support (e.g., Employee Assistance Program, community resources) for any unresolved trauma from their own past, so as not to be triggered by a youth’s aggressive, destructive, or disturbing behaviors—or the correctional environment itself.

See Juvenile Offenders with Mental Health Disorders: Who Are They and What Do We Do with Them for management strategies specific to youth in custody with conduct disorder, ADHD, depression, bipolar, PTSD, learning disorders, fetal alcohol syndrome, self-injury, and other mental health conditions.[54]

Foundational Treatment Strategies

Effective behavior management, physical activity, and good nutrition are the foundation of effective treatment for youth with mental health, substance use, co-occurring, and trauma-related conditions.

Effective Behavior Management

Key principles of effective behavior management in custody include:

  • Caring staff who model pro-social behavior and coping skills.
  • Structured programs and meaningful activities with clear expectations for youth.
  • Behavioral consistency among staff on all shifts.
  • Frequent reinforcement of youth success, no matter how small. A minimum of four reinforcers for every one punishment.[55]
  • A well-designed, easy-to-understand, easy-to-implement, and effective strength-based token-economy system.
  • Sanctions or negative consequences match the level and type of youth misbehavior.
  • Staff recognition of how difficult it is for youth to modify numerous key behaviors at the same time (e.g., attend school, control emotions, control behavior, develop new social skills, stop using profanity, participate in treatment), while simultaneously discontinuing their typical coping skills (e.g., intimidation, aggression, social withdrawal, alcohol or other drugs, running away).[See Ch. 14: Behavior Management]

Physical Activity

Vigorous exercise can enhance self-esteem, decrease depression, reduce anxiety and tension, and help youth sleep better.[56] Exercise changes chemicals in the brain, including those associated with mood-related disorders. Providing youth in custody with a variety of opportunities to be active and participate in outdoor recreational activities gives them a chance to demonstrate success in pro-social activities and burn off high levels of energy. Team sports help youth resolve conflict without intimidation and aggression and engage in healthy competition. Individual recreation activities should also be available, as some youth are self-conscious about their coordination or skill level.

Yoga helps reduce stress, and decreases depression and anxiety.[57] It appears to impact the fight or flight mechanism (commonly affected among youth with trauma histories). Yoga may be as effective as exercise, or even more so, for reducing fatigue and aiding sleep.[58]

Good Nutrition

What youth eat and drink impacts their mental health.[59] Nutrients affect areas of the brain that regulate mood and behavior, including the cerebral cortex. Providing youth in custody with healthier foods, less sugar, and more nutrients appears to help them better control their behavior.[60] Providing a vitamin-mineral supplement and essential fatty acid supplements reduced violence among incarcerated juveniles and young adults.[61]

Psychotherapy (“Talk Therapy”) In Custody

Brief, practical, evidence-based psychotherapy can be provided to youth in short-term facilities, with more intensive psychotherapy provided in the community upon release. Youth in long-term facilities, or residing in detention or jail for lengthy periods, should receive more comprehensive evidence-based psychotherapy in custody, plus transition services upon return to the community. Regardless of the facility type or length of stay in custody, staff should encourage parent or caregiver involvement in psychotherapy.

Research on effective psychotherapy for youth in custody with mental health, substance abuse, co-occurring, and trauma-related needs (especially those who are aggressive and violent), is significantly lacking and desperately needed. The following treatments have shown beneficial effects for justice-involved youth, although most have primarily been used in the community. Some of these therapy approaches have been researched and evaluated; others are promising and need further evaluation.

  • Cognitive Behavioral Therapy (CBT)[62] Most evidence-based therapy has cognitive-behavioral therapy at the core.
  • Motivational Interviewing (MI) and Motivational Enhancement Therapy (MET)[63]
  • Trauma Affect Regulation: Guide for Education and Therapy (TARGET)[64]
  • Dialectical Behavior Therapy (DBT) and DBT-Corrections Modified (DBT-CM)[65]
  • Aggression Replacement Training (ART)[66]
  • Functional Family Therapy (FFT)[67]
  • Trauma-Focused CBT (TF-CBT)[68]
  • Trauma Grief Component Therapy-Adolescent (TGCT-A)[69]
  • Trauma Recovery & Empowerment Model for Girls (G-TREM)[70]
  • Eye Movement Desensitization and Reprocessing (EMDR)[71]
  • Seeking Safety[72]
  • Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS)[73]

Multi-Systemic Therapy (MST);[74] and Wraparound Services[75] are community-based interventions that can be used in lieu of incarceration for some youth. Regarding youth in custody, community approaches are most appropriate for those who are briefly incarcerated. Youth housed for lengthy periods should receive treatment while confined, but can benefit from community-based interventions upon release. [See Ch. 10: Effective Programs and Services]

Individual treatment sessions can range from 20 to 60 minutes, depending on a youth’s attention span and level of engagement.

Group treatment is the norm within most juvenile justice facilities. Treatment groups tend to be most effective 1) with a smaller number of participants, 2) with a 45- to 60-minute maximum, 3) when led by individuals who have experience working with justice-involved youth and experience running treatment groups, and 4) when led by professionals who want to lead them.

Although the aforementioned therapy approaches may benefit incarcerated youth with mental health, substance use, co-occurring, and trauma-related conditions, maintaining treatment gains once formal treatment ends remains a challenge. The goal is for youth to function more effectively in a variety of situations and contexts—not just while they are in custody. Emotional and behavioral change within facilities is no guarantee of continued change in the community. Despite clinically sound treatment principles and programs, generalizing what youth learn in secure settings to their real-world circumstances is difficult unless treatment continues within their natural home environment after release. [See Ch. 18: Transition Planning and Reentry]

Key Treatment Issues

Qualified Mental Health Professionals (QMHPs)

According to NCCHC, QMHPs include psychiatrists, psychologists, psychiatric social workers, psychiatric nurses, and others who—by virtue of their education, credentials, and experience—are permitted by law to evaluate and care for the mental health needs of patients.[76] However, qualified is essential; an advanced degree does not ensure the specific knowledge or clinical skills necessary to work with incarcerated youth, one of the most clinically complex and challenging groups of young people.

Within facilities, QMHPs should play a key role in:

  • Mental health assessments (and screening when necessary).
  • Crisis intervention.
  • Individual counseling.
  • Treatment groups.
  • Staff training.
  • Psychotropic medication.
  • Individualized treatment plans.
  • The placement of youth on or removing youth off of intensive monitoring (e.g., suicide watch, safety watch).
  • Treatment programming.
  • Screening mentally ill youth prior to placement in isolation.
  • Assessing the effects of potentially traumatizing experiences (e.g., isolation, witnessing peers’ self-injury or suicide attempts).

Strategic and creative hiring of QMHPs is often necessary, because many clinicians are too intimidated or frightened to work with incarcerated youth; rural facilities may struggle to find eligible applicants due to limited QMHPs in the community. Facilities that struggle to find qualified applicants have had success advertising nationally, sharing a position with the local jail, choosing professionals early in their career or shortly after retirement, or finding professionals looking to supplement a private practice. Hiring unqualified mental health professionals can result in a pattern of misdiagnosis and inappropriate treatment, both of which can escalate a youth’s suffering, create an unsafe environment, and expose facilities to liability issues.

QMHPs should have knowledge, training, and experience with youth who have a broad range of emotional and behavioral disorders, as well as key issues related to:

  • Normal adolescent development.
  • Interactive effects of mental illness and substance use.
  • Impact of trauma, including multiple interpersonal traumas.
  • Cognitive, emotional, behavioral, and lifestyle issues common among incarcerated youth.
  • Best practices for screening and assessing youth in custody.
  • Evidence-based interventions or best practices for justice-involved youth who have mental health, substance use, co-occurring, and trauma-related symptoms.

If currently employed QMHPs need additional training, facilities should ensure they receive it.

QMHPs hired to work in facilities must be willing to collaborate with juvenile justice, medical, and educational professionals and use terms and concepts easily understood by youth and non-clinical staff. They must also understand the strengths and limitations of a youth’s self-report; many youth in custody are savvy about the mental health system, knowing precisely what to say to receive a prescription of psychotropic medication, facilitate admission to a psychiatric hospital, or avoid mental health treatment.

Psychiatric Hospitalization

Facilities vary considerably regarding their 1) physical design, 2) quantity and quality of mental health resources, and 3) provision of mental health treatment and programming. Many large and resource-rich facilities can manage youth with significant mental health needs, whereas others can manage youth with low to moderate mental health needs, but must transfer those with serious symptoms or disorders.

Most facilities, if not all, may need to transfer severely and acutely mentally ill youth (e.g., psychotic, imminently suicidal, manic, seriously self-injurious) to a psychiatric hospital or emergency room. Most facilities are not designed for—nor are they adequately equipped—to manage these youth or those with serious and chronic psychiatric disorders that require intensive, long-term treatment.

Hospitalization can stabilize youth and keep them safe during a crisis, but long-term behavior change is unlikely. Current lengths of stay in most psychiatric hospitals range from several days to several weeks, which is not enough time to treat complex mental health conditions.

Well before a crisis occurs, written agreements should be in place with all hospitals that may be used during an emergency. All parties should be clear regarding what entity has authority or responsibility for youth and who pays for hospital services. Criteria for a youth’s admission and discharge from a hospital should be explicit, and behavior that automatically results in a youth’s expulsion from a hospital also must be made clear.

Youth should not be released from a hospital without 1) a summary of what occurred during hospitalization, 2) a detailed discharge plan, and 3) thorough verbal communication with a QMHP and juvenile justice administrator at the facility.

Confidentiality

Administrators and mental health professionals must know federal and state laws and statutes that govern confidentiality and the release of mental health information in juvenile detention, corrections, and adult jails and prisons. Often, mental health information can be disclosed without youth consent to professionals within the facility who are involved with a youth’s care if it is related to the health or safety of the youth, other residents, staff, or the facility itself.

Mental health staff should be discreet and only disclose information that is absolutely necessary to help other professionals safely supervise and manage mentally ill youth. Even if mental health information can be disclosed, clinicians are not obligated to provide it if they believe disclosure is not in the best interest of a particular youth; in the spirit of collaboration, this should not be a frequent occurrence.

Key Role of Line Staff in Mental Health Treatment

Effective facilities understand the important connection between youth and responsible, caring adults. Line staff are in an ideal position for this responsibility and are some of the most consistent adults in the lives of repeat offenders or those with lengthy sentences. Trust is built during day-to-day interactions, and many youth with mental health disorders share more details about their lives and suffering with line staff than mental health clinicians.

Many youth respect, admire, and become emotionally attached to staff; their understanding of a youth’s mental health issues can facilitate the growth of this relationship and help it remain strong. Attachments between line staff and youth can actually reduce the impact of negative events in a youth’s life.[77] In small and mid-size communities, youth and staff may know each other from the “outs”—they may live in the same neighborhood or even be extended family members. This can positively impact their relationship, or in some circumstances may be an obstacle to overcome.

The saying, “I can’t hear you because your actions are so loud” is relevant to the way youth continually observe line staff. How staff cope with stressful individuals and events on the unit likely teaches youth more than anything staff can tell them.

Mentally ill youth instinctively know when staff care about them and what they have been through. Some staff heavily invest in youth success; at times working harder than youth do for themselves, and believing in youth more than they believe in themselves. Staff may not be formally trained as counselors, but informal counseling occurs throughout facilities during card games, watching television, shooting hoops, lifting weights, or just passing time on the unit. Line staff will never know the number of seeds they planted or “aha moments” they have been responsible for. They will never know how many suicidal juveniles chose not to take their lives because of the support or concern they knowingly or unknowingly provided. The number of juveniles who call or send letters to staff after release is a testament to this critical connection.

Psychotropic Medication and Youth in Custody

Many youth in custody take psychotropic medication to help control their moods or behavior. It can be vital to a youth’s success, and for some, it is lifesaving. However, the benefit and safety profiles of many of these medications are largely unknown for adolescents. Other than stimulants, there are few studies that examine the long-term impact of taking psychotropic medication beginning in childhood or adolescence. The limited data that are available are not encouraging.[78] Therefore, professionals who prescribe these powerful medications must exercise caution.

Psychotropic medication is particularly complicated and potentially dangerous among justice-involved youth because they often:

  • Do not take psychotropic medication as prescribed.
  • Take several different types of psychotropic medication simultaneously.
  • Use alcohol or other drugs while taking psychotropic medication.

No research exists on the above issues, even among youth in the community.

Even if they agree to remain substance-free upon release, youth are likely to return to alcohol or other drug use. This can interfere with the therapeutic benefits of the medicine, as well as be physiologically harmful—or potentially lethal. Highly addictive medication should not be prescribed to youth in custody.

Psychotropic medication should only be considered if youth are 1) experiencing major distress, 2) in danger of harming themselves or someone else, or 3) experiencing major problems in day-to-day functioning. These brain-impacting medications should not be prescribed solely because youth are loud, annoying, or defiant. Psychotropic medication is only one piece of a comprehensive treatment plan and should be used after a youth’s mental health diagnosis is validated and non-medication approaches have been tried and proven unsuccessful.

When administered appropriately, psychotropic medication can help stabilize youth behavior so they can participate in programming and interventions. For example, youth with ADHD may be unable to sit still and focus during treatment groups, psychotic youth may be too confused to interact with peers, and depressed youth may be so preoccupied with thoughts about dying that they cannot concentrate in school. Some youth with mental health disorders struggle with basic token economy programs or skill-based treatment groups because of difficulty controlling their emotions and behavior. Not every problematic youth requires medication; most need to learn skills to regulate their emotions, modify their thinking, behave pro-socially, and cope with current stressors.

Youth who are prescribed psychotropic medication should be educated about their medicine in a brief, understandable way, including:

  • Why a particular medication has been prescribed for them.
  • What positive behavior changes are expected to occur from taking the medication.
  • How the medication works within their body.
  • Potential side effects of the medication (how common or rare) in case they experience unusual bodily changes.

Many youth in custody who have taken psychotropic medication for years have never received this type of information.

Despite similar rates of mental health disorders, lower rates of psychotropic medication are observed among African-American and Latino youth;[79] Asians, African Americans, and to a lesser extent, Hispanics respond to lower doses of some psychotropic medications, and may have more side effects even at lower doses.[80]

Ensuring that youth completely swallow their pills (versus “cheeking” them or vomiting them up) prevents youth from storing up their medication and overdosing. It also reduces opportunities for youth to sell or trade their pills as part of a black market, or for peers to obtain substances that are not prescribed for them. When youth have difficulty swallowing pills, medical staff can often crush them or order a liquid form of the medication, if it is available.

Medication Refusal Among Youth in Custody

Youth cannot be forced to take prescribed psychotropic medication, except in specific situations defined by law (e.g., imminent threat to self, peers, or facility staff). Parents or caregivers should be contacted if a youth’s repeated refusal of psychotropic medication places him or her at risk. Reasons for refusing medication among youth in custody are varied, but usually involve one or more of the following:

  • Not wanting to be viewed as “crazy.”
  • Bothersome side effects.
  • Believing that medication is not helping or making them worse.
  • Difficult swallowing pills.
  • Adolescent autonomy and independence.
  • Sedation and fuzzy thinking, making them vulnerable among dangerous peers.
  • Wanting control in a setting where they have little say.
  • Parents or caregivers are opposed to it.
  • Psychotic beliefs the medication will harm or kill them.

When administering medication, staff can reduce a youth’s embarrassment or stigma by not shouting a youth’s name aloud in front of peers and not requiring them to go to a public and visible area. Providing opportunities to make choices in programming and other areas of treatment can help, if control is an issue.

Psychotropic Medication Side Effects

Psychotropic medication has side effects—some mild, some serious—and juvenile justice and mental health staff should receive basic training on those that are most common. Increased irritability, lethargy, and restlessness are side effects that often lead to negative responses from staff, as well as sanctions for youth.

As previously mentioned, avoiding unpleasant and uncomfortable negative side effects is a frequent reason that youth refuse their medication. Potential side effects include:

  • Headaches.
  • Insomnia.
  • Major weight gain or weight loss.
  • Nausea or stomachaches.
  • Fatigue or drowsiness.
  • Rapid or skipping heartbeat.
  • Constipation.
  • Dry mouth.
  • Dizziness or lightheadedness.
  • Skin rashes.
  • Irritability.
  • Blurred vision.
  • Loss of appetite.
  • Restlessness.

A lower dose or different, but comparable, medication may alleviate youth discomfort. Abruptly stopping psychotropic medication can be dangerous; discontinuing these medications should be gradual and done under the supervision of a medical professional.

Because some antipsychotic medications can cause significant weight gain, diabetes, and metabolic disturbances, they should be prescribed only when absolutely necessary. Sedation or drowsiness is a common side effect of psychotropic medication; youth who cannot wake up in the morning, fall asleep during the day, or are completely out of it should be referred for a medication re-evaluation. The “start low and go slow” strategy is best when prescribing psychotropic medication to confined youth.

The healthcare administrator and mental health authority should work together to develop policies and formal guidelines that address:

  • Prescribing psychotropic medication to confined youth.
  • Continuing a youth’s prescription of psychotropic medication when entering a facility.
  • Medical monitoring of youth taking psychotropic medication.
  • Communication, treatment linkages, and prescribing practices when youth are about to be released.
  • Forced medication during emergency situations.

Prescribing physicians should make every effort to collect information about a youth’s previous medications (e.g., which ones were helpful), review previous medical records, and consult with past treatment providers. Nursing staff can often help gather this information.

Policies and procedures related to identifying and correcting medication errors must be in place; all medication errors should be immediately reported.

Who Should Prescribe and Administer Psychotropic Medication

Due to the complex clinical picture of mentally ill youth in custody, plus the high percentage of co-occurring substance use disorders among this population, a child or adolescent psychiatrist or psychiatric mental health nurse practitioner trained in pediatrics is best for prescribing psychotropic medications and associated treatment. Facilities should ensure that the professionals who prescribe this type of medicine have the required education, training, and experience to work with incarcerated youth.

Medical staff should administer medication to youth. If this duty must be done by juvenile justice staff due to limited medical resources, medical staff must supervise and train staff (including routine refresher courses) on psychotropic medication including, but not be limited to 1) the different classes of medications, 2) identifying and dispensing medication, 3) immediate and long-term side effects, 4) responding to youth who have a bad reaction, 5) ensuring that youth swallow the medication, and 6) effectively handling medication refusal and noncompliance.

Interdisciplinary Team Approach

Communication, coordination, and collaboration are essential within facilities and between facilities. Neither juvenile justice nor mental health professionals can effectively manage youth with mental health disorders single-handedly. They must work closely with one another, with professionals from other disciplines, with a youth’s parents or caregivers, and with youth themselves. These key individuals must communicate, coordinate, and collaborate—formally and informally. Professionals from various disciplines should understand the roles of others, as well as how the work of other professionals impacts their own. Collaboration should begin at screening and continue through all assessment, treatment, and transition services. Important information from previous mental health and substance abuse evaluations should be communicated to and used by the treatment team.

Interdisciplinary Team (IDT) Meetings

Formal, structured IDT meetings should be held at least once or twice weekly based on the number of youth in a facility. A staff member from each discipline should be in attendance; the goal is to use the unique skills and knowledge of every individual in the room. When team members have different backgrounds, training, philosophies, work experience, and current roles, treatment plans tend to be more informed, comprehensive, and strategic.

At each meeting, the team should discuss:

  • Youth progress toward treatment goals.
  • Current barriers impeding youth progress toward goals.
  • Youth achievements or positive behavior change.
  • Youth disciplinary issues.
  • How the facility and staff are positively or negatively influencing youth behavior. Additional strategies or resources that should be provided to increase or maintain youth positive behavior change.
  • Appropriateness of goals previously established.
  • Modifications to treatment plans, as needed.

IDT meetings should be welcoming and supportive, with input solicited from everyone attending. Parents or caregivers should be encouraged to attend IDT meetings (e.g., in person, by phone, or by webcam), as should key individuals from the community such as probation or parole staff, treatment providers, vocational or residential placement personnel, etc. If they are unable to participate, these individuals (especially parents or caregivers) should be encouraged to submit information (e.g., positive feedback, issues of concern, suggestions) in writing. The team should communicate this information during the meeting, and a designated team member should follow up with parents or caregivers to summarize all that was discussed.

Youth should be present for a significant part of the IDT meeting, be involved in the development and review of the treatment plan (versus solely being informed about it and providing a signature), and have the opportunity to ask questions, seek clarifications, and make requests. When a youth’s request cannot be granted, he or she should be given an explanation as to why and instructed on ways to earn it, if the request is reasonable.

Informal Consultation with Mental Health Staff

Mental health professionals who spend time on living units interacting with juveniles and line staff show themselves to be part of the team and build relationships and the trust needed for effective collaboration. Ideally, line staff should seek input from mental health professionals about managing mentally ill or difficult-to-manage youth. Mental health staff should regularly seek input from juvenile justice professionals about the youth in their care and strategies that have or have not been effective. Managing incarcerated juveniles with mental health disorders is made easier with information from mental health staff; mental health assessments and treatment are more individualized and effective with input from line staff.

Isolation of Youth with Mental Health Disorders

In this chapter, isolation refers to separating youth from other residents during non-sleeping hours by placing them alone in a small, locked room or cell. Isolation may occur in a youth’s room or a specially designed cell. Three of the most common types of isolation that juveniles with mental health disorders experience in custody are*:

  • Seclusion (Emergency Isolation).
  • Room Confinement (Disciplinary Segregation).
  • Protective Custody (Safety Housing).

*Facilities and national standards differ in the exact names used to describe these main types of isolation.

Seclusion (Emergency Isolation)

When youth behavior threatens imminent harm to themselves, others, or the facility, youth may be isolated as a safety intervention of last resort to contain their current acting out behavior, if staff have tried a range of less restrictive strategies and were unsuccessful. This type of isolation should only be used when absolutely necessary to help agitated, angry, aggressive, or out-of-control youth calm down and gain control of their mood and behavior. Youth should be secluded for the briefest amount of time possible—minutes, not hours or days—and only to the extent necessary to maintain their immediate safety or the safety of those around them. Staff should clearly explain to youth that they can return to programming as soon as they are calm and no longer pose a threat. Staff should observe youth on a 1:1 ratio and engage in crisis-intervention techniques while youth are secluded.[81] Seclusion should never be used as punishment. There is little to no quality research showing that seclusion is effective as a therapeutic tool; research that does exist shows that it can potentially be harmful.[82] If a QMHP determines that a juvenile needs more intensive crisis intervention services, the youth should be taken to a mental health or medical facility.

Room Confinement (Disciplinary Segregation)

Some facilities use isolation as a disciplinary measure when youth violate major facility rules or become violent or destructive; this is a response after the incident occurs. Room confinement is the most serious sanction given to youth in custody. Thus, it is “reserved for incidents in which the juvenile’s behavior has escalated beyond the staff’s ability to control the juvenile by counseling or other disciplinary measures and presents a risk of injury to the juvenile or others.”[83] The juvenile justice field is moving toward significantly reducing and eliminating room confinement for disciplinary reasons.

Judges involved with isolation-related litigation have set limits of two to five hours for the amount of time youth can spend in room confinement.[84] And one set of facility assessment standards prohibits the use of room confinement altogether for discipline or punishment.[85]

In the very rare event that room confinement lasts for longer than 24 hours, the American Correctional Association standards require a review every 24 hours by a facility administrator or designee who was not involved in the incident; and that room confinement for any offense should not exceed 3–5 days.[86] Youth who receive room confinement as a disciplinary measure should be given a maximum time limit, and a clear opportunity to return to general population sooner if they meet specific behavioral expectations.

Youth charged with major rule violations should have an impartial disciplinary hearing as soon as possible,[87] with a QMHP present to discuss what role, if any, the youth’s mental health, cognitive, or trauma-related symptoms played in the incident. Alternative dispositions to room confinement should be sought for all youth, but especially for those with mental health or trauma-related issues, low cognitive functioning, or organic brain damage; room confinement should never be used when these conditions are severe.

Staff must be protected—as must all youth in the facility—and accountability for violent behavior is essential. However, there is no evidence that room confinement decreases angry, aggressive, or destructive behavior. Lengthy periods spent in room confinement can cause psychological harm, are costly, and are likely to worsen behavior.

Protective Custody (Safety Housing)

Some facilities isolate youth who would be at increased risk of harm from other residents or themselves if placed in general population (e.g., youth in adult facilities; suicidal, self-injurious, severely mentally ill youth) as a form of protective custody. Although intended to be in the youth’s best interest, an isolated setting can negatively impact the mental health status of these vulnerable youth.

Youth in protective custody should not be treated as if they are on room confinement or housed with individuals isolated for disciplinary reasons. They should have similar socialization opportunities, environmental stimulation, access to programming (e.g., education, treatment groups), recreation, out-of-cell time, and privileges as youth residing in general population. Security and treatment professionals should work together to resolve the issue that necessitates the need for protection or find alternative permanent housing within the facility.[88]

Time Out

The use of "time-out" lasts 15–60 minutes and is used for minor violations or a cooling off period; youth return to the group once their negative behavior is under control.[89] Allowing youth to take a voluntary time-out can be particularly helpful to prevent major behavioral incidents for those with mental health or trauma-related disorders, intellectual disabilities, and organic brain damage. Time-out is typically not considered isolation.

Harmful Effects of Isolation

Lengthy periods of isolation in correctional settings has been associated with uncontrollable anger, depression, confusion, memory problems, concentration problems, obsessions, paranoia, panic attacks, psychotic thinking, and suicidal and self-injurious thoughts and behavior—even among individuals without histories of these issues.[90] The degree of psychological deterioration in isolation varies and depends on several factors, including but not limited to: the duration of isolation, the intensity of social isolation, the extent of environmental deprivation, and whether the youth perceives the isolation as threatening or unjust.

Youth are inherently more vulnerable to the damaging effects of social isolation than adults; they are still developing cognitively, emotionally, physically, and psychologically. A study of suicide among incarcerated youth found half of those who died by suicide were on room confinement status at the time, and almost 2/3 had been isolated at some point.[91] Isolation can produce or exacerbate feelings of depression, hopelessness, agitation, and thoughts of dying.

Individuals with mental health and trauma-related disorders are also inherently more vulnerable to the potentially damaging effects of isolation. Therefore, incarcerated young people with these conditions have at least double the risk of psychological harm in less time due to the combination of their developmental level and mental or emotional issues. Youth labeled as “troublemakers” in juvenile and adult facilities are often “troubled” and typically need more socialization and programming, not less.

Isolation Policy and Daily Practice

Because isolation can exacerbate the symptoms of mentally ill youth or produce mental health symptoms in non-mentally ill youth, facilities should reduce this practice and work toward eliminating it. If isolation must be used, it should only be done as a response of last resort, used for the briefest amount of time possible, and only in extreme circumstances when it is absolutely necessary for safety. In addition, the following recommendations should be addressed in facility policies and daily practice with all isolated youth:[92]

  • Policies and procedures should distinguish between the three types of isolation, and each should have its own set of clear guidelines; staff should be extensively trained on the different types of isolation, and the differences should be clearly explained to youth. QMHPs and physicians should be involved in the development of or review of all isolation policies and procedures.
  • Before placement in isolation, youth should be screened by a QMHP for psychotic thinking, an intellectual disability, suicide risk, and other significant mental health issues to ensure that no contraindications for placement in an isolated setting are present. If so, a less restrictive setting should be sought and treatment provided to address the vulnerability.
  • Decisions about the duration of isolation (and any associated restrictions) should be made collaboratively between juvenile justice and mental health staff, taking into account 1) the reason for isolation, 2) the seriousness of a youth’s dangerous or destructive behavior, 3) age, 4) mental health status, 5) prior behavior, 6) the current treatment plan, 7) any history of trauma, and 8) other relevant factors. Isolation should always be for the briefest time possible.
  • Staff should visually observe and monitor youth in room confinement and protective custody at staggered intervals not to exceed 10 or 15 minutes (depending on youth behavior) and must document their observations. Youth in seclusion should be on constant 1:1 observation.
  • In the very rare cases when youth are placed on room confinement for 24 hours or more, they should have an individually-tailored behavior plan (in addition to their treatment plan) that clearly identifies 1) why they have been placed in isolation, 2) positive qualities and strengths, 3) specific behaviors they must exhibit for room confinement to cease, and 4) what consequences will occur if behavioral expectations are not met. Youth may need assistance from staff in meeting behavioral expectations if they lack the skills to do it on their own. Youth should not be secluded for more than 4 hours.[93]
  • If placed on room confinement or protective custody for over 24 hours, mental health, religious, administrative, and medical professionals should visit youth daily (in-person, not through a cell window or door). QMHPs should assess the psychological functioning of these youth once per day (more often if required) and provide mental health treatment as necessary. Staff should contact QMHPs regarding youth behaviors of concern, and juveniles should be able to request time with a QMHP.
  • To prevent psychological deterioration, youth in isolation should have opportunities for meaningful socialization, educational or vocational activities, daily outdoor physical activity, adequate amounts of nutritious food, family contact, mental health treatment, and rehabilitative programming, even if delivered in small groups or individually (in cases of significant safety risk).
  • Staff must observe isolated youth who become suicidal on a continuous, uninterrupted basis (e.g., 1:1) until the youth is evaluated by a QMHP. If found to be at risk, youth should remain on continuous observation. Rooms designated for isolation purposes should be suicide resistant (see “Suicide Prevention” section of this chapter). Isolation is an extremely high-risk environment for suicide.
  • If suicidal, self-injurious, or seriously mentally ill youth must be placed in isolation, they should be out of their rooms and engaged in daily programming (with more intensive staff monitoring) as much as is safely possible. Juvenile justice staff and QMHPs should work together to help ensure these youth are out of their rooms and engaged in meaningful activities.
  • Staff should talk with youth (using a nonjudgmental tone) to help youth identify what behavior resulted in their restricted placement and what they can do differently in the future to avoid a similar outcome.
  • The isolation of youth in juvenile and adult facilities should be severely limited, rigidly regulated, and carefully monitored.

Wanting Time Alone

Some confined youth with mental health or trauma-related issues, low cognitive functioning, or organic brain damage want brief periods of time alone in their room when they 1) feel overly-stimulated by unit activity, 2) fear for their safety and want protection, 3) experience auditory hallucinations, 4) are easily annoyed by peers, 5) suffer from depression and want to withdraw, and 6) attempt to avoid school or other programming expectations.

When a particular youth is repeatedly placed in seclusion or room confinement, an IDT should explore whether he or she is intentionally getting isolated to meet a specific need; if so, intervention strategies should focus on resolving the underlying issues.

The Vicious Cycle

A small number of youth typically create the majority of behavioral disruptions in a facility. Incarcerated youth with mental health and co-occurring disorders, as well as those with cognitive issues (e.g., intellectual disabilities, organic brain damage) tend be at high risk to respond in ways likely to result in isolation because they often:

  • Have more difficulty adjusting to incarceration.
  • Are more impulsive.
  • Are less able to control their moods and behavior than other confined youth.

Plus, traumatized youth are more likely to act out reactively due to their irritability, recklessness, and tendency to perceive hostility where none exists.

Lengthy periods of isolation characterized by sterile surroundings, and a lack of socializing and meaningful activity can be unbearable for these types of youth (sometimes triggering past trauma) and can result in additional negative behaviors (e.g., tearing up mattress, flooding the room, smearing or throwing feces). When negative reactions to being isolated lead to additional time in isolation and further restrictions, increasingly worse behavior invariably results. This vicious cycle can continue for days, weeks, or months—an unacceptable and avoidable situation.

When youth are repeatedly placed in isolation (including when a vicious cycle is at play), an IDT team should dedicate the necessary time and energy to identifying the exact dynamics at work and addressing those issues, with the goal of helping youth transition to less restrictive housing or an alternative setting. Creative problem-solving, individually-tailored treatment plans, and re-evaluation of current behavioral expectations are typically required. All interventions tried should be documented, along with their level of effectiveness.

Special Management Units

Some facilities have specialized disciplinary units that use isolation to house the most dangerous and unmanageable youth. Recommendations listed in this chapter to reduce the harmful effects of isolation are just as relevant to these special management units, if not more so. Although reserved for the most violent and destructive youth, specialized disciplinary units too often end up housing the most mentally ill and traumatized youth.

Special management units must be staffed by experienced and effective juvenile justice and mental health professionals who should have additional training on working with clinically complex youth who have mental health disorders, trauma-related issues, head injuries, cognitive disabilities, as well as criminal attitudes and behavior. Special management units should be staffed at a different ratio than general population units, with staff required to supervise significantly fewer numbers of youth.

Moving from a special management unit (e.g., intense structure, increased supervision, highly individualized programming) to general population can be overwhelming and stressful for young people. Youth should have a multitude of opportunities to earn increasing amounts of freedom and autonomy so they can practice necessary skills; this helps ease their transition to general population and keeps them from returning shortly after departing.

Solitary Confinement

Solitary confinement—meaning social isolation for 22–24 hours, excessive idle time, and no access to education or vocation, treatment groups, or programming—is inappropriate and unethical for all youth (including those separated from adults for their own protection) and puts facilities at risk for litigation.[94] This is especially true for youth with mental health and trauma-related disorders, intellectual disabilities, or organic brain damage.

Restraint of Youth with Mental Health Disorders

Mechanical or Therapeutic Restraint

Therapeutic restraint typically refers to the application of a device, material, or equipment that confines a youth’s bodily movements, restricts their physical activity, and which youth cannot remove. Some facilities use “therapeutic” or soft restraints such as fleece-lined leather, canvas, or rubber hand and leg restraints.[95] Their use in juvenile and adult facilities should be exceptionally rare—only in emergency situations where 1) youth are an extreme and imminent danger to themselves, staff, or peers and 2) less intrusive and intense measures to help youth gain control of their behavior were tried and were ineffective. Many youth who become restrained while incarcerated suffer from mental health and trauma-related disorders, intellectual disabilities, or organic brain damage.

Restraint Policy and Practice

Because restraints can be physically dangerous and psychologically traumatizing for both youth and staff (especially those with histories of abuse and trauma), restraints should always be an emergency response of last resort. Serious injuries and deaths have occurred as a result of restraint—even when properly applied.[96] Therefore, medical and mental health personnel should be involved in the development and review of all restraint policies.

Youth must be clearly told, and calmly reminded, the exact behavior they need to demonstrate to be released from restraints; restraints must immediately cease when they exhibit that behavior. Restraints should never be applied for a pre-determined period of time or be used as discipline, retaliation, or as a quicker or easier way to elicit compliance.

Placing a youth in restraints should require approval from administration (e.g., superintendent, warden, director) and a mental health or health care authority. Restrained youth must be continuously monitored, and the continuing need for restraint must be documented every 15 minutes. A QMHP and licensed medical professional should assess a youth’s psychological and physical health every 15 minutes and determine if the youth should be transferred to a medical or mental health facility.

Debriefing with youth and staff is essential after every restraint; parents or caregivers should be contacted to discuss what occurred and to elicit suggestions regarding effective strategies with their child.

Unnatural Positions and Fixed Restraints

Juveniles should never be restrained in unnatural positions such as face down, hog-tied, or spread-eagled.[97] Some national standards prohibit the use of soft restraints as well as fixed or four- or five-point restraints (e.g., restraining a youth’s arms, legs or head to a stationary object such as a chair or bed).[98] Moving Away From Hardware: The JDAI Standards on Fixed Restraints provides a detailed description of the dangers inherent to fixed restraints and why JDAI believes a complete ban of such methods and equipment is necessary.[99] Other national standards permit the use of soft restraints and approved fixed restraints, although only in extreme circumstances.[100] Facilities should eliminate the use of fixed therapeutic restraints (including restraint chairs) and work toward ending the use of soft restraints with youth, using alternative and less restrictive management strategies instead.

Restraint-Related Training

Every professional who could potentially be involved in restraint incidents (e.g., ordering, approving, applying, assessing) must receive restraint-related training and practical coaching and must demonstrate competency in his or her particular role. Training should include verbal de-escalation, conflict resolution, and crisis intervention with volatile and violent youth, including those with mental health or trauma-related disorders, intellectual disabilities, and organic brain damage. Training should address the small, but incredibly difficult-to-manage group of youth who want to be restrained and who intentionally engage in highly dangerous behavior to force staff to restrain them.

Oversight of Restraints

The use of therapeutic restraints should be meticulously monitored, with rigorous multi-disciplinary review and administrative oversight. The inappropriate or unnecessary restraint of youth should be immediately addressed and corrective action taken. Videotaping restraint incidents can provide essential footage for incident review, training, and staff coaching.

Reducing the Isolation and Restraint of Youth in Custody

Decreasing, and eventually eliminating, the isolation and restraint of youth housed in juvenile and adult facilities (e.g., frequency, duration, and severity) typically requires 1) a major cultural shift involving everyone from administration to line staff, 2) significant staff training, 3) practical coaching on the units, and 4) accountability for staff behavior (e.g., rewarding effective use of less restrictive management strategies, disciplining inappropriate use of isolation or restraint).

As the number of youth in custody decreases, those who remain in confinement are typically the most violent, mentally ill, criminal, or difficult to treat. Managing unpredictable, volatile, and aggressive youth can be demanding, draining, and dangerous. Reducing isolation and restraint at a time when facilities primarily house youth who have difficulty regulating their emotions and behavior, or who are prone to use violence to solve problems, is a complex and multi-dimensional endeavor.

When asked to decrease or eliminate isolation and restraint, it is natural to ask, “What major disciplinary measures can we use instead of isolation?” or “How are we supposed to contain youth when they are out of control?” Fred Cohen, national expert in correctional mental health law, stresses that it is more helpful for facilities to focus on “What can we do to help prevent incidents requiring isolation and restraint from happening in the first place?”[101] These dialogues go beyond examining what triggered a particular incident. We often need to take 10 or 20 steps back to explore how a situation or an individual got to the point where such extreme measures were necessary, and what adjustments and modifications may need to occur.

According to Cohen, disruptive behavior should not be viewed as a violation and disciplinary event; instead, it should be seen as acting out and be dealt with as part of a treatment or behavior management protocol.[102] Dynamics between staff and aggressive or acting out youth improve when staff members prevent confrontations, de-escalate provocative situations, and model calm responses to insults and threats.[103]

Balancing safety and security with youth rights and effective treatment and rehabilitation is often extremely challenging. Implementing the strategies in this chapter (e.g., adequate staff-to-youth ratios; effective behavior management strategies; well-trained staff; screening and assessment of mental health, co-occurring, trauma-related, and organic brain disorders; individual treatment plans; positive youth–staff relationships; mental health and trauma-responsive treatment; cognitive-behavioral therapy; developmentally appropriate evidence-based programming and skill-based groups) can help facilities move toward that balance and hopefully reduce the need for isolation and restraint.

Transitioning Youth with Mental Health Disorders Back to Community

When not adequately prepared for the transition from confinement back to the community, youth with mental health disorders can become overwhelmed, frustrated, and discouraged. Treatment gains may disappear if appropriate support services are not in place. Because mentally ill youth often have multiple needs upon release, they typically require support and services from multiple systems.

  • Family.
  • Mental health.
  • Substance abuse.
  • School or vocational.
  • Housing.
  • Child welfare.
  • Medical.

Family involvement is essential; effective behavior management strategies should be reviewed, encouraging parents or caregivers to reinforce pro-social youth behaviors at home and to discipline or not reinforce negative and antisocial behaviors. Realistic rules and family boundaries should be discussed and clearly explained to youth before they leave the facility. Prior to release, youth who receive mental health services (including medication) during confinement must have an appointment scheduled with a mental health professional in the community. Efforts must be made to link youth with treatment providers with whom they already have a relationship. Youth with mental health disorders must be engaged in school or work;[104] and they often need assistance choosing peers and how to spend their free time.

The Bridge Program at the Juvenile Temporary Detention Center (JTDC) in Cook County is one example of a collaborative partnership that focuses on successfully transitioning mentally ill youth back into the community.

Coordinated Case Management

Case managers can 1) build relationships with community providers, 2) connect youth to relevant services, 3) keep track of a youth’s treatment progress, 4) monitor a youth’s compliance with conditions imposed by the court, mental health providers, and any other relevant agencies, 5) engage and motivate youth and their families, and 6) help resolve the sometimes-conflicting interests of youth, their parents or caregivers, the juvenile justice system, and mental health treatment providers. Case management works best if it is initiated when youth enter a facility and then follows youth as they move the phases of the juvenile justice continuum. If formal case managers are not available, probation or parole officers, treatment providers, or child welfare representatives can coordinate the myriad of services youth with mental health disorders require and serve as the central individual with whom everyone communicates.

A variety of individuals involved with a youth’s supervision and treatment should provide input into community transition plans; they should be written in objective language understood by youth, their parents or caregivers, and professionals from diverse systems. [See Ch. 18: Transition Planning and Reentry]

Housing Issues

Youth with serious mental health disorders may require specialized residential placements or specific intervention services immediately upon release, including 1) an inpatient psychiatric hospital, 2) a day treatment program, 3) therapeutic foster care, and 4) intensive home-based treatment. Parents or caregivers may need crisis intervention services or access to respite care. Some parents or caregivers may not have the capacity or willingness to take care of mentally ill youth upon their release from custody. Every effort should be made to connect youth with family members (even if they are distant relatives or do not live nearby) rather than out-of-home placements.

The longer youth with mental health disorders have been incarcerated, the more aftercare services they typically require due to the extreme change in circumstances; these youth require a gradual transition back into the community. Allowing youth to visit their family home or reside for a short time in a less restrictive residential setting (e.g., step-down program, group home) helps them practice functioning with fewer external controls before fully returning to the community.

Probation and Parole

Youth are more likely to attend and participate in mental health services after release if services are mandated by probation or parole. Positive incentives for treatment compliance are essential; however, the fear of sanctions for noncompliance is also a powerful motivator for many youth and their families. Probation or parole should maintain regular contact with mentally ill youth to monitor their involvement at home, in school or work, and with peers; they should be alert to a worsening of a youth’s functioning or a return or exacerbation of mental health symptoms. As they reintegrate, youth need stable adults to provide support during challenging times.[105] Probation or parole staff are in an ideal position to serve in that important role. In addition, random drug testing with youth who have co-occurring disorders can strengthen their motivation to remain clean and sober.

Mental Health Training Is Essential

Working with youth who have mental health, substance use, co-occurring, and trauma-related needs, is physically and emotionally stressful.

When juvenile justice staff receive little or no training on these issues, they can easily become frustrated and discouraged, leading to burnout and ineffective—and sometimes harmful—management strategies. Without training on how to effectively manage youth with mental health disorders, staff can unintentionally escalate a crisis situation, exacerbate distress, or trigger a deterioration of a youth’s symptoms. This is dangerous for both youth and staff. Other reasons staff require this training include:

  • Youth with mental health disorders spend significantly more time with line staff than with mental health staff.
  • Line staff can manage youth more strategically if they understand a youth’s key issues.
  • Line staff are in an ideal position to detect a youth’s mood and behavior changes.
  • Line staff are central members of the treatment team.
  • Some juvenile justice staff administer mental health screening tools.
  • Every interaction between mentally ill youth and line staff can positively or negatively impact youth.
  • Some line staff do not believe in “mental illness” and assume youth are faking symptoms to avoid tasks or responsibilities.
  • Line staff can misinterpret a youth’s mental health symptoms as attention-seeking or as defiance.
  • Positive relationships between youth and line staff are vital and can serve as a protective factor for a youth’s future.
  • Training staff on the identification and management of youth in custody with mental health disorders can reduce liability.

In addition to providing informal counseling to youth, line staff refer youth of concern to mental health professionals, provide critical information regarding youth behavior, give feedback about medication side effects they observe, and report on whether medication seems to be positively impacting a youth’s behavior. Even when trying to do the right thing, staff may unintentionally reinforce a youth’s aggression, angry outbursts, self-injury, and medication refusal if staff do not know how to respond effectively. In addition, when line staff view legitimate symptoms of mental illness as purposeful, oppositional, or manipulative, youth with mental health disorders can receive a multitude of negative consequences, more restrictive placements, and longer periods of confinement.

Providing mental health training to all staff increases safety and the effective management of troubled youth; it is also an important way a facility or agency can demonstrate that it is not deliberately indifferent to the needs of the mentally ill youth in their care—something for which detention and correctional facilities can be sued.

A survey of correction officers found the following:[106]

  • 90% said that working with mentally ill offenders adds to the stress of the job.
  • 86% said the training for their current job did not prepare them to work with offenders who have mental health disorders.
  • 95% said they wanted more training to deal with mentally ill offenders.

Although the study involved staff who work with confined adults, the same sentiments are consistently found among those working with incarcerated youth.

Training all staff (direct-care to administration) on the following topics is essential to running safe and secure living units and meeting the needs of confined youth:

  • Identifying and managing incarcerated youth with mental health, substance use, co-occurring, and trauma-related needs.
  • Effective behavior management with clinically complex and difficult-to-manage youth, including effective alternatives to isolation and restraint.
  • Suicide prevention specifically related to youth in custody.

For this chapter, these three types of trainings are included under the umbrella term "mental health training."

Who Should Attend Mental Health Training?

Anyone who has direct contact with incarcerated youth will come into contact with those who have mental health disorders. Therefore, the following professionals should receive mental health training:

  • All levels of juvenile justice staff.
  • Teachers, principals, and school psychologists.
  • Vocation, recreation, art, and occupational therapy staff.
  • Mental health, substance abuse, and sex offender treatment providers.
  • Maintenance and food service staff.
  • Chaplains.
  • Medical personnel.

Training a diverse group of participants is a good way to bring together the various disciplines that must collaborate and coordinate the care of youth with mental health disorders. The training itself can help the members of different systems learn more about one another and serves as a starting point for making professional contacts and exchanging ideas.

Staff must also effectively coordinate and collaborate within their own discipline. Staff teams, as well as entire units or facilities, have lost focus and ended up in chaos over the management of seriously mentally ill youth. Half the staff believe that certain youth are faking symptoms and should receive restrictions and consequences for their negative behavior; other staff want youth to receive extra support and fewer behavioral expectations. This type of division is common and detrimental to youth with mental health disorders, staff teams, and living units. Therefore, sending entire staff teams to mental health training ensures that they all hear the same information and recommendations. Admission or orientation units, specialized mental health units, and disciplinary units should have first priority to attend mental health training, because they supervise the largest numbers of mentally ill youth.

Key Components in Mental Health Training

Mental health trainings can often be perceived as dry, boring, or discouraging. The following factors help keep staff engaged and increase the likelihood they will walk away with new mental health knowledge and skills:

  • Making complex clinical material easy to understand.
  • Ensuring the material is relevant to the type of facility, participants’ job duties, and available mental health resources (or lack thereof).
  • Employing trainers with extensive knowledge and experience in both mental health disorders and juvenile justice settings.
  • Employing down-to-earth trainers who recognize the expertise of juvenile justice staff.
  • Recommending specific, practical, and easy-to-implement strategies.
  • Scheduling the training so there is adequate time to cover the material and allow for questions and clarification.
  • Using real-life case examples of youth in custody with mental health disorders.
  • Presenting the material in a variety of modalities (e.g., slides, video clips, lecture) and involving participants (e.g., small- and large-group activities, role playing).

Following mental health training, juvenile justice staff often describe having 1) a better understanding of youth with mental health disorders, 2) more confidence managing youth with mental health disorders, 3) an increased willingness to communicate and collaborate with mental health staff, and 4) an appreciation for why mental health issues should be integrated into juvenile justice treatment plans.

Mental health professionals often need training on safely and effectively providing care in correctional environments. Graduate programs typically do not prepare clinicians to work with potentially dangerous youth who have clinically complex emotional and behavioral conditions. Plus, there may have been significant advances in the field since they received their degree or licensure. In addition to attending relevant trainings that juvenile justice staff receive (e.g., mental health, suicide prevention, and effective behavior management) mental health professionals need information on evidence-based screening and assessment, and on providing evidence-based individual, group, and family therapy specifically with incarcerated juveniles.

Given the high numbers of incarcerated youth with mental health, substance use, co-occurring, and trauma-related disorders, mental health training for all staff should be mandatory.

Conclusion

Ideally, justice-involved youth with mental health, co-occurring, and trauma-related disorders are held accountable and receive appropriate treatment in the community; all systems should be working toward that goal. When these youth must be placed in juvenile detention, juvenile corrections or adult facilities, much can be done to reduce the potential harm and increase the positive changes these young people experience.

For more information:

 

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Endnotes


[1] O. Collins, R. Vermeiren, C. Vreugdenhil, W. van den Brink, T. Doreleijers, and E. Broekaert, “Psychiatric Disorders in Detained Male Adolescents: A Systematic Literature Review,” The Canadian Journal of Psychiatry 55 (2010): 255–263.; T. Doreleijers and E. Broekaert, “Psychiatric Disorders in Detained Male Adolescents: A Systematic Literature Review,” The Canadian Journal of Psychiatry 55 (2010): 255–263.; N. Karnik et al., “Prevalence of and Gender Differences in Psychiatric Disorders Among Juvenile Delinquents Incarcerated for Nine Months,” Psychiatric Services 60 (2009): 838–841.; L.A. Teplin et al., “Psychiatric Disorders in Youth in Juvenile Detention,” Archives of General Psychiatry 59 (2002): 1133–1143.

[2] Morris et al., “Health Risk Behavior Survey From 39 Juvenile Correctional Facilities in the United States,” Journal of Adolescent Health 17 (1995): 334–344.; A.J. Sedlak and K. McPherson, Survey of Youth in Residential Placement: Youth’s Needs and Services, SYRP Report, (Rockville, MD: Westat, 2010).

[3] J.C. Gagnon and C. Richards, Making the Right Turn: A Guide About Youth Involved in the Juvenile Corrections System, (Washington, DC: National Collaborative on Workforce and Disability for Youth, Institute for Educational Leadership, 2008).; J.W. Coid et al., “Gang Membership, Violence, and Psychiatric Morbidity,” American Journal of Psychiatry 170 (2013): 985–993.; K. Corcoran, T.A. Washington, and N. Meyer-Adams, “The Impact of Gang Membership on Mental Health Symptoms, Behavior Problems and Antisocial Criminality of Incarcerated Young Men,” Journal of Gang Research 12 (2005): 25–35.

[4] D.S. Davis, G.J. Bean, J.E. Schumacher, and T.L. Stringer, “Prevalence of Emotional Disorders in a Juvenile Justice Institutional Population,” American Journal of Forensic Psychology 9 (1991): 5–17.

[5] R. Cohen et al., “Characteristics of Children and Adolescents in a Psychiatric Hospital and a Corrections Facility,” Journal of the American Academy of Child and Adolescent Psychiatry 29 (1990): 909–913.

[6] Committee on Government Reform, Special Investigations Division, Minority Staff, “Incarceration of Youth Who Are Waiting for Community Mental Health Services in the United States.”

[7] S. Vitanza, R. Cohen, and L. Hall, Families on the Brink: The Impact of Ignoring Children with Serious Mental Illness: Results of a National Survey of Parents and Other Caregivers (Arlington, VA: The National Alliance for the Mentally Ill, 1999).

[8] M.P. Krezmien, P.E. Leone, M.S. Zablocki, and C.S. Wells, 2010. “Juvenile Court Referrals and the Public Schools: Nature and Extent of the Practice in Five States,” Journal of Contemporary Criminal Justice 26 (2010): 273–293.

[9] American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (5th ed.), (Arlington, VA: American Psychiatric Publishing, 2013).

[10] L.M. Boesky, Juvenile Offenders with Mental Health Disorders: Who Are They and What Do We Do With Them (2nd Edition), (Alexandria, VA: American Correctional Association, 2011).

[11] M. Hoeve, L.S. McReynolds, and G.A. Wasserman, “The Influence of Adolescent Psychiatric Disorder on Young Adult Recidivism,” Criminal Justice and Behavior 40 (2013): 1368–1382.

[12] G.A. Aarons, S.A. Brown, R.L. Hough, A.F. Garland, and P.A. Wood, “Prevalence of Adolescent Substance Use Disorders Across Five Sectors of Care,” Journal of the American Academy of Child and Adolescent Psychiatry 40 (2001): 419–426.; O. Collins et al., “Psychiatric Disorders in Detained Male Adolescents.”; T. Doreleijers and E. Broekaert, “Psychiatric Disorders in Detained Male Adolescents: A Systematic Literature Review,” The Canadian Journal of Psychiatry 55 (2010): 255–263.; Karnik et al., “Prevalence and Gender Differences.”; Teplin et al., “Psychiatric Disorders.”

[13] L.A. Teplin, K.M. Abram, G.M. McClelland, and M.K. Dulcan, “Comorbid Psychiatric Disorders in Youth in Juvenile Detention,” Archives of General Psychiatry 60 (2003): 1097–1108.

[14] R.H. Peters, M.G. Bartoi, and P.B. Sherman, Screening and Assessment of Co-occurring Disorders in the Justice System, (Delmar, NY: CMHS National GAINS Center, 2008).

[15] Brent et al., “Psychiatric Risk Factors for Adolescent Suicide: A Case Control Study,” Journal of the American Academy of Child and Adolescent Psychiatry 32 (1993): 521–529.

[16] K. Craswell, B. Maughan, H. Davis, F. Davenport, and N. Goddard, “The Psychosocial Needs of Young Offenders and Adolescents From an Inner City Area,” Journal of Adolescence 27 (2004): 415–428.; B.E. Perron, and M.O. Howard, “Prevalence and Correlates of Traumatic Brain Injury among Delinquent Youths,” Criminal Behaviour and Mental Health 18 (2008): 243–255.

[17] K.M. Abram et al., PTSD, Trauma, and Comorbid Psychiatric Disorders in Detained Youth. Juvenile Justice Bulletin, (Washington, DC: OJJDP, 2014).

[18] W.E. Copeland, G. Keeler, A. Angold, and E. J. Costello,Traumatic Events and Posttraumatic Stress in Childhood,” Archives of General Psychiatry 64 (2007): 577–584.; R.M. Giaconia, H.Z. Reinherz, A.B. Silverman, B. Pakiz, A.K. Frost, and E. Cohen, “Traumas and Posttraumatic Stress Disorder in a Community Population of Older Adolescents,” Journal of the American Academy of Child and Adolescent Psychiatry 34 (1995): 1369–1380.; R. Gilbert et al., “Burden and Consequences of Child Maltreatment in High-Income Countries,” The Lancet 373 (2009): 68–81.; V. Ruchkin, “Violence Exposure and Psychopathology in Urban Youth: The Mediating Role of Posttraumatic Stress,” Journal of Abnormal Child Psychology 35 (2007): 578–593.

[19] J.D. Ford, J.D. Elhai, D.F Connor, M.D., and B.C. Frueh, “Poly-Victimization and Risk of Posttraumatic, Depressive, and Substance Use Disorders and Involvement in Delinquency in a National Sample of Adolescents,” Journal of Adolescent Health 46 (2010): 545–552.

[20] K.M. Abram et al., “Posttraumatic Stress Disorder and Trauma," 403–410.; Cauffman et al., “Posttraumatic Stress Disorder Among Female Juvenile Offenders,” Journal of the American Academy of Child and Adolescent Psychiatry 37 (1998): 1209–1216.; H. Steiner, I.G. Garcia, and Z. Matthews, “Posttraumatic Stress Disorder in Incarcerated Juvenile Delinquents,” Journal of the American Academy of Child and Adolescent Psychiatry 36 (1997): 357–365.

[21] Giaconia et al., “Traumas and Posttraumatic Stress Disorder,” 1369–1380.; D.G.Kilpatrick, B.E. Saunders, and D.W. Smith, Research in Brief: Youth Victimization: Prevalence and Implications (NCJ 194972), (Washington, DC: National Institute of Justice, 2003).

[22] B.C. Kok, R.K. Herrell, J.L. Thomas, and C.W. Hoge, “Posttraumatic Stress Disorder Associated with Combat Service in Iraq or Afghanistan: Reconciling Prevalence Differences between Studies,” Journal of Nervous and Mental Disease 200 (2012): 444–450.; L.K. Richardson, B.C. Frueh, and R. Acierno, “Prevalence Estimates of Combat-Related PTSD: A Critical Review,” Australian and New Zealand Journal of Psychiatry 44 (2010): 4–19.

[23] K.M. Abram, J.J. Washburn, L. Teplin, K. Emanuel, E.G. Romero, and G.M. McClelland, “Posttraumatic Stress Disorder and Comorbidity among Detained Youths,” Psychiatric Services 58 (2007): 1311–1316.

[24] J.A. Cohen, and M.S. Scheeringa, “Posttraumatic Stress Disorder Diagnosis in Children: Challenges and Promises,” Dialogues in Clinical Neuroscience 11 (2009): 91–99.

[25] J.A. Cohen et al., “Practice Parameter for the Assessment and Treatment of Children and Adolescents with Posttraumatic Stress Disorder,” Journal of the American Academy of Child and Adolescent Psychiatry 49 (2010): 414–430.

[26] K.M. Abram et al., PTSD, Trauma, and Comorbid Psychiatric Disorders in Detained Youth. Juvenile Justice Bulletin, (Washington, DC: OJJDP, 2013).; SAMHSA, 2012, Promoting Recovery and Resilience for Children and Youth Involved in Juvenile Justice and Child Welfare Systems.

[27] W. D’Andrea, J. Ford, B. Stolbach, J. Spinazzola, and B.A. van der Kolk, “Understanding Interpersonal Trauma in Children: Why We Need a Developmentally Appropriate Trauma Diagnosis,” American Journal of Orthopsychiatry 82 (2012): 187–200.; B.A. van der Kolk, “Developmental Trauma Disorder,” Psychiatric Annals 35 (2005): 401–408.

[28] S.R. Dube et al., “Long-Term Consequences of Childhood Sexual Abuse by Gender of Victim. American Journal of Preventive Medicine 28 (2005): 430–438.; D. Finkelhor, G. Hotaling, I.A. Lewis, and C. Smith, “Sexual Abuse in a National Survey of Adult Men and Women: Prevalence, Characteristics, and Risk Factors,” Child Abuse and Neglect 14 (1990): 19–28.

[29] W.C. Holmes and G.B. Slap, “Sexual Abuse of Boys: Definition, Prevalence, Correlates, Sequelae, and Management,” Journal of the American Medical Association 280 (1998): 1855–1862.

[30] M.D. Debellis, S.R. Hooper, E.G. Spratt and D.P. Woolley, ”Neuropsychological Findings in Childhood Neglect and their Relationships to Pediatric PTSD,” Journal of the International Neuropsychological Society 15 (2009): 868–878.; M.H. Teicher et al., “Developmental Neurobiology of Childhood Stress and Trauma,” The Psychiatric Clinics of North America 25 (2002): 397–426.; S. Whittle et al., “Childhood Maltreatment and Psychopathology Affect Brain Development During Adolescence,” Journal of the American Academy of Child & Adolescent Psychiatry 52 (2013): 940–952.

[31] B.D. Perry, “The Neurodevelopmental Impact of Violence in Childhood,” in Textbook of Child and Adolescent Forensic Psychiatry, eds. D. Schetky and E.P. Benedek (Washington, DC: American Psychiatric Press, 2001), 221–238.

[32] NCCHC, Standards for Health Services in Juvenile Detention and Confinement Facilities, (Chicago, IL: Author, 2011).

[33] G. Griffin et al., “Addressing the Impact of Trauma before Diagnosing Mental Illness in Child Welfare,” Child Welfare 90 (2011): 69–89.

[34] L.M. Boesky, Juvenile Offenders with Mental Health Disorders.; T. Grisso, G. Vincent, and D. Seagrave, Mental Health Screening and Assessment in Juvenile Justice, (New York: Guilford Press, 2005).

[35] NCCHC, Standards for Health Services in Juvenile Detention and Confinement Facilities.

[36] J.A. v. Barbour, Case No. 3:07-cv-394 DPJ.JCS; S. H. v. Stickrath, Case No. 2:04-cv-1206-GCS-TPK.; Youth v. Polk County Jail, Case No. 8:12-cv-00568.

[37] P.A. Griffin, H.A. Hills, and R.H. Peters, “Mental Illness and Substance Abuse in Offenders: Overcoming Barriers to Successful Collaboration Between Substance Abuse, Mental Health, and Criminal Justice Staff,” in Criminal Justice Substance Abuse Cross Training: Working Together For Change, eds. S.H. Schnoll and S.M. Reiner, (Richmond, VA: Virginia Addiction Technology Transfer Center, Virginia Commonwealth University, 1996).

[38] Ibid.

[39] Bureau of Justice Statistics, “Deaths in Custody Statistical Tables: State Juvenile Correctional Facility Deaths, 2002–2005.”

[40] J.V. Penn, C.L. Esposito, L.E. Schaeffer, G.K. Fritz, and A. Spirito, “Suicide Attempts and Self-Mutilative Behavior in a Juvenile Correctional Facility,” Journal of the American Academy of Child and Adolescent Psychiatry 42 (2003): 762–769.; A.J. Sedlak, and K. McPherson, Survey of Youth in Residential Placement.

[41] K.M. Abram et al., PTSD, Trauma, and Comorbid Psychiatric Disorders in Detained Youth.

[42] Lindsay M. Hayes, Juvenile Suicide in Confinement: A National Survey, (Washington, DC: OJJDP, 2009).

[43] L.M. Boesky, Juvenile Offenders with Mental Health Disorders.

[44] NCCHC, Standards for Health Services.

[45] Lindsay M. Hayes, Juvenile Suicide in Confinement: A National Survey (Washington, DC: OJJDP, 2009).

[46] Ibid.

[47] J.N. Cooper et al., “Suicide After Deliberate Self-Harm: A 4-year Cohort Study.”

[48] P.A. Griffin et al., “Mental Illness and Substance Abuse in Offenders.”

[49] G. Griffin et al., “Addressing the Impact of Trauma.”

[50] M.T. Marrow, K.J. Knudsen, E. Olafson, and S.E. Bucher, “The Value of Implementing TARGET within a Trauma-responsive Juvenile Justice Setting,” Journal of Child & Adolescent Trauma 5 (2012): 257–270.

[51] G. Griffin, E. J. Germain, and R.G. Wilkerson. “Using a Trauma-responsive Approach in Juvenile Justice Institutions,” Journal of Child & Adolescent Trauma 5 (2012): 271–283.

[52] J.D. Ford, and J. Hawke, “Trauma Affect Regulation Psychoeducation Group and the Milieu Intervention Outcomes in Juvenile Detention Facilities,” Journal of Aggression, Maltreatment & Trauma 21 (2012): 365–384.

[53] J.O. Prochaska, C.C. DiClemente, and J.C. Norcross, “In Search of How People Change: Applications to Addictive Behaviors,” American Psychologist 47 (1992): 1102–1114.

[54] L.M. Boesky, Juvenile Offenders with Mental Health Disorders.

[55] P. Gendreau, “The Principles of Effective Interventions with Offenders,” in Choosing Correctional Options That Work, ed. A.T. Harland, (Thousand Oaks, CA: Sage, 1996), 117–130.

[56] K.R. Fox, “The Influence of Physical Activity on Mental Well-Being,” Public Health Nutrition 2 (1999): 411–418.

[57] M. Balasubramaniam, S. Telles, and P.M. Doraiswamy, “Yoga On Our Minds: A Systematic Review of Yoga for Neuropsychiatric Disorders,” Frontiers in Psychiatry 3 (2013): 1–16.; C. Smitha, H. Hancock, J. Blake-Mortimer, and K. Eckert, “A Randomized Comparative Trial of Yoga and Relaxation to Reduce Stress and Anxiety,” Complementary Therapies in Medicine 15 (2007): 77–83.

[58] A. Ross, and S. Thomas, “The Health Benefits of Yoga and Exercise: A Review of Comparison Studies,” The Journal of Alternative and Complementary Medicine 16 (2010): 3–12.

[59] G.P. Amminger et al., “Long-Chain Omega-3 Fatty Acids for Indicated Prevention of Psychotic Disorders: A Randomized, Placebo-Controlled Trial,” Archives of General Psychiatry 67 (2010): 146–154.; F.N. Jacka et al., “Maternal and Early Postnatal Nutrition and Mental Health of Offspring by Age 5 Years: A Prospective Cohort Study,” Journal of the American Academy of Child and Adolescent Psychiatry, (forthcoming).; S.F. Suglia, S. Solnick, and D. Hemenway, “Soft Drinks Consumption Is Associated with Behavior Problems in 5-Year-Olds,” Journal of Pediatrics 163 (2013): 1323–28.Behavior Problems

[60] S. Schoenthaler and W.E. Doraz, “Types of Offenses Which Can Be Reduced in an Institutional Setting Using Nutritional Intervention: A Preliminary Empirical Evaluation,” International Journal of Biosocial Research 4 (1983): 74–84.

[61] C.B. Gesch et al., “Influence of Supplementary Vitamins, Minerals and Essential Fatty Acids on the Antisocial Behaviour of Young Adult Prisoners,” British Journal of Psychiatry 181 (2002): 22–8.; S. Schoenthaler et al., “The Effect of Randomized Vitamin-Mineral Supplementation on Violent and Non-violent Antisocial Behavior Among Incarcerated Juveniles,” Journal of Nutritional & Environmental Medicine 7 (1997): 343–352.

[62] S.N. Compton et al., “Cognitive-Behavioral Psychotherapy for Anxiety and Depressive Disorders in Children and Adolescents: An Evidence-Based Medicine Review,” Journal of the American Academy of Child and Adolescent Psychiatry 43 (2004): 930–959.; J.R. Weisz et al., “Cognitive-Behavioral Therapy Versus Usual Clinical Care for Youth Depression: An Initial Test of Transportability to Community Clinics and Clinicians,” Journal of Consulting and Clinical Psychology 77 (2009): 383–396.

[63] W.R. Miller and S. Rollnick, Motivational Interviewing: Preparing People for Change, (New York: Guilford Press, 2002).

[64] J.D. Ford and J. Hawke, “Trauma Affect Regulation Psychoeducation,” 365–384.; M.T. Marrow et al., “The Value of Implementing TARGET.”

[65] M. Linehan, Skills Training Manual for Treating Borderline Personality Disorder, (New York: Guilford Press, 1993).; A.L. Miller, J.H. Rathus, and M.M. Linehan, Dialectical Behavior Therapy for Suicidal Adolescents, (New York: Guilford Press, 2006).; D. Shelton, K. Kesten, Z.W. Zhang, and R.L. Trestman, “Impact of a Dialectic Behavior Therapy—Corrections Modified upon Behaviorally Challenged Incarcerated Male Adolescents,” Journal of Child and Adolescent Psychiatric Nursing 24 (2011): 105–113.

[66] A.P. Goldstein, B. Glick, and J.C. Gibbs, Aggression Replacement Training: A Comprehensive Intervention for Aggressive Youth, (Champaign, IL: Research Press, 1998).

[67] J. Alexander et al., Blueprints for Violence Prevention, Book Three: Functional Family Therapy, )Boulder, CO: Center for the Study and Prevention of Violence, 1998).; C.D. Morris, D.J. Miklowitz, and J. A. Waxmonsky, “Family-Focused Treatment for Bipolar Disorder in Adults and Youth,” Journal of Clinical Psychology 63 (2007): 433–445.

[68] J.A. Cohen, A.P. Mannarino, and E. Deblinger, Treating Trauma and Traumatic Grief in Children and Adolescents, (New York: Guilford Press, 2006).

[69] Stevie N. Grassetti et al., “Narrative Focus Predicts Symptom Change Trajectories in Group Treatment for Traumatized and Bereaved Adolescents,” Journal of Clinical Child Adolescent Psychology 13 (2014): 1–9.

[70] M. Harris, Trauma Recovery and Empowerment: A Clinician’s Guide for Working with Women in Groups, (New York: The Free Press, 1998).

[71] F.E. Shapiro, “Eye Movement Desensitization and Reprocessing (EMDR): Evaluation of Controlled PTSD Research,” Journal of Behavior Therapy and Experimental Psychiatry 27 (1996): 209–218.

[72] L.M. Najavits, Seeking Safety: A Treatment Manual for PTSD and Substance Abuse, (New York: Guilford Press, 2002).

[73] R. DeRosa and D. Pelcovitz, “Igniting SPARCS of Change: Structured Psychotherapy for Adolescents Responding to Chronic Stress,” In Treating Traumatized Children: Risk, Resilience and Recovery, eds. J. Ford, R. Pat-Horenczyk and D. Brom, (New York: Routledge, 2008).

[74] N.M. Curtis, K.R. Ronan, and C.M. Borduin, “Multisystemic Treatment: A Meta-Analysis of Outcome Studies,” Journal of Family Psychology 18 (2004): 411–419.; S.W. Henggeler et al., Multisystemic Treatment of Antisocial Behavior in Children and Adolescents, (New York: Guilford, 1998).

[75] B.J. Burns, S.K. Goldman, L. Faw, and J. Burchard, 1999. “The Wraparound Evidence Base,” In Promising Practices in Wraparound for Children with Serious Emotional Disturbances and Their Families: Systems of Care, eds. B. J. Burns and S. K. Goldman, (Washington, DC: American Institutes for Research, Center for Effective Collaboration and Practice, 1999), 77–100.; M.D. Pullman et al., “Juvenile Offenders With Mental Health Needs: Reducing Recidivism Using Wraparound,” Crime & Delinquency 52 (2006): 375–397.

[76] National Commission on Correctional Health Care, Standards for Health Services in Juvenile Detention and Confinement Facilities, (Chicago, IL: Author, 2011).

[77] M. Born, V. Chevalier, and I. Humblet, “Resilience, Desistance, and Delinquent Career of Adolescent Offenders,” Journal of Adolescence 20 (1997): 679–694.

[78] J.F. Leckman and R.A. King, “A Developmental Perspective on the Controversy Surrounding the Use of SSRIs to Treat Pediatric Depression,” American Journal of Psychiatry 164 (2007): 1304–1306.

[79] L.K. Leslie et al., “Racial/Ethnic Differences in the Use of Psychotropic Medication in High-Risk Children and Adolescents,” Journal of the American Academy of Child and Adolescent Psychiatry 42 (2003): 433–442.; R. Goodwin, M.S. Gould, C. Blanco, and M. Olfson, “Prescription of Psychotropic Medications to Youths in Office-Based Practice,” Psychiatric Services 52 (2001): 1081–1087.; J.M. Zito et al., “Psychotropic Practice Patterns for Youth: A 10-Year Perspective,” Archives of Pediatric Adolescent Medicine 157 (2003): 17–25.

[80] S.M. Wells, 1998, “Research Shows Ethnicity a Factor in Medication Response,” Evaluation FastFacts. The Evaluation Center at HSRI.ff-03.pdf

[81] Annie E. Casey Foundation, “Detention Facility Self-Assessment: A Practice Guide to Juvenile Detention Reform.”; NCCHC, Standards for Health Services.

[82] L.M. Finke, “The Use of Seclusion is Not Evidence-Based Practice,” Journal of Child and Adolescent Psychiatric Nursing 14 (2001): 186–190.

[83] NCCHC, Standards for Health Services.

[84] NCCHC, Standards for Health Services.

[85] Annie E. Casey Foundation, Juvenile Detention Facility Assessment: 2014 Update, (Baltimore, MD: Author, 2014).

[86] American Correctional Association, Performance-Based Standards for Juvenile Correctional Facilities, (Alexandria, VA: American Correctional Association, 2009).; Annie E. Casey Foundation, Detention Facility Self-Assessment.

[87] American Correctional Association, Performance-Based Standards for Juvenile Correctional Facilities, (Alexandria, VA: American Correctional Association, 2009).; Annie E. Casey Foundation, Detention Facility Self-Assessment.

[88] ACA, Performance-Based Standards.

[89] Ibid.

[90] S. Grassian, “Psychiatric Effects of Solitary Confinement,” Journal of Law and Policy 22 (2006): 325–383.; C. Haney, “Mental Health Issues in Long-Term Solitary and Supermax Confinement,” Crime and Delinquency 49 (2003): 124–156.

[91] Lindsay M. Hayes, Juvenile Suicide in Confinement.

[92] ACA, Performance-Based Standards.; Annie E. Casey Foundation, Detention Facility Self-Assessment.; NCCHC, Standards for Health Services.

[93] Annie E. Casey Foundation, Juvenile Detention Facility Assessment: 2014 Update.

[94] American Academy of Child and Adolescent Psychiatry, 2012, “Policy Statement, Solitary Confinement of Juvenile Offenders.”: Human Rights Watch/ACLU, Growing Up Locked Down.

[95] National Commission on Correctional Health Care, Standards for Health Services.

[96] W.K. Mohr, T.A. Petti, and B.D. Mohr, “Adverse Effects Associated With Physical Restraint,” Canadian Journal of Psychiatry 48 (2003): 330–337.

[97] National Commission on Correctional Health Care, Standards for Health Services.

[98] Annie E. Casey Foundation, Detention Facility Self-Assessment.

[99] Sue Burrell, Moving Away from Hardware: The JDAI Standards on Fixed Restraint, (Baltimore, MD: Annie E. Casey Foundation/Juvenile Detention Alternatives Initiative, 2009).

[100] ACA, Performance-Based Standards for Juvenile Correctional Facilities (4th Edition).: ACA, 2012 Standards Supplement.; NCCHC, Standards for Health Services in Juvenile Detention and Confinement Facilities.

[101] F. Cohen, personal communication, October 29, 2013.

[102] F. Cohen, “Penal Isolation: Beyond the Seriously Mentally Ill,” Criminal Justice and Behavior 35 (2008): 1017–1047.

[103] S. Simkins, M. Beyer, and L.M. Geis, “The Harmful Use of Isolation in Juvenile Facilities: The Need for Post-disposition Representation,” Washington Journal of Law and Policy 38 (2012): 241–287.

[104] M. Bullis, P. Yovanoff, G. Mueller, and E. Havel, “Life on the ‘Outs’—Examination of the Facility-to-Community Transition of Incarcerated Youth,” Exceptional Children 69 (2002): 7–22.

[105] L.S. Abrams, K.S. Shannon, and C. Sangalang, “Transition Services for Incarcerated Youth: A Mixed-methods Evaluation Study,” Child and Youth Services Review 30 (2008): 522–535.

[106] P.R. Kropp, D.N. Cox, R. Roesch, and D. Eaves, “The Perceptions of Correctional Officers Toward Mentally Disordered Offenders,” International Journal of Law and Psychiatry 12 (1989): 181–188.

Ch.12 Healthcare

Ch.12 Healthcare web_admin Mon, 12/27/2021 - 11:04

Author: Michelle Staples-Horne, MD, MS, MPH, CCHP

Youth and families involved in the juvenile justice system are considered one of the most at-risk populations in the community. Unmet or inconsistent mental healthcare has been identified by the juvenile courts as one of the major issues causing youth to remain in the system, usually for reoffending. Unmet medical healthcare needs also play an important role in the rehabilitation of these juveniles. Health and mental health issues impact each other, so both must be addressed simultaneously in the juvenile system. The courts have mandated a comprehensive healthcare system for incarcerated persons to address both physical and mental health needs.[1] For some youth, the system during detention can be more stable than the circumstances in which they live on a daily basis in their community.

Juvenile offending behavior is strongly related to poor health, deteriorating family relationships, worsening school performance, lack of employment, and other social and psychological problems, including lowered school performance, poor family relationships, high rates of conduct disorders, and increased interactions with alcohol and drug abusing peers.

Often, the public perceives juvenile offenders as “well enough to get in trouble.” Ironically, it is often the behaviors that got them into the juvenile justice system that increase their risk for premature death and disease. Detained youth are more likely to have experimented with smoking, alcohol, and drugs; used weapons; and been exposed to violence and trauma compared to the non-offender population. Engagement in risky sexual behaviors such as multiple sex partners and lack of condom use increases the risk of exposure to HIV and other sexually transmitted infections. All these behaviors increase their likelihood of injury, overdose, suicide, and early disease.

The care of youth in custody is unique and requires correctional facilities—whether it is juvenile facilities or adult facilities that house youth—to accommodate their needs. In adult facilities, housing, including medical care, must be provided separately—outside of sight and sound of adult inmates. If a separate area for medical care cannot be provided, facility staff should adjust the schedule to bring youth to the medical area at a different time.

The American Correctional Association (ACA) and the National Commission on Correctional Healthcare (NCCHC) clearly outline the requirements for healthcare in this population. Often it is the development and implementation of health policies and procedures that ensure that the standards are met; policies and procedures are the key to consistency. They should never be developed in isolation. Input should occur from medical and security staff, with representation from line staff as well as administrators. Health policies and procedures should include definitions, be simple to follow, and not be too long. They should outline a broad approach to facility operation, but also define required details in a local operating procedure (LOP). Staff must be trained and must practice implementing procedures. Health policies and procedures should not be stagnant, but should include an annual review process to determine their effectiveness and the need for any modifications or revisions. Finally, it is inadequate to have policies and procedures without a continuous quality improvement program to monitor compliance and ensure that the practices of the healthcare staff lead to improved healthcare outcomes for youth.

Staffing and Equipment

No organization has been able to create a standardized staffing pattern for healthcare providers in a juvenile setting. Most correctional healthcare standards use the term “adequate” when referring to staffing. How do you determine what is adequate healthcare staffing for your facility? That decision should be based on purpose, form, and function.

What is the purpose of the facility? Short-term detention centers need more healthcare staff, due to the high turnover of admissions and discharges compared to a long-term juvenile facility. If an adult facility houses juveniles, will there be enough staff to care for youth separately? Will the facility house females or a special population with high mental health needs that will increase the use of health services?

The next consideration is form. What is the layout and location of the facility? Larger facilities will require more staff, but how many also depends on whether all services are in one building or spread across a large area. Location in a rural community or even a highly competitive urban area may require some creative staffing. It may be difficult to hire full time healthcare staff at a competitive rate, or the personnel may not be available in the area. In these cases, consider contracting for healthcare staff or partnership agreements with community providers such as public health and teaching hospitals or universities. Agreements and contracts should be as detailed and inclusive as possible.

Finally, how does the clinic function? Is there enough healthcare staff to meet the needs of the youth within the healthcare standard’s recommended time frame? This consideration will take a continuing reassessment of staffing to determine if all healthcare service needs are being met in a timely manner.

The first step in staffing is the establishment of the health authority. This person is responsible for all levels of healthcare and for providing quality, accessible health services to all youth. The position may be filled by a nurse or other health professional, particularly in a small facility, or by a health administrator, which may be more applicable in a larger facility. When this health authority is anyone other than a physician, clinical judgment rests with a single designated responsible physician licensed in that state. A dentist, psychiatrist, and pharmacist should be available for consultation by the responsible physician, if these providers are not available on site. The health authority manages the schedules of all clinicians and serves as a member of the facility administrative team. The health authority should be involved in the hiring and supervising of the healthcare staff and should serve as a consultant to the facility administration and security staff regarding all aspects of health. Clinical decisions and actions regarding healthcare services provided to youth are the sole responsibility of the healthcare staff and must never be compromised for security reasons. The health authority should cooperate with security staff to create an environment that meets the health needs of the youth, without compromising safety.

All healthcare staff should be licensed and credentialed as required by state and federal law; licensing needs ongoing monitoring to ensure up-to-date compliance. Requirements for continuing education vary by state and should be promoted. Continuing education specific to correctional health is strongly recommended.

The use of interns and students must include agreements with the schools and must entail close supervision. Exposure of healthcare students to correctional medicine is a great opportunity to encourage recruitment of future staff.

There should be an on-call healthcare system for facilities that do not operate 24/7. Minimally, a nurse should be on call when the clinic is closed. The nurse should have access to the physician, dentist, and psychiatrist. A designated clinic cell phone allows security staff to have immediate access to healthcare staff when the clinic is closed. All staff should be trained and certified in first aid and CPR for immediate response to an emergency. Basic training and annual updates on medical emergencies should be provided to non-healthcare staff. Medical emergency drills should include all staff.

Adequate equipment and supplies are essential to the operation of the clinic. Input from clinical staff should be included during site planning and construction. Appropriate equipment should be chosen by the staff that will use them on a daily basis. Once a facility is equipped for operation, it should be a simple matter for healthcare staff to order supplies and equipment from their designated budget. It is helpful to designate the types of medical equipment and supplies required by policy. This practice will standardize the clinic and eliminate squabbles over budgets. The facility health authority should designate strategic points inside the facility to locate Automated External Defibrillators (AEDs) and first aid kits. This equipment should be readily accessible to CPR-trained staff for use in an emergency. Personal protective supplies and equipment for avoiding contamination with biohazards such as body fluids should be available to all staff. A system of storage, collection, and decontamination of biohazardous waste must be in place and controlled by the health authority. Staff should use and account for safety needles, syringes, and all medical sharps. An inventory of safety needles and syringes should be completed at the start of each shift. The superintendent should take a periodic unannounced count of needles and syringes at least quarterly. Needles should never be re-capped, bent, or broken after use. Needles and other sharps should be disposed of intact in designated, puncture-resistant containers located in a secure area.

Intake Screening and Assessment

Many facilities lack 24-hour nursing care. Correctional officers or whoever first comes in contact with the youth at intake must be trained in basic medical and mental health screening procedures. There must be a clear mechanism to determine if healthcare staff need to be contacted if they are off site or if a youth needs further assessment prior to admission. The screening should be simple enough for health-trained security staff to be able to make a determination whether to place a youth in general population or in isolation for infection control. Screening instruments should reflect the common concerns among this population and include mental health and dental status as required by the ACA and NCCHC standards. (See Ch. 9: Admission and Intake)

If the facility houses adults, there should be some modification of the screening instrument to reflect the needs of youth, such as inclusion of immunization history and questions to identify sexual and physical abuse history. A mechanism to report and address any allegations of abuse must be incorporated throughout the system, beginning at intake, for all facility types. Long-term juvenile facilities that accept youth transferred from short-term detention facilities or transfers between secure facilities should still use a screening instrument at intake. Healthcare staff must complete the health assessment after health-trained security staff complete the initial intake screening. Healthcare staff should review the intake screening results and obtain additional information on past medical, dental, and psychiatric history. This assessment involves a more detailed line of questioning of the youth.

Ideally, healthcare staff would be available 24 hours a day to conduct the intake screening and the health assessment, especially in a high-volume detention center. But, due to staffing limitations, 24-hour on-site care may not be available. If it is not, it is critical to have a system in place to address medical emergencies with on-call medical staff and to access outside emergency services. Licensed clinicians should complete a thorough physical examination (PE) within the required timeframes, according to ACA and NCCHC standards. The PE should include areas specific to the adolescent population, such as scoliosis screening, developmental pubertal staging, growth charting, vision and hearing screening, and the identification of physical characteristics that may reflect conditions such as fetal alcohol syndrome (FAS). Some youth display many behavioral characteristics and intellectual impairments of FAS and may not have been previously diagnosed. If applicable, youth should receive physical examinations annually.

Sick Call and Clinic Visits

It is essential to implement an unimpeded process for access to sick call for youth. Sick call boxes, with forms available, should be easily accessible. Access to sick call boxes should be limited to healthcare staff to protect the confidentiality of the youth. Consideration should be given to literacy skills when sick call requests are written. Also, youth may sometimes request services for something other than the real problem for which they need to be seen, due to embarrassment or fear of peer criticism.

Policy and procedure should outline the sick call process and set time frames for completion. Sick call clinic hours should be flexible, and not always during school or recreational hours. Facilities that house adults need policies that exclude youth from copays or other systemic barriers to healthcare. Youth may not prioritize the need for healthcare, given the choice between the sick call copay and a snack from the commissary.

Nursing staff can triage the initial sick call. Medical assessments should be completed by the healthcare staff trained and credentialed to do so. In most states, nurses use protocols developed by physicians to treat common ailments, such as a colds and acne, with over-the-counter medications. Depending on the location, advanced practice nurses and physician assistants can diagnose and treat with prescription medications. These types of staff greatly augment the healthcare provided in juvenile correctional facilities. Every facility needs a physician who will ultimately be responsible for the healthcare of the residents, even if only through remote supervision or limited on-site visits. This tiered approach to sick call assessments can be very efficient in a juvenile healthcare setting. Most ailments in this population are minor and can be addressed by nursing staff. However, when a youth’s condition fails to improve, staff should consult a higher-level clinical provider. Youth may make multiple complaints, which staff sometimes perceive as malingering. Chronic complaining may require further medical assessment or may be a somatic symptom of a mental health condition or situational stress. All complaints must be taken seriously and assessed thoroughly. If all medical and psychological reasons have been ruled out, it may be beneficial for some youth to have regularly scheduled appointments with healthcare staff, thus reducing the number of sick call requests.

A significant number of clinic visits in juvenile settings are for injuries—both intentional and accidental. Intentional injuries from fights and self-inflicted wounds are very common and always require a clinic visit for assessment. Be certain to involve behavioral health staff when a youth presents with a self-inflicted wound or any suicidal ideations. Accidental injuries are also quite common and result from sports, adolescent horseplay, or security control measures. X-rays can verify or rule out any potential fractures; any fracture should be treated and followed up. Access to healthcare staff who can suture wounds on site is exceedingly valuable in a juvenile healthcare setting. For more serious injuries, emergency care is required. Healthcare staff should determine when youth are to be transported outside the facility for urgent care. Some juvenile facilities maintain infirmary beds for youth who may need a higher level of care than the living unit can provide, but do not require inpatient hospitalization. Infirmary care requires 24-hour skilled nursing. It is rare that a youth will require inpatient hospitalization for an extended period or is diagnosed with a serious medical condition such as leukemia. Under these circumstances, administrators may want to approach the courts to request a release from custody or a stay in sentence.

Healthcare staff play a vital role in the special incident reporting process when youth or staff are involved in physical altercations. Healthcare staff should be allowed privacy in interviewing youth about the incident. Policy should require an examination to be completed within specific time frames. Healthcare staff reports should be used to cross reference security reports and serve as an unbiased account of the event; reports should document any injuries or allegations of abuse.

Ancillary Care

Ancillary care (labs, X-rays) should be available as a part of the facility’s healthcare program. All efforts should be made to provide these services on site. Transporting youth off site for these services increases the demand for staffing and the risk of escape. Mobile radiology services allow studies to be completed inside the facility. Contracts should include interpretation by a Board Certified Radiologist. When emergency X-rays are needed off site, staff should coordinate with providers to reduce wait times in the emergency room or urgent care center.

Detention intake should include a standard set of admission labs. Simple Clinical Laboratory Improvement Amendment (CLIA) waived tests can be incorporated into the admissions process. A single urine sample can be used for urinalysis testing, pregnancy testing, and screening for gonorrhea and chlamydia. Medical staff are not involved in the collection of forensic evidence, such as urine drug screening, so youth should be made aware of the purpose of the specimen collection. Pregnancy testing should be performed on all females routinely as a part of the intake process, regardless of their sexual history. Pregnant girls will require specialized care, and pregnancy may prohibit some security measures, such as the use of restraints during labor and delivery. Additional laboratory services should be accessible if they are medically necessary. A laboratory contract will provide fixed prices, supplies, and pick-up schedules. Many labs offer online electronic results. Smaller facilities or those located in rural areas may not be able to contract with the larger labs for service. Such facilities may be able to contract with a local hospital for service. Another option is to partner with another agency, such as the adult department of corrections to take advantage of a larger purchasing group. In some locations, public health agencies can provide laboratory support. Administrators may contract for other ancillary services such as optometry, physical therapy, speech pathology, etc. based on volume. Again, if possible, bring the services to the facility. In some cases, education departments or school systems can provide or pay for these types of services for special needs youth while they are detained.

Dental Care

Dentistry is probably the most common unmet need among youth offenders. Many have never seen a dentist since they were screened for admission into elementary school. A dental clinic with adequate equipment and supplies should be a component of every juvenile health system. If the facility is too small or rural to attract a dentist, some arrangement must be made with a community provider for care.

Dental screening is a part of the admission process. If dental staff are not available, nursing staff can be trained by the dentist to conduct an initial dental screening. Nurses can inquire about dental pain, note dental decay, note the presence of braces and missing teeth and note abnormalities of the mouth. In the case of positive screenings, staff must contact with dental providers for further instruction. In some settings, dental protocols can be developed to allow nurses to accommodate dental needs on a temporary basis, such as giving acetaminophen for dental pain.

Only a licensed dentist may conduct dental examinations and treatment. The presence of a dental assistant allows the dentist to conduct treatment more efficiently. Community recommendations are for two routine dental visits a year for examination and cleaning (prophylaxis). Detention centers, especially those where youth may move in and out several times a year, should establish a tracking system for examinations. Dental education is key in this population and can be accomplished by dental staff, nurses trained by dental staff, or educational DVDs. Larger juvenile systems can benefit from hiring a dental hygienist for cleaning and instruction. Tooth brushing and flossing should be allowed only with security-approved items and should be scheduled as a routine part of the youth's hygiene practice.

In juvenile settings, dental care should go beyond only providing extractions and should focus on preventive and restorative dental care. Youth housed in adult facilities will require restorative dental services that may not routinely be available to the adult inmate population.

Adolescents commonly present with pain related to wisdom tooth (third molar) eruptions. There is also the likeliness of jaw fractures occurring from fights. An oral surgeon should be available for consultation and treatment in these two areas. Sometimes youth are admitted while under the treatment of a community orthodontist. In short-term detention facilities, continued use of braces may be acceptable. Deterioration or self-removal of braces creates a security risk. For youth with longer sentences or those confined to adult facilities, the community orthodontist may recommend temporary removal of these dental appliances.

Pharmacy and Medications

Pharmacy policy and procedure should outline how medications are handled at every point within the facility. In short-term facilities such as detention centers, detained youth may be carrying their current medications. Policy should dictate whether that medication can be accepted for administration or whether it should be held in a secure manner until the youth is released. For security and patient safety, medical staff need to confirm the medications to limit contraband. A pharmacist by employment or contract must be available to monitor pharmaceutical practices and ensure compliance with all state and federal drug laws. In a small or rural facility, the facility can arrange with the local drug store pharmacist to visit and monitor compliance. Larger systems may want to employ a full-time pharmacy director.

It is recommended that a formulary (list of preapproved medications) be generated by a physician trained in pediatrics or family medicine. A formulary can also help control pharmaceutical costs. However, a mechanism must be in place to allow for dispensing of non-formulary medications when they are clinically indicated. Many medications—even over-the-counter medications such as aspirin—are not appropriate for children and adolescents and should not be included on the formulary for juveniles. Adults are generally not treated in the adult correctional systems for certain diagnoses such as Attention Deficit Hyperactivity Disorder (ADHD). The use of stimulant medications to treat ADHD is needed for youth attending school, but has potential abuse by youth and staff. These drugs and other newer and more costly psychotropic medications should be included on medication formularies for facilities that house youth. Some medications need dosage modifications based on body weight; others are not approved for use with children.

In facilities that house youth with adults, it is often the practice to allow inmates to keep on person (KOP) medications for self-administration. It may not be developmentally appropriate for youth to self-administer medication; directly observed therapy (DOT)—where staff administer medication to youth—may be called for. Young people would be more likely than adults to mismanage their medication through noncompliance, overdosing, or sharing their medication with other youth.

Inventory of all medications is essential to all correctional facilities. A unit dose packaging system works best for management of drug inventory. Medical staff must document and account for any medication refusals. Clinical staff should be notified if youth refuse their medication. Depending on the jurisdiction and legal status of the youth, parental consent also may be required for the administration or discontinuation of medications to juveniles. In some juvenile and adult systems, officers are allowed to administer medications. If, after intensive review, this practice is allowed, specific training and procedures for administration must be developed and enforced. Errors may occur within the routine administration of medication. A system must be in place to document and report these errors to the responsible physician, address any related adverse event, and review them as a part of a continuous quality improvement process during the committee meetings that deal with pharmacy and therapeutics.

Specialty Care or Chronic Care

In general, youth populations do not have the number or severity of the chronic medical conditions that exist in an adult population. Probably the most common chronic medical condition in this population is having a mental health diagnosis. Asthma is probably the next most common. As more children and adolescents have become overweight, more are being diagnosed as hypertensive, diabetic, and having high cholesterol. Medications for treating these conditions should be included on the facility formulary. With adequate medical screening and examination upon admission, staff can identify and oversee the treatment of chronic medical conditions. Community standards for treatment of chronic illnesses must be followed using appropriate clinical guidelines.

The care of a youth with a chronic medical condition may require some modifications to the correctional environment. For example, a youth with a seizure disorder should not be assigned to an upper bunk. Staff should be instructed not to place objects in the mouth of an actively seizing youth and to remove objects to prevent injury and support the youth’s airway. Youth that have asthma should not be assigned to cleaning duties or other activities where there may be environmental triggers such as cold air. Inhalers may be the only exception to the rule about KOP, depending on the severity of the symptoms. Inhalers must be readily available after clinic hours. In previous years, Type I Diabetes was the most common type of diabetes in this population. These youth require insulin injections to keep their blood sugar under control, since they cannot produce it. Now with the increasing epidemic of obesity, Type II Diabetes is more common. Youth with this type of diabetes make insulin, but the body’s cells are resistant, and the blood sugar is not reduced. Most Type II Diabetics can be managed with oral medication; however, sometimes youth may require insulin injections. Ideally, the injection of insulin and monitoring of blood sugars with finger sticks should be supervised by the healthcare staff. This is not always possible in facilities that do not operate a 24-hour clinic. Depending on the youth’s knowledge and skill level, he or she may be allowed to administer his or her own insulin under staff supervision. All staff should have training and knowledge of the signs of very high and very low blood sugars, either of which can lead to serious injury or death. Bedtime snacks and food sugar sources approved by the healthcare staff should be available on the unit for immediate need. Staff and youth should also be educated and compliant regarding dietary restrictions and activity requirements.

Most youth with chronic medical conditions have been diagnosed in the community prior to detention. But in many instances, they have not had consistent follow-up care by their community medical providers. It is critical to get the medical history from the parent and community provider to achieve better continuity of care while the youth is detained. If possible, prescribed medications should be continued for youth in short-term detention to prevent disruption in treatment. A referral network for pediatric specialty care and hospitalization should be established for each facility, even for adult facilities that house youth. Youth with chronic medical conditions that do not have a community provider should be referred to one prior to discharge.

Medical and education staff must jointly address special medical needs of youth. Glasses, hearing aids, and other prostheses and assistive devices can create security issues in a detention center unless there is coordination. Medical staff must collaborate with educational staff to develop IEPs (Individual Educational Plans) and to provide the required devices or special services to the youth. Once a need is identified, security staff must be involved in the decisions regarding the required accommodation so that any security risk can be minimized.

Girls and young women have health needs that demand special consideration. Evidence suggests that detained young women are likely to have significant medical problems including untreated Sexually Transmitted Infections (STIs), pregnancies, chronic medical conditions, substance use, and psychiatric disorders. There are other acute and chronic medical conditions that certainly occur in this population as well. Mental health diagnoses, obesity, diabetes, hypertension, and asthma are increasingly prevalent among young women in detention.

Providing health services to young women requires an interdisciplinary approach to staffing and program development. It is important to include licensed health professionals in staffing a juvenile correctional facility, but line staff must also be well trained and educated about the medical needs of the population they serve. A young woman's history of victimization may make compliance with simple medical regimes an issue. Emotional issues may trigger somatic responses such as a Herpes outbreak or gastrointestinal upset. Sometimes this leads to the perception by staff that the youth is being manipulative or feigning illness. All staff should be trained to take all medical complaints seriously and respond appropriately. Medical staff should be aware of the health problems more likely to affect girls of color, who are disproportionately represented in the juvenile justice system. Diabetes, for instance, appears with greater frequency among African-American girls and young women. Cultural sensitivity on the part of medical, administrative, and security staff is mandatory and should go beyond just creating cultural diversity through staff hiring. Gender equity in juvenile justice programming should be the rule and not the exception.

Greater healthcare expenses should be anticipated in the operation of a female juvenile facility compared to a male facility. Females in general use more medical care even while in the community. Staffing patterns and ratios at female facilities should reflect this increased need. The greater prevalence of chronic diseases, including mental health diagnoses, and the provision of prenatal care and delivery also tend to increase healthcare costs at female juvenile facilities.

Sexual Behaviors and the Prison Rape Elimination Act (PREA)

PREA was enacted by Congress and requires all confinement facilities, including those that house youth, to implement policies and procedures to eliminate sexual assault and sexual harassment. The law supports the elimination, reduction, and prevention of sexual assault and sexual harassment within confinement settings. The healthcare staff perform an important role in implementing the national PREA Standards. Each facility should develop policies and procedures to address the requirements specific to their setting. Healthcare staff should become familiar with applicable federal and state laws, as well as their professional code of ethics. The medical intake should be conducted in a confidential manner—in a private area—to determine any history of sexual abuse, the date it occurred, where, and by whom. (See Ch. 14: Behavior Management: Staffing Ratios, Turnover, and Deployment)

Child or Sexual Abuse

A standardized child abuse reporting procedure for sexual abuse should be established by policy, keeping in mind that healthcare staff are considered mandatory reporters for suspected child abuse. Adult facilities that house youth are also obligated to report allegations of child abuse. If this initial information is obtained by security staff, they should have a procedure to immediately notify healthcare staff for further instruction regarding the need for an immediate medical assessment. Secondary reporting methods for sexual abuse can include toll free numbers and sick call or clinic visit requests to healthcare staff.

If the sexual abuse occurred within the time limitations for assessment and collection of evidence, a forensic examination is required. These examinations must be completed by a Sexual Assault Forensic Examiner (SAFE) or Sexual Assault Nurse Examiner (SANE), when possible. If SANEs or SAFEs cannot be made available, the examination can be performed by other qualified medical practitioners. A facility medical practitioner who has also successfully completed specialized training for treating sexual abuse victims can conduct forensic examinations, but an outside qualified medical practitioner is preferred to ensure objectivity. Where sexual abuse is alleged, the agency shall use investigators who have received special training in sexual abuse investigations involving youth victims to gather and preserve direct and circumstantial evidence. Examinations must be made available on site or at an outside facility without monetary cost to the youth. Facilities may choose to enter agreements with local hospitals for SANE or SAFE examinations. A facility may choose to contract directly with SANE or SAFE examiners to come to the facility. Keep in mind, with this option, proper equipment and examination resources need to be available.

PREA Standard 115.353 requires the facility to "provide residents with access to outside victim advocates for emotional support services related to sexual abuse, by providing, posting, or otherwise making accessible mailing addresses and telephone numbers, including toll free hotline numbers where available, of local, State, or national victim advocacy or rape crisis organizations, and, for persons detained solely for civil immigration purposes, immigrant services agencies.”

Medical and mental health staff should coordinate appropriate follow-up care for continued services after the assault, in collaboration with the security staff. If the sexual assault occurred prior to the time appropriate for the collection of forensic evidence—usually less than 72 hours—reporting requirements are still applicable. Healthcare staff should still screen for sexually transmitted infections, determine whether additional examinations are required, and refer youth for mental health follow up.

Sexual History

The discussion of sexual behaviors, including risk and protection, should be included in every preventive medical encounter. Healthcare staff should include questions about a youth’s age at first vaginal, oral, and anal intercourse; current sexual practices; number of partners within the last 3 months; and gender(s) of partners. Though sexual relations between youth residents is officially prohibited, many residents may have had same-sex sexual experiences prior to detention. When questioning all youth about sexual behaviors, it is important to use the word partner and not boyfriend or girlfriend, so as not to assume heterosexuality. Many youth may be having sex with casual partners or sex work clients whom they would not consider as a boyfriend or girlfriend. They may use these terms to refer to a regular partner with whom they may have an emotional attachment.

Condoms

Additionally, all clinical interviews about reproductive health should include a discussion about condoms. Though juvenile justice systems often have restrictions on displaying and dispensing condoms within the facility, medical providers and health educators can educate residents about the correct and consistent use of condoms so they will be better equipped to protect themselves after their release from confinement. Prior to release, youth should know where to purchase or get free condoms in the community.

Sexually Transmitted Infections

Chlamydia

Because chlamydia rates are so much higher in detention facilities than in the general population, chlamydia screening is recommended for all females and, depending on local public health statistics, males as well. Gonorrhea rates are also disproportionately high for youth residents, who should be considered for screening. Routine syphilis screening is appropriate for pregnant girls and sexually-exploited youth who may be more at risk. It should be noted that other STIs such as herpes and genital warts are also common in this population. Local epidemiological data should determine the type of STI testing. Healthcare staff must be trained in the detection and treatment of STIs. The CDC STI Treatment Guidelines should be followed.[2]

New urine-based tests can improve compliance for STI testing and may be easily incorporated into the facility’s intake process. The urine-based nucleic acid amplification tests (NAATs) are highly sensitive and specific. In many cases, the use of a urine specimen can reduce the necessity for a pelvic examination on young women (urethral swabs for males), thus extending the facility’s diagnostic capability for detecting these infections. Youth may be more compliant with STI testing if staff use these less invasive collection procedures. Also, pap smears are no longer recommended for young women under the age of 21; this also reduces the need for routine pelvic examinations.

HIV

The prevalence of HIV is unknown in the youth population. However, the behaviors that place them at risk for HIV infection are common, such as multiple sex partners, low condom use, drug use, and unsafe tattooing and piercing. HIV screening should be made available to youth when they request it and when it is clinically indicated. Infection rates are increasing among adolescents. If HIV testing were done routinely, unless the youth refused (Opt Out), it would increase our ability to identify youth that are HIV positive and refer them for specialty care. In all cases, facilities should educate youth about how to prevent HIV. Youth who are known to be HIV positive should not be isolated, nor should their status be disclosed for nonmedical reasons. Basic precautions—with the use of gloves, goggles, and protective gowns—to prevent exposure to body fluids should be standard for everyone.

Public health agencies must consider partnering with juvenile justice agencies to promote and facilitate STI screening and treatment of youth prior to their return to the community. Partnerships should include communication and reporting of required infections, treatment and follow up of positive cases, medication if a youth is released prior to receiving treatment, and partner notification. A Memorandum of Understanding (MOU) can allow sharing information across agencies and can define all parties’ responsibilities, whether in kind or with some fiscal responsibility.

Gender Identity

It is difficult to ascertain the true percentage of youth who are grappling with questions about their sexuality and gender identity. The majority of states do not include such questions in their Youth Risk Behavior Surveys. The limited data that we do have regarding sexual orientation indicate that between 2% and 4.5% of high school students self-identify as gay, lesbian, or bisexual. These data are definitely underestimates, as many youth have difficulty understanding the complexity of sexual attractions or they fear revealing personal information. There are virtually no data on transgenderism in the adolescent population. PREA Standard 115.341 requires that, within 72 hours of a resident’s arrival at the facility, the agency must obtain and use information about the resident’s personal history and behavior to reduce the risk of sexual abuse by or upon a resident. Sub-paragraph (c) (2) of that standard specifically requires the agency to attempt to ascertain information about any gender-nonconforming appearance or manner or identification as lesbian, gay, bisexual, transgender, questioning, or intersex (LGBTQI), and whether the resident may therefore be vulnerable to sexual abuse. Transgender is an umbrella term that refers to a range of individuals whose gender identity does not match anatomic or chromosomal sex. Transgendered individuals can live as full- or part-time members of another gender and can be heterosexual, homosexual, or bisexual. Gender identity is a person’s internal sense of being male or female, regardless of the person’s gender at birth. A person whose sexual or reproductive anatomy or chromosomal pattern does not seem to fit typical definitions of male or female is considered intersex. Intersex medical conditions are sometimes referred to as disorders of sex development.

Most likely as a result of isolation caused by societal homophobia, a disproportionate number of LGBTQI youth turn to drugs or alcohol, suffer from depression, and engage in risky sexual behavior—including “survival sex,” or sex in exchange for food and shelter. These factors can increase the risk of youth confinement in this population. Though very little data exists regarding the actual number of LGBTQI youth in the system, it is estimated these youth make up between 4% and 10% of residents. These youth in confinement are at greater risk of victimization, sexual abuse, and rape. PREA requires that policies and practices prohibit discrimination on the basis of sexual orientation or gender identity and provide training for staff on how to create safe environments. (See Ch. 19: Complex Issues and Vulnerable Populations)

Infection Control

Correctional facilities present an increased risk for the spread of infectious diseases, due to individuals being confined in relatively close quarters. Also, in detention settings, failure to recognize infectious diseases at intake and isolate infected individuals can allow infections to spread rapidly throughout the facility. Admissions screening instruments should include questions about signs and symptoms of infection. Cough, fever, rash, or other skin lesions should prompt intake officers to notify healthcare staff and isolate a potentially infected person until a health assessment can be made. Healthcare staff should determine whether a youth should be admitted into general population if signs of infection exist.

Tuberculosis

Tuberculosis (TB) skin testing should be a routine part of the admission health assessment. If the TB test is positive, it should not be repeated. Healthcare staff should be trained in the placement and accurate reading of the TB skin test. The health record must document the TB skin test placement and results. Correctional, immigrant, homeless, and HIV positive populations are more at risk for TB. The Centers for Disease Control and Prevention (CDC) publishes guidelines for the prevention and treatment of TB in correctional settings. All facility staff should be TB tested annually, and the results should be documented in their human resources health record. The local health department may be able to assist the facility in its TB monitoring program. A positive skin test in a youth most often indicates latent TB, or that the individual has been exposed to the TB germ. These youth are not contagious. Active TB, the only form that is contagious, is less common in youth. A chest X-ray can confirm the status of the TB germ. It is important to appropriately treat both latent and active TB with the proper medication.

Influenza

Influenza is another respiratory infection that can easily spread throughout the facility. Prevalence of the flu in the community creates an increased risk in the correctional setting. Influenza vaccines should be administered to all youth unless the vaccine is contraindicated. Staff should also be encouraged to be immunized either through public health services or their private provider; staff should stay home if they develop flu symptoms.

Parasites

Screening for lice and other ectoparasites is a critical part of the intake process and should be repeated when youth are transferred from one facility to another. Routine treatment with medication with no indication is unacceptable. Staff can be trained to use a Wood’s lamp (a special light) to inspect for these ectoparasite infections. Treatment should be administered on an individual basis. If infestation does occur in the facility, healthcare staff can provide direction to staff for eliminating and controlling it. To prevent facility contamination, soiled laundry should be bagged prior to being transported and should be handled as little as possible. Staff should wear personal protective equipment (gloves, cover gown, masks, face shield) when collecting or handling soiled laundry, linen, and clothing. Clean laundry should be handled, processed, and transported separately from soiled laundry.

Containing Infectious Conditions

Youth in correctional settings are also at risk of skin infections such as athlete’s foot and MRSA (Methicillin-resistant Staphylococcus aureus). These germs are spread by direct contact with skin and contaminated surfaces. Routine cleaning and disinfection of showers, mats, shoes, sports equipment, restraints, etc. will reduce the spread of these and other types of skin infections. Each facility should develop local procedures for containing respiratory illnesses and skin infections such as influenza and MRSA. The procedures should include, at a minimum:

  • Guidelines for respiratory and contact isolation.
  • Infection control inspections by a Registered Nurse.
  • An allowance for limiting youth transfers.
  • Notification to the designated health authority of pending youth transfers.
  • Proper staffing during an outbreak of any major infection or virus.

All staff should be educated on infection control and how to protect themselves and their families. When called for, healthcare staff should recommend the use of protective equipment such as gowns, gloves, goggles, and masks. Hand washing and using hand sanitizers can help prevent the spread of many types of infections. There are some instances when units or even entire facilities should be quarantined to prevent the spread of infection. In these cases, certain staff and visitors may need to be excluded from the facility as directed by the health authority and responsible physician.

Immunizations

The best way to reduce the risk of certain infections in correctional settings is through a robust vaccination program and adequate levels of immunization. The federally-funded Vaccines for Children (VFC) program may be used to provide free vaccine to incarcerated youth. Juvenile justice health administrators should approach public health agencies aggressively to enroll all juvenile correctional facilities in this program and assist them in meeting program requirements. Formal agreements can also be made between the juvenile facility and the local public health department to have public health nurses administer vaccines to youth. Adult facilities that house youth are also eligible for participation to provide free vaccines for youth 18 and under. Due to the high-risk sexual behaviors in this population, routine vaccination for Hepatitis A, Hepatitis B, and (Human Papillomavirus (HPV) are highly recommended. All can be sexually transmitted. Youth should be able to give their own consent for these vaccinations; facilities should not require consent of the parent or guardian. At age 15, youth are usually due for a booster dose of the TDap (tetanus, diphtheria, and acellular pertussis or whooping cough) vaccine. All institutions should offer influenza and meningitis vaccinations and the potential for these respiratory diseases to spread quickly. Special medical conditions such as pregnancy and sickle cell anemia may require or prohibit certain vaccines.

Many states have implemented systems to electronically track immunizations. These systems allow for immunization data to be both retrieved and entered by all registered health providers. Public health agencies have taken the lead in this effort, working with community healthcare providers. Juvenile justice agencies should gain access to these databases, review immunization status on intake to facilities, and assure that patients are fully immunized prior to release. Healthcare providers should enter data into these immunization databases without indicating linkage to the juvenile justice system, as that information could then be revealed to the public. Where full immunization is not possible because of a short detention stay, public health agencies can follow up after the youth’s release on any remaining required doses. If immunization information is not available through the public health department, the most recent school that the youth attended may be contacted for records. Keep in mind that these records may not be up to date and may require catch-up immunizations.

Nutrition

Juvenile detention facilities and adult facilities that house school-age youth may qualify for the federal school nutrition program; these are most often administered by the state department of education.[3] To receive reimbursements from this program, diets must meet USDA requirements for fat, sodium, and calorie counts. Reimbursable meals include breakfast, lunch, and an afterschool snack. Dinner and a bedtime snack should be made available, but are not reimbursed. A registered dietician should develop menus that will be appropriate for youth, both in nutritional content and food preference. In adult facilities that house youth, menus will need modification to at least provide milk at meals rather than tea or coffee. A registered dietician should be consulted, if not employed, to provide special diets ordered by healthcare staff. Youth should receive nutrition education and other wellness related topics at every available opportunity.

Detained youth often are not likely eating a healthy diet prior to admission. Diet-related disorders include obesity, iron deficiency anemia, and other problems. Low blood count or low hemoglobin is usually discovered at admission and is often due to poor diet. In the case of anemia, dietary improvements often resolve their problem before youth are discharged. Many obese youth will also lose weight during detention due to dietary improvements. This is especially important for youth with weight-related diabetes, hypertension, and increased cholesterol.

Allergies

Many youth report food allergies upon admission. It may be difficult to distinguish between true allergies and food preferences. Some will claim allergies to avoid certain foods associated with gang affiliations. Staff should obtain a thorough history and contact the parent or guardian, if possible. The most objective way to verify or rule out food allergies is to have medical staff conduct blood testing for the specific food item.

Hunger Strike

Hunger strikes are a rare event among youth in custody. If a youth is acknowledging a hunger strike, it is important that the actual food and fluid intake be monitored and verified. Sometimes youth will claim to be on a hunger strike, but are getting snacks from other detainees. Initially, maintaining adequate hydration is more critical than food intake. Medical staff and security staff must work together closely to monitor such a situation. Intervention by medical staff may be required if it is clinically indicated. Court involvement is required if medical staff recommend forced feeding or hydration.

Eating Disorders

Eating disorders also tend to be rarely identified in detained youth. Bulimia and anorexia are more prevalent among girls than boys. Inquiry into eating habits should be made at intake. Special management plans that include medical, behavioral health, and security staff are required if a youth is identified as having an eating disorder.

Food Safety

Food safety is a health concern in all correctional settings. Foods should be stored, cooked, and served at proper temperatures to reduce the risk of food poisoning. Food service operations should be monitored internally and by local authorities and should include staff that have been certified in the ServSafe Program.

Physical Activity

Adolescents today are not as physically active as they were a generation ago. There are many reasons for this, such as more time spent with technology, unsafe neighborhoods, reduced physical education in schools, and costs of extracurricular sports activities. Youth who enter facilities today are not accustomed to physical activity. Standards require one hour of daily physical activity. Medical screening and examination should occur before initial participation in rigorous physical activities. Care should be taken to gradually increase activity levels. Warm ups and adequate stretches will reduce the number of sports-related injuries. Youth may appear in the clinic with chest pain, not from cardiac causes, but from chest muscles unaccustomed to pushups. A full assessment is still required. Overweight youth should be encouraged to participate at reasonable levels. Activity modifications may be needed for youth with asthma or other medical conditions. An alert system should be in place to notify all staff of any activity restrictions imposed on the youth.

A significant number of injuries occur in relationship to sports activities. Administrative, security and medical staff should review the types of sports activities allowed and determine if too many injuries are related to a particular sport. Environmental modifications such as padding goal posts or gym floors may help reduce injuries and pay for themselves in cost savings realized by reducing emergency room visits.

Sunscreen application and access to drinking water are essential for outdoor activities, especially when the weather is hot. The health authority should intervene and coordinate with administration to prohibit outdoor activities when temperatures are too high or too low.

Mental Health and Substance Abuse Medical Implications

Research demonstrates that between two-thirds and three-quarters of detained juveniles have one or more psychiatric disorders. Nearly one-third of teens report episodes of sadness, depression, or hopelessness. Every juvenile health program must address mental health needs as well as physical health needs to promote better outcome for youth. Mental health diagnoses, such as clinical depression, can change behavior, physical health and appearance, academic performance, social activity, and the ability to handle everyday decisions and pressures. These feelings may prevent troubled youth from seeking preventive healthcare and complying with health regimens. Some mental health medications require medical interventions such as labs and other diagnostic testing. Youth with mental health disorders that also have concomitant substance use disorders may also require modification of medications.

Due to the high prevalence of drug use in this population, intake personnel must be trained to recognize signs and symptoms of drug intoxication. Healthcare staff should be available to provide immediate direction as to whether the youth should be accepted into the facility. Alcohol withdrawal is not as common, but should be monitored as well. Medical emergency care may be required for acute drug intoxication or withdrawal. Facility healthcare staff should not perform drug testing of youth routinely. This collection of forensic evidence by healthcare staff interferes with the patient–provider relationship and should be left to outside agencies or security staff. The use of “designer drugs” should also be a consideration for assessment of intoxication.

A range of mental health and substance abuse treatment services are needed in juvenile justice settings, as the problem of substance use is more pronounced. The following behavioral health services should be provided at a minimum: screening; assessment; direct services, including individual, group, and family counseling; and referral to mental health, substance abuse, and other community-based services upon release.

Health Records, Confidentiality, and Consent

Youth require a confidential area for medical intake screening and assessment. They may not easily disclose medical facts unless they trust that the information will remain confidential. Confidentiality is a concern of detained youth, particularly when they are asked to share information with adult staff. Staff should be trained about how to respect confidentiality of health information in conjunction with HIPAA (Health Insurance Portability and Accountability Act) requirements. Youth are also more likely to share personal health information with their peers. Staff still should be mindful of confidentiality requirements and encourage youth to do the same. (See Ch. 9: Admission and Intake)

HIPAA privacy rules may apply to youth even though adult inmates in correctional settings are excluded. Legal counsel should be involved to determine the level of confidentiality of health information required. There is a general HIPAA exclusion for correctional facilities; however, if any part of a juvenile justice system is billing electronically for medical services such as Medicaid, the juvenile justice agency should be HIPAA compliant. It is also advisable that public health and juvenile justice facilities both be HIPAA compliant, so that medical information can pass freely between agencies. Information sharing improves continuity of care and facilitates appropriate consents from youth and parents or guardians. MOUs between agencies can address any concerns about sharing of confidential medical information.

Laws differ by state as to what health information can be shared and under what circumstances. Usually, substance abuse treatment, pregnancy related services, sexually transmitted diseases including HIV, and certain psychological notes require specific releases from the youth, even if the recipient is a parent or guardian.

Concerns about confidentiality keep many youth from disclosing crucial health information and from seeking care. In the juvenile justice system, parents or guardians may not be present, but concerns about confidentiality still exist, and youth should be assured that their disclosures will be kept confidential. However, there are times when the provider may need to contact a parent and times when the law allows such contact, but the bias should be toward confidentiality. If a youth appears to be a danger to himself or herself or to another person, state laws mandate that a provider inform parents or authorities.

Laws governing minors’ access and confidentiality to services also differ by state, and many healthcare providers are unaware of a youth's ability to consent to certain confidential health services. Title X dictates that family planning services must be confidential. In many states, confidentiality is decided by the provider, but because Title X is federal, it preempts state statutes. Medicaid provides for confidential services to minors along with Title X. Federal Medical Privacy Regulations also apply. Juvenile settings must determine if they will also comply with this community Title X healthcare standard with regards to providing confidential family planning services, when applicable.

The advent of the electronic health record (EHR) has challenged the confidentiality of the health record. More controls must be in place to protect health information transmitted electronically to be HIPAA compliant. Most hospitals and private practices already have implemented the use of EHRs to improve efficiency and portability of patient health information. The Affordable Care Act requires practitioners in the community to do so as well. Correctional facilities, however, are not required to do so and have hesitated to embrace these technological ideologies and practices. This reluctance is understandable, considering the many challenges involved in the use of EHRs in the correctional environment. Computer equipment in the medical unit needed for the EHR can be used as a weapon or can become a target for theft and vandalism if it falls into the hands of a youth. Computers may allow youth access to the outside world to acquire contraband or to make illegal contacts. Earlier software systems were often expensive and not suitable for corrections, because they did not consider complex requirements for administering medication or sick call procedures. Although there has been improvement in correctional applicability and some reduction in cost, it is still challenging to determine which software system is most advantageous. The advantage to implementing an EHR system is the ability to have complete, easily accessible, and transferable medical, mental health, and dental records. This automation allows real-time tracking of the youth's health information, which is especially important when operating short-term secure facilities with high turnover and readmission rates. The EHR also allows for remote and on-site quality-assurance monitoring of all health records. The EHR system prevents unnecessary duplication of health services, saving both a provider's time and the cost of repeating labs and other assessments. The implementation of EHR systems in correctional settings should ultimately reduce costs related to duplication of services and staff time. In addition, correctional EHRs will provide greater continuity of care for youth as they transition from one correctional facility to the next and into the community.

Healthcare and Reentry

Many barriers remain for youth and their families in getting appropriate healthcare and support services upon reentry into the community. Youth are often disenfranchised from their families and are not aware of how to navigate support systems on their own. Many parents and caregivers are also unaware of healthcare services that may be available for their family members and may not seek out these services without direction from a government agency. Juvenile justice facilities, in collaboration with community health providers, should emphasize the development of a comprehensive healthcare reentry system to overcome these barriers. Because there is such a high incidence of substance abuse, acute illnesses, sexually transmitted diseases, unplanned pregnancies, and psychiatric disorders among detained youth, it becomes more critical that the treatment of these conditions continue in the community after release.

Given the potential for recidivism, continuity of services that enhance family support and address unmet physical and mental health needs is imperative. Appropriate systems can help facilities to effectively assess, address, and manage these issues. This will help youth transition successfully back into the community, which benefits and stabilizes the youth themselves, their families, and the community. Families are often not fully engaged in the rehabilitation process while their youth are incarcerated or engaged in any subsequent aftercare or community services. Family problems can worsen or contribute to the youth’s problems. The inclusion of family members into the treatment process is critical to the success of the youth during reentry and is essential to reducing recidivism. Youth should be reconnected with healthcare insurance including Medicaid and other plans created through the Affordable Care Act upon their release from the facility. Immediate access to medical care, medication, mental health services and substance abuse counseling is essential. A lack of continuity puts this already vulnerable group at high risk for relapse or reoffending. (See Ch. 18: Transition Planning and Reentry)

Conclusion

Providing adequate healthcare during detention or correctional confinement is not only a constitutional mandate, but an incredible opportunity to impact the health status of youth. A youth’s encounter with healthcare while in custody may save his or her life by diagnosing an unknown medical condition, by improving management of a chronic medical problem, or even avoiding future ailments through immunization and other preventive health services. The healthcare provided contributes to the overall wellness of each youth served, as well as protecting the institution or agency from the legal liability of inadequate healthcare.

 

Endnotes


[1] Estelle v. Gamble, 429 U.S. 97 (1976).

[2] Centers for Disease Control and Prevention, “Sexually Transmitted Diseases (STDs),” https://www.cdc.gov/std/.

[3] U.S. Department of Agriculture, “National School Lunch Program (NSLP),” https://www.fns.usda.gov/nslp.

Ch.13 Education

Ch.13 Education web_admin Mon, 12/27/2021 - 11:07

Author: Randall W. Farmer, M.Ed., Carol Cramer Brooks

One of the more complex programming functions within facilities that confine youth is the delivery of the spectrum of educational services, which is vital to this population. Both the characteristics of the youth and the conditions of the particular confinement setting have an impact upon the ability of staff to provide quality educational services. The wide range of youth abilities, the high rates of special needs, the complex histories of the youth, and the variations in youth’s current legal status contribute to the unique challenge of educating this population. The educational needs of students in confinement settings require a wide continuum of services, and a multitude of non-school related variables are continuously influencing a student’s education program. This keeps many students’ education goals in a dynamic state.

The many limitations of a confinement facility’s procedures, safety and security requirements, resource availability, physical structure, and budget contribute to the challenges of developing meaningful, engaging, and functional education services within the confinement setting. By definition, the confinement facility creates a significant challenge for education programs: the high rate and unpredictable nature of student mobility (pre-adjudicated youth moving in and out of primarily short-term facilities), the variable lengths of stay in treatment options for adjudicated youth, and the need to match curricula from multiple school districts served by the facility. However, when successful, high-quality educational services from intake to reentry can help reduce recidivism, contribute to credit recovery, diploma completion, future employment, and support a youth’s successful reentry into family and community.

Rather than requiring the students to adapt to the program, high-quality confinement education programs should adapt to and meet the diverse needs of the student population and make adjustments as needed within the constraints of safety and security and youth trauma. This is what makes confinement education programs unique from their public school and alternative education counterparts. Additionally, educational programs within facilities that confine juveniles operate in a unique circumstance. They are functionally distinct and geographically isolated from the traditional educational services in a public school district. Education staff also do not function in the same way as safety and security staff function. Consequently, the confinement education staff often feel isolated or separated from both colleagues working in their field of education, and other staff in the facility. To the degree the education staff work in tandem with the facility staff, they may overcome the isolation factor, which in turn can have a positive impact on the quality of the education program.

Why Provide an Educational Program?

There are many reasons to provide education programs in juvenile detention, corrections, adult jails, and prisons including legal requirements, such as compulsory and special education laws. Philosophically, education is a core component of programming that promotes youth rehabilitation and transformation. There are also economic and restorative principles behind the reasons for educating youth in custody. In summary, education is provided because:

  • It is the law, and confinement facilities of all types are required to provide full educational services. Federal regulations such as No Child Left Behind [NCLB] and individual state regulations require all youth up to a specific age to attend school as well as the days and hours of compulsory education.
  • Most youth admitted to facilities have a history of poor academic performance.
  • A positive educational experience often begins during a period of crisis for youth, which can serve as a catalyst for change.
  • In long-term facilities, an extended period of stability offers an opportunity for planning and implementation of a clarified educational or career plan.
  • In short-term facilities, youth who are enrolled in school have an opportunity to keep current with their studies and return to school when released with minimum disruption to their education.
  • Academic or vocational successes help to enhance the youth’s chances of employment following release.
  • Academic success helps youth to see themselves differently, which can lead to enhanced self-esteem and improved problem-solving abilities.
  • Youth who are not enrolled in school, who will not have the opportunity to complete an education at their home school, or who are not interested in education, have opportunities to explore a general equivalency diploma (GED), life skills, and career or vocational opportunities.
  • Youth engaged in pro-social programming such as education during their time in custody exhibit fewer behavior problems.[1]

Creating the Culture “Of and For” Learning: The Role of the Administrator or Leader

Culture counts. In an environment where education is not typically the first consideration, establishing a learning culture based on trust and mutual respect is critical. High achieving and effective confinement schools are safe, nonviolent places where students work hard and demonstrate respect for the physical and human environment. This often requires the lead teacher to actively protect instructional time and push back on the correctional culture by questioning long-standing policies that adversely impact teaching and learning and may compromise educational values. Creating the culture “of and for” learning is a deliberate responsibility of school and facility administrators and staff and is described in the following sections.[2]

Identify and Incorporate Values, Vision, and Mission

Effective confinement education programs are built on clearly articulated values, vision, and mission. Although it is probable that the values connect the education programs in the various confinement settings (all students can learn); it is equally probable that the vision and mission are affected by the nature of the custody setting and the characteristics of the students served. For example, education programs in juvenile corrections and adult prison settings can legitimately include, as part of pathways to the vision and mission, completion of high school credits, graduation, and preparing for or enrollment in post-secondary options. Alternatively, an average length of stay that is less than two weeks places real limits on the vision and mission for juvenile detention education programs to critical aspirations of reconnecting, inspiring, motivating, and rekindling hope in disenfranchised students.

Lead teachers must review program materials and ensure compliance with all state and federal regulatory requirements regarding the education of youth. Additionally, the education lead teacher is responsible for developing educational policy statements that conform with or reflect the mission, philosophy, goals, and objectives of the facility.

Examples of Vision and Mission Statements that Reflect Program Values

From the Pathfinder Education Program in the Lancaster Youth Services Center in Lincoln, Nebraska, a short-term pre-adjudicated detention facility operated by the Lincoln Public Schools.

“Our priority is inspiring students to want to learn and providing them with the necessary tools to be successful learners. (Randall Farmer, Director, in an open letter outlining the program purpose)[3]

Mission Statement: “The students in the Pathfinder Education Program have diverse backgrounds, interests, needs, and academic records. It is the mission of the education program to provide educational opportunities that allows students the opportunity to enhance basic academic skills, technology, career options, and develop personal growth skills through individualized instructional programs of study. The education program introduces multiple pathways which might include earning credits toward completing a high school diploma, preparation for the General Education Diploma testing, and Skills needed for lifelong learning.”[4]

From the See Forever Foundation, Maya Angelou Academy at New Beginnings in Washington, D.C., a secure residential treatment facility operated by the Division of Youth Rehabilitation Services. Maya Angelou operates several charter schools in the D.C. area including New Beginnings.

Mission Statement: “Our mission is to create learning communities in lower income urban areas where all students, particularly those who have not succeeded in traditional schools, can reach their potential and prepare for college, career, and a lifetime of success. At Maya Angelou our students develop the academic, social, and employment skills they need to build rewarding lives and promote positive change.”[5]

From the State of Washington Department of Corrections, Policy Title: Education and Vocational Programs for Offenders

POLICY:

  1. The Department’s philosophy and goals for offender education and vocational programs are to improve offender functioning in literacy, employment, communication and life skills, and community transition. The Department, working with the Washington State Board of Technical and Community Colleges and other contractors, develops education and vocational programs to prepare offenders for higher skills work programs and to qualify for living wage jobs upon release.
  2. The Department will provide vocational programs that develop the skills needed for facilities and Correctional Industries jobs and are accepted by community based training programs to allow the offender to transfer and complete the programs upon release, if necessary.
  3. Academic and vocational programs are accredited, recognized, certified, or licensed by the state or other acceptable organization.
  4. Offenders may be required to participate in a combination of work, education, and vocational programs.[6]

Get the Right People: Qualities of an Effective Teacher

Recruiting, hiring, and retaining the right people are the most critical elements to operating an effective education program in a custody setting.[7] Administrators should look for individuals who embody the education program’s values, vision, and mission. A qualified teacher should have the appropriate licensure and the education program must implement requirements for the continuous professional development of anyone teaching classes. Given what we know about student needs, at a minimum, confinement education programs should have teachers with certifications or endorsements in reading, math, and special education. Certified teacher–training programs prepare teachers in lesson design, assessment, evaluation, educational psychology, and a myriad of other skills that professionalize the delivery of instruction. A professional, licensed educator enhances all components of a program, engages with other professionals in the facility, and is required by law to provide a state-certified credit or diploma.

As part of NCLB 2001 (subsequently reauthorized), teachers are required to meet “Highly Qualified” requirements. Highly Qualified teachers hold a bachelor’s degree or higher from an accredited 4-year institution of higher education, have the content knowledge required to teach a core subject area and can pass a competency test in that area. At the time the NCLB Act was passed, there was great controversy around the implementation of this requirement. Teachers had to be reassigned to different classrooms and schools or had to return to school to earn credentials in the appropriate areas to be qualified to continue to teach in their classrooms. Rural schools and small education programs, such as a lot of confinement education programs, struggle to meet the Highly Qualified requirements. Although the intent was larger than this, over time, requiring states to develop plans to ensure that poor and minority children had access to experienced, knowledgeable, certified, and in-their-field teachers also had a positive impact on youth in custody education programs.[8]

Whether a confinement education program is required to hire teachers that meet the Highly Qualified requirements depends on the type of funding the program receives. If the confinement education program is a Local Education Agency (LEA) under state law or is under the authority of the State Education Agency (SEA), teachers of core academic subjects employed by those entities must be highly qualified. If, however, the entities that employ these teachers are neither LEAs as defined under state law nor under the SEA’s authority, the requirements do not apply. Nevertheless, it is critical that all students, regardless of school setting, are able to achieve to the State’s academic content and academic achievement standards. Therefore, all educational entities—whether covered by the highly qualified teacher requirements or not—are urged to ensure that students have teachers with the content knowledge and pedagogical skills needed to help them succeed.”[9]

Although administrators cannot dismiss the importance of teachers having proficiency in their content area, there are other qualities that are equally important for teachers who work in custody settings. These intangible qualities include passion for the most difficult to teach students, knowledge of learning styles, ability to integrate engaging instructional strategies, and the persistence to present information—one more time, in yet a different way. Ideal qualities also include fortitude to overcome the multitude of obstacles presented by students, families, communities, and systems (juvenile justice, public school education, mental health) and the ability to form relationships with resisting, untrusting, and challenging individuals in a very short period of time. These qualities do not appear anywhere on a state teaching certificate or a NCLB matrix. However, these are the highest qualities a teacher in a custody school can possess.[10]

Ideally, the custody education program has an on-site administrator (education programs with five or more teachers) or lead teacher (education programs with four or fewer teachers) who is responsible for the day-to-day operations of the school program and who is in continuous communication with facility staff and administration. The administrator should be a licensed school administrator with the appropriate skills to oversee a custody education program. An administrator should be skilled in working with at-risk youth and should understand all aspects of program design and management. The best administrators have specific skills related to finding creative solutions in unique environments. When there is an on-site educational administrator, the facility administrator has a partnership or advisory role in programmatic and staffing decisions as they relate to the education staff.

As an alternative, facility administrators may assume responsibility for the day-to-day operations of the education program with oversight provided by an off-site education administrator that provides programmatic support. In this scenario, the off-site administrator should conduct frequent (at least bi-weekly) programmatic site visits in addition to being available to provide the necessary support for teachers and facility administrators. With this administrative design of the education program, facility administrators must have a supervisory role over the day-to-day operation of the education staff and program.

Hiring and Retaining Teachers

Most teachers applying for positions in custody education programs have experience in the public school setting and never intended to work as a confinement educator. Additionally, there are very few certified teacher–training programs that offer student teaching experiences in juvenile or adult detention or corrections. Consequently, when hiring a new teacher, the administrator should consider requiring the candidate to teach sample lessons or to interview with a panel of youth prior to offering them a position and should not hire a person based only on credentials and licensure. The skill set that allows a candidate to experience success in the traditional school setting does not automatically translate to success in the custody setting. Especially in programs where there is not an on-site education administrator and the facility administrator is responsible for the day-to-day operations and supervision of the school program and personnel, it is equally important to include this person in the decision-making process.

“More can be done to improve education by improving the effectiveness of teachers than by any other single factor.”[11] It is critical that, once hired, teachers receive ongoing training specific to the custody environment and to the skills teachers need to engage this population is critical. To the consternation of security staff, educators in confinement settings make questionable security decisions quite frequently. Teachers trained to provide education in a public school setting are not going to understand the nuances of providing education in a custody setting unless they are provided specific training to do so. The National Partnership for Juvenile Services (NPJS), with a grant from the Office of Juvenile Justice and Delinquency Prevention (OJJDP), created the National Training Curriculum for Educators of Youth in Confinement to address this and similar issues. Similarly, direct care staff who are trained to focus solely on the principles of safety and security would benefit from knowledge of adolescent development and learning principles to support the educational process in the facility. For these purposes, cross–training between education staff and direct care staff is encouraged.

Additionally, teacher quality is improved through a consistent system for teacher observation and evaluation based on current best practice. Holding teachers accountable and not retaining low-performing teachers who are not working hard to improve is critical to the quality of the overall education program and the individual success of each student.[12]

Identifying Physical Classroom and Education Space

The education program should be in a location that is physically, environmentally, and aesthetically conducive for learning. Ideally, the school program should be in a low-traffic area with as few distractions as possible, separate from the living units. Often the location of the education program is dependent on the size, age, and mission of the facility. The boundaries that separate educational space from daily living space are crucial to the student’s ability to delineate and mentally separate between school and daily living activities.

Quite frequently, the location of the education program also reflects the degree to which the facility staff is involved in the school’s operation. For example, in a small facility, the school may be in the dayroom area, with facility care workers actively involved in the classroom activities. In a large facility, the school may operate in its own space, resulting in facility staff being much more isolated from the school staff and educational activities. These situations require more direct effort on the part of direct care facility staff to be involved in the school program.

No matter how old or run down the facility, the education environment should reflect its values and exude high expectations and trust and provide for adequate space for instruction. In addition to good air, good lighting, low noise, and comfortable temperatures, student work and art should cover the walls and be recognizable reminders of student success.

Other possible education program space needs might include group activity space; individual study spaces; a library; storage for files, records, materials and books; and teacher planning and work space.

Securing Equipment, Furniture, Materials, and Supplies

All confinement education programs must develop, purchase, and maintain sufficient materials, furniture, and equipment to meet the needs of traditional classroom programs and nontraditional individualized learning programs. Depending on the size of the facility and the location of the education program, equipment and furniture may be either permanently installed or mobile. Furniture should be durable and able to accommodate individual or group learning arrangements. Equipment should allow teachers to address the different learning levels, abilities, and styles of the youth served.

Equipment should include computer technology and software, DVDs, television, personal computers, tablets, projectors, screens, calculators, photocopiers, and miscellaneous office supplies. The teachers at the Maya Angelou Academy in the New Beginnings Residential Treatment facility (operated by the Division of Youth Rehabilitation Services in Washington D.C.), have skillfully incorporated Smart Board technology (the use of interactive whiteboards) into their daily lessons as a strategy for engaging students. The Correctional Education Association (CEA) announced the release of its Secure Education Prison Tablet, which allows agencies to customize applications including GED, adult literacy, reentry skills, English as a second language, and computer literacy and keyboarding. In addition, post-secondary courses through Ashland University are also available.

Materials and supplies should support the curriculum and the teacher's instruction method of teachers. For example, the program might need books, individualized learning folders, paper (colored, plain, or drawing), pens, pencils, rulers, clips, and erasers. It is important to consult with facility personnel concerning appropriate safety and security measures to be developed and followed when ordering, using, and storing equipment and supplies.

Ensuring Access to Computers and the Internet

The rapid and continuous development of technology creates a challenge for educators. Educators need to be trained and equipped to properly use and to safely control technology in the classroom. Acceptable moral, ethical, and socially appropriate usage policies are not yet standardized. There is a wide range of views and perspectives across the country about the appropriate uses of technology and the internet for students. Guidance for usage should be obtained by consulting facility administration, local school districts, and the local community. Up-to-date equipment and software are essential to providing students with an understanding of the real-world value and application of technology. The practical use of technology is a critical life and employment skill for youth. And, access to technology can enhance a student's motivation to learn.

Common security concerns with internet access includes student communicating in an unmonitored way with people outside the facility through chat boards or email or the possibility of students accessing inappropriate content. A wide variety of blocking and monitoring software is available to mitigate the potential for inappropriate uses. However, software requires specialized training and staff vigilance. Complications can arise when the technological skills of youth exceed the security skills of the adults. In general, the best climate of safety and support exists when information technology departments (IT) are engaged to support the facility needs. Facilities will benefit from aligning their technology supports with the county or state government agencies or the local school district or post-secondary institution. These institutions have dedicated IT personnel that stay updated on new developments and have the expertise necessary to meet the demands of secure facilities.

Transfer of Education Files

Youth in the justice system experience many transitions as they move from one facility to another or from a facility to a community school. Education records frequently fall into a “black hole.” Processes must be put in place to ensure smooth and timely transition of educational records, ideally in advance of the youth’s placement, which is more feasible in the case of placement in or from juvenile corrections and adult prison programs than juvenile detention and adult jail programs.

Generally accepted minimum standards call for maintaining education files separately from the resident filing system within the facility. Many states and local education agencies have developed electronic files for educational records. Facility education programs should make every effort to gain access and to contribute to these electronic systems to facilitate a timely transfer of educational records.

This proactive records exchange assists schools in placing students with appropriate services and in maintaining continuity in the student’s educational instruction.

Although always considered preferable practice to do so, it is not a legal requirement to have parental or student consent to transfer school records from educational agencies and schools to the custody education program. The Family Educational Rights and Privacy Act (FERPA) has explicitly included correctional and juvenile justice facilities, longer-term alternative programs, and dropout prevention programs within the definition of “educational programs” to facilitate the exchange of educational records for students in these settings.[13]

Create a Reliance on Data

High-performing custody education programs have the tools to collect and assess student and school performance on a range of key metrics. These metrics should include such things as student academic achievement, student engagement, student behavior plan accomplishments, the number of students successfully achieving program outcomes. Once these are gathered, the administrator and staff must have the courage to use the data to inform bold, meaningful changes based on the analysis, with the singular purpose of improving student outcomes. Once the initial reliance on a data-based culture is established, data collection systems can be expanded to monitor other key practices such as teacher recruitment, performance, and retention.

Manage Funding Options

Funding for confinement education programs varies from one jurisdiction to another. In some states, such as Nebraska, the Health and Human Services Department funds the detention education programs. Other local detention facilities, such as those in Michigan, primarily receive funding through special education funds. Some programs bill the individual schools or districts on a per-day basis. State-operated facilities may fund the education program as part of the facility budget. This inability to identify a consistent method for funding confinement education programs contributes to the difficulty programs experience in hiring the quality and quantity of staff required and in attaining the resources necessary for the variety of services required by the youth.

Contrary to established practice for the funding of many detention education and jail education programs, funding based on the population in the facility on a specific day of the calendar year (“fourth Friday”) is not an appropriate funding formula. The unpredictable in-and-out nature of the facility population that is not within the scope of control of the school program means the facility could be way under capacity on the designated count day and over capacity on subsequent days. Making staffing and resource decisions in this manner could result in being understaffed and under resourced for a very long time. More appropriate funding formulas may be based on the facility’s license capacity—provided overcrowding is not a chronic issue in the facility—or on average daily population numbers (ADP).

Student Per Diem Payments

Both SEAs that operate education programs in juvenile corrections and adult prison facilities and LEAs or Regional Service Educational Agencies (RESAs) that operate the education programs in juvenile detention and adult jail facilities receive student per diem rates from the state department of education for the students enrolled in the program. The amount of the per diem is state specific and varies depending on whether the youth is a general or a special education student. In most states, it is the intent that the per diem is attached to the student. Therefore, for whatever time period the student is enrolled in the custody education program, the program should receive the state education per diem rate.

Title I, Part D, Subparts 1 and 2 of the Elementary and Secondary Schools Act (as amended by No Child Left Behind, 2001)

Title I provides formula grants to SEAs for supplementary education services to help provide education continuity for children and youth in state-run institutions and for youth in adult correctional institutions (Subpart 1). The money is available to be used so that these youth can make successful transitions to school or employment once they are released. Although Subpart 1 focuses on transition and reentry services, Subpart 2 focuses on educational services in institutions. The Federal Department of Education allocates Subpart 2 funds based on the number of youth between the ages of 5 and 17 (on a specific date) living in a locally-operated facility that meets the definition of an institution for neglected children, delinquent children and youth, or an adult correctional institution.[14] In most cases, the facility administrator is responsible for submitting documentation to the LEA for this allocation. When there is an on-site school administrator or lead teacher responsible for the education program, this task is frequently delegated to this individual. The LEA is required to allocate a portion of its Title I Subpart 2 monies for the educational program at the institution.

Foundations and Grants

Many custody education programs supplement their activities with funding from foundations and other grants. Foundations often have large pools of donors and are willing to solicit them to fill various needs. In turn, foundations provide a way for the public to give tax-free donations. Examples of these are nonprofits such as the Lincoln Public Schools Foundation, which supports the Pathfinder Education Program in the Lancaster County Youth Services Center in Lincoln, Nebraska, or the Kalamazoo Juvenile Home Foundation, which supports the Juvenile Home Schools in the Kalamazoo County Juvenile Home in Kalamazoo, Michigan.

Supplementing the Education Program with Grant Funding: A Review of Successful Practices

Field Author, John M. Luvera

John Luvera is an educator from the state of Washington who works in a small detention center on an island off the coast. John has done exceptional work bringing together community resources and programming to provide a unique and diverse educational program. John represents the best of the best in terms of getting things done and finding creative solutions.

At the Island County Juvenile Detention Center (JDC), in Washington State, Coupeville Schools operates the educational program. The program experienced a 30% reduction in Title 1 funding, which once supported a secretary, transition specialist, a school-to-work program, life-skills, and fine arts. As the funding began to shrink, due to a reduction in incarceration rates, the remaining teacher began to search for alternative funding sources. The teacher contemplated how to meet the needs of the students and where to find and secure enough funding to continue to implement innovative and creative approaches, with the goal of engagement and shifting students norms. Fortunately, successful grant efforts have maintained the level of support programs.

Educational programs wanting to enhance programming options should consider multiple small grants instead of large grant support. The JDC education program has had a better success rate reaching out to small local charities for assistance and program support than with the larger agency or government grants. JDC has cobbled together a variety of types of grants.

In-Kind Grants. An in-kind grant is one that offers materials, supplies, or services instead of money. These are perhaps the easiest to obtain because these requests are for things your grantee is already supplying. Look to your local hospitals, medical services or even long-term care providers to help you locate guest speakers on health topics such as smoking cessation, STIs, or the benefits of dental care. Make requests of local office supply stores for their clearance, returns, or discontinued products that match student or program needs. Other charities may be willing to assist you by sharing their donated products. For example, food banks can share food items for a cooking class. When requesting an in-kind grant, be sure to specifically identify the need. Explain the rationale and the intended impact or outcome. If you are awarded an in-kind grant for materials or services, always send a thank you note. Be as public with the thank-you as possible, recognizing the group notifies the community of the help and reminds the community you are there, serving kids.

Financial Grants. These are more challenging than in-kind grants, because they involve the grantee receiving money. There is typically an application process that requires applicants to describe how the award will help the community. Many of these grants can be found at the business web page. Carefully read each grant application and note the items the grantee is requiring for a funding request. You will need to inform most grant providers of your outcomes once the grant is completed.

In addition to in-kind grants, seek financial support from small agencies. Many communities across the country have community service groups such as the Elks, Lions, Kiwanis, and Soroptomists. The Coupeville community is fortunate to have all of these groups and many others, including a group of local artists. These organizations assist with meeting student needs. Many have grant applications with annual deadlines, but some accept requests on an ongoing basis. It is not difficult to write a letter of request with specific needs and financial requirements to meet those needs. Carefully review the group’s mission statement and make sure the request matches the community service goals. Volunteer as a guest speaker for their meetings. Staff of the JDC education program attends many community meetings to share their work and the impact the JDC has on kids in the Coupeville community. Nearly every organization has a community service component in their charter. Look for this as the “hook” to serve your needs.

Local Agencies. Don’t ignore the local groups in your own community. Look to your local business owners and agencies for small requests. There are often foundations associated with them. For example, many school districts have foundations to support educational efforts. There are small grants available through large retailers; Wal-Mart and Target both have educational grant funding for charitable groups located within their sales regions. Check the websites of major retailers to search for these types of grants.

Successful grant seeking should not rule out retailers, civic groups, or government agencies. Consider which businesses could fulfill your needs. Often retailers have merchandise to donate or even small foundations willing to help. Search their web pages for grants or better yet, meet the managers in person. There are times when larger government agencies are attempting large systemic change grants. Align your goals with their project and join them to gain some financial support.

Charitable Pools. There are churches, social groups, nonprofit thrift stores, and other resources to turn to as well. They often pool resources to make a greater impact. Searching for funding from groups or associations can be successful. Appealing to church councils with specific needs can bring both in-kind and financial resources. Many of these groups will offer you one-time funding for a specific project. Do your homework; ask around and search local directories for foundations, church councils, and other organizations. Be willing to present your project goals and to attend meetings of potential funders.

Partner Grants. At times you can be a part of a larger grant. Many counties, states, or other agencies pursue large systemic grants. These are too complex for a small center to take on, often requiring hiring personnel to create a desired change in programming. Your organization can choose to partner with a larger group or agency to apply for these types of grants. Consider suggesting large grants available from the federal government to appropriate agencies and suggest what role the school can play. Be specific with ideas and the funding level you would need to fulfill your part of the grant. Be careful about outcomes, documenting progress, and deadlines for completing the grant-funded project. Often your partner agency will take on the accounting duties and you will be responsible for your itemized services. This is a way to get funding without all the challenges of managing the grant.

Restorative Approach Enhances Grant Opportunities. The JDC is not just a place to house youth. The JDC is a community service agency as well. The youth want to give back and feel successful. It is natural for youth to want to hear encouragement and praise. The youth serve the community while incarcerated through the community partnerships. This type of service has helped us succeed in requesting funding or in-kind assistance. The JDC education program has partnered with Habitat for Humanity in a project to refinish furniture for housing and for a thrift store to support their community-based efforts. The students repair, sand, and repaint furniture to be sold. The JDC is recognized as a place of rehabilitation and contribution, which enhances the requests for support, because they give back. Look to the community, town, or neighborhood for a need your students could fulfill while they are confined. Document your work, photograph your projects (omit student photos), and get the word out! Your students can be known in your community as contributors, making your requests for help so much more meaningful to the support groups.

Sure, you can go for those big grants, keeping your fingers crossed, but you may have greater success with your own community, supporting their own youth. If you are unsure of where to start, look at your town, city, or neighborhood to see what is happening right around you. Chances are there are people and civic groups waiting to help.

General educational grant guidelines to consider:

  • Obtain small, one-time funding sources.
  • Evaluate local community-based agencies in your area.
  • Identify retailers in your area.
  • Partner with other agencies.
  • Match specific needs with requests and with the mission of the organization to which you are applying.
  • Focus on projects that allow students to give back to their own community.
  • Describe outcomes or results that have an impact or change.
  • Follow all institutional requirements and school policies when applying for grants.
  • Comply with your grant statements. If you are awarded, try to meet all or as many targets as you stated you would meet.
  • Document your progress to prepare audits and reports required by the grantee.
  • Thank all providers publicly.

Creating the Culture “Of and For” Learning: Program Design Considerations

The Role of Education in Juvenile Detention, Juvenile Corrections, and Adult Facilities that Serve Youth

Educators in custody education programs struggle to establish identity in the confinement facility. In traditional education programs, education is the only purpose; however, in a confinement facility, education is one of several programs, all of which compete for scheduling time and maintain alignment with the values, vision, and mission of the facility. To maximize the partnership between the justice facility and education staff, the following features are important:

  • Regardless of the operating partnership, administrators and staff of the confinement facility consider the school program to be an integral part of the total facility program.
  • The lead teacher regularly participates in confinement administrative team meetings.
  • Confinement staff support the school program and school staff in every way possible.
  • Education programs are given priority over other daily activities except for legal proceedings or a medical or mental health crisis.
  • Confinement staff stress the importance of the school program and the expectation that each youth participate daily in a meaningful way.
  • The school program implements a common behavior-management system at the confinement facility (token economy, point system, reinforcement program).
  • The confinement facility staff share with school staff any information that could affect a youth’s program or behavior in school (information reported by the probation officer, behavior observed in other parts of the facility, or known physical problems).
  • Facility administrators expect and receive regular feedback from the school staff regarding the youth’s performance and achievement in the school program.[15]

The Role of Facility Staff in the Education Program

A critical component that impacts the delivery of education for youth in custody is the relationship between the direct care staff and the education staff. Without collaboration between them, the student’s educational experience is disjointed and conflicted by the opposing influences in their daily routine. When both programs are adequately staffed and all aspects of programming are functioning at the optimum level, the appropriate use of facility direct care staff would be in the role of a supportive parent who maximizes communication with the educational program and follows through with appropriate actions outside of school. However, some program designs and staffing levels require direct care staff to engage more actively in the education classrooms. If this is the case, consideration should be given to the following guidelines for engaging direct care staff in the education classrooms:

  • In a spirit of mutual respect, the teachers and direct care staff operate as a team in the classroom.
  • Teachers are responsible for teaching and classroom management; direct care staff are responsible for actively supporting the teacher in this process.
  • Teachers are responsible for communicating with direct care staff what that support might look like in the classroom.
  • Direct care staff are responsible for minimizing the disruption to the educational process with additional job duties.
  • In collaboration with the direct care staff, education staff understand and practice the principles of safety and security in the classroom.

When these two components are synchronized, the opportunities are maximized for engaging students, and engaged students are less likely to behave inappropriately. The results for the facility are enhanced safety and security and smoother daily procedures. If the focus remains on the best results for students, in terms of both safety and education, then both groups have a foundation for collaboration. Maximizing the available school hours benefits all parties. Students receive more educational services; engaged youth minimize behavioral risks for the facility; and students maximize their academic skills and credit recovery. All of this eases a student’s transition back into school upon release. The role of education staff and facility direct care staff in an education program includes support of the program even beyond the classrooms; there should be an integration of education into the entire culture of the facility.

Implementing Behavior Plans

Behavior plans within the school program of any facility require coordination and collaboration with the facility’s behavioral programming, outside of the school day. The nature of a successful and engaging academic setting is to generate a challenging, invigorating learning environment. This can, at times, put students into states of emotional stress, both highs and lows; it can create frustration as students are pressed to perform at their best. Even the process of academic discourse generates emotional excitement, passion, and anger; this is what makes scholarly pursuits meaningful and valuable to students. Educators press students to perform at their best, stretch their understanding and analysis, and consider new and controversial perspectives. These are not behaviors and activities that impulsive youth with emotional control issues—youth typically found in confinement education classrooms—always handle appropriately. But, such experiences are valuable, teachable moments. This sometimes places educational programs in conflict with the rigorous structure of a safety and security-driven facility. The challenge is to find the middle ground that allows a school to function in the best way to engage students, and yet maintains the necessary (and primary) function of safety and security. There are a number of behavioral programs available to educators that may be incorporated into a confinement facility’s behavior-management program. Examples of three commonly used behavioral programs in schools are:

  • Behavior Intervention Support Team (BIST). BIST is an intervention model designed to help teachers confront disruptive behavior. BIST services are developed specifically for a particular school. The stated mission is to help teachers, administrators, parents, and students learn techniques to effect positive change and create a healthy learning environment for all.
  • Positive Behavioral Interventions and Supports (PBIS). PBIS is designed as a prevention-oriented way for school personnel to organize evidence-based practices, improve their implementation of those practices, and maximize academic and social behavior outcomes for students.
  • Response to Intervention (RTI). RTI is a multi-level prevention system consisting of universal screening, progress monitoring, and data-based decision making to address students who may potentially have poor learning outcomes.

In summary, BIST is a program that systematically addresses behaviors that are interfering with academic progress in the classroom. PBIS is aligned with teaching positive behaviors using positive language to let students know what they should be doing, not what they should not be doing. RTI is an academically focused tool for responding to academic needs, measuring the response, and then applying adaptions.

High-level, focused, and consistent adult engagement and training are critical to the success of any behavior plan implementation. The purpose of any school-based behavior management plan is to create a safe environment that will enhance student engagement, resulting in higher student achievement. Behavior management can enhance cognitive, emotional, and behavioral engagement in students. These key components of the education program should be consistently monitored and the data used to enhance program development. The unique nature of the confinement setting creates an environment where the teaching of new behaviors in one part of the program allows for the reinforcement of those behaviors in other parts of the program. Therefore, any behavior-management plan developed and successfully implemented in the custody education program should also be generalized to the living units, and vice versa.

School Year Versus Year-Round Calendar

Educational services should occupy the maximum amount of time allowed by facility procedures, schedules, and budgets. The consistent need for remediation, credit recovery, skill development, and simple daily engagement within the facility would indicate a strong need for year-round school. Juvenile corrections and adult prison education programs typically operate on a year-round school schedule. Juvenile detention education programs frequently operate on a traditional 36-week school calendar, and educators are forced to create a separate summer school program, often using Title I funding to support the additional education program. The problem arises in facilities where the juvenile justice staff are left to develop educational programming for the summer months with no additional funding. Staff have neither the educational expertise nor the funds to operate the school program. A detention education program should operate on a 52-week schedule and should be designed and administrated by licensed educators.

Class Size

According to Sherwood Norman, class sizes should be small, with a ratio of 10 students per teacher.[16] He specifically recommended that there should be no more than five students per class when teaching remedial subjects. Significant discussion surrounding staff-to-student ratios revolves around whether adults in all roles should be counted in the ratio. Certificated teachers, paraprofessionals, and facility staff all have different roles and provide different services. Two key considerations are that, regardless of qualifications, the positions should be defined by the role each person serves. The role of a teacher is different from the role of a paraprofessional (even if that person is certified), and the role of a direct care staff is different from that of an educator. Teaching, classroom support, and safety and security require attention to different components of the classroom, different interactions with students, and different physical activities within the classroom. The teacher’s ability to focus his or her full attention on all aspects of teaching maximizes learning for students.

Creating the Culture “Of and For” Learning: Teaching and Learning

Student Motivation and Engagement

Although the pursuit of credits and, ultimately, graduation is paramount, the instability in students’ lives often creates a need to first reengage an interest in learning. This is frequently a primary purpose of the short-term education program in a juvenile detention facility or jail. If students do not have an internal desire or a lifelong connection to learning, then internalization of their educational experience—knowledge—cannot take place.[17] For education to give youth a pathway to graduation and to create the kinds of adults who will contribute to society, students must be inspired to want to learn, to enjoy learning, rather than be coerced into learning or to learn simply to avoid negative consequences. Motivation is the desire to want to do something, and engagement is the action of doing it, but without a say about what is meaningful to them, youth take little ownership in their education.[18] A powerful avenue to develop a mindset of life-long learning is through showing students real world scenarios and examples that relate to their understanding and prior world knowledge and giving them multiple ways to express their understanding. Connecting learning to what is relevant has always been best practice in educating youth. Understanding what is relevant for youth that are confined, and demonstrating the relevance of an existing curriculum are the challenges for educators in confinement settings.

Using Feedback to Increase Cognitive, Emotional, and Behavioral Engagement in Neglected and Detained Youth: Literature Review

Field Author: Bridget Koehler

Bridget Koehler is a new teacher at the Lancaster County Juvenile Detention Center with an extensive educational and research background in student engagement in a juvenile detention center. As part of her post-graduate studies she submitted the following work, which she shares now with the readers of the Desktop Guide:

Often when we think of engagement, we think of students doing their work and following instruction. Although these behaviors are part of engagement, the emotional and cognitive aspects of a student’s learning must also be given attention if true engagement is to be achieved.

There are multiple definitions of engagement, but the most relevant comes from a book by education expert Marzano titled, The Art and Science of Teaching, in which he defines “engagement.”

“Engagement includes on-task behavior, but it further highlights the central role of students’ emotions, cognition, and voice…. When engagement is characterized by the full range of on-task behavior, positive emotions, invested cognition, and personal voice, it functions as the engine for learning and development.”[19]

In a study titled, A Motivational Perspective on Engagement and Disaffection: Conceptualization and Assessment of Children’s Behavioral and Emotional Participation in Academic Activities in the Classroom, researchers Furrer, Kindermann, and Skinner, also defined “engagement.” “At its most general, engagement refers to the quality of a child’s or youth's connection or involvement with the endeavor of schooling and, hence, with the people, activities, goals, values, and place that comprise it.”[20]

When students are engaged, we detect positive signs that manifest in on-task behavior and positive emotional states; and students show an increase in interest and enthusiasm. What this study examined was not whether students could be trained to control their behavior and focus their attention, but rather what barriers exist in schools that hinder a student’s engagement. The researchers go on to state that if we examine engagement, we must also understand and examine its opposite. The opposite is not simply a lack of engagement, but disaffection. This disaffection does not necessarily mean that students are behaving poorly. When a student is disaffected, he or she exhibits signs described by Furrer, Kindermann, and Skinner as “passivity, lack of initiation, and giving up sometimes accompanied by the emotions of dejection, discouragement, or apathy.”[21]

Many disaffected students will go through the required motions but also exhibit signs of boredom, alienation, anxiety, and avoidance. Many students who feel disaffected have lost the desire to remain in their school setting, but because they cannot physically retreat, they emotionally retreat. Thus, to truly examine a student’s engagement, their behavior, emotions, cognition, and disaffection must all be taken into account, because all these factors affect one another.

An article from the California Psychologist titled, “An Exploration of Meaningful Participation and Caring Relationships as Context for School Engagement,” agreed with the findings of Furrer, Kindermann, and Skinner. The article stated that engagement required the students to feel a sense of autonomy, dignity, control, and ownership. In addition, the student must also feel that they are competent, active participants, and that they can relate to the material. These emotions are driven by the student’s positive relationships with adults, and their positive perception of their own ability.[22]

Student engagement is the most critical function of an education program in juvenile detention, long-term corrections, or for youth in adult facilities. Without engagement, learning will not take place.

Educational Assessments

Assessments provide insight into students’ capabilities and their growth over time, both of which provide guidance to teachers and administrators for program design, instruction level and function. When used as designed, appropriate, high-quality, reliable, and valid instruments help inform and improve instruction and guide programmatic changes.

Historically, districts or states that provided large-scale, standardized tests often overlooked youth in confinement facilities. The academic challenges common among incarcerated youth were not beneficial to the overall average test scores, and with the high rates of mobility, the youth were often difficult to locate or access. NCLB—as a component of the Elementary and Secondary Education Act (PL107-110)—has mandated that every student must be tested to monitor a school’s progress toward federal requirements for student achievement. Consequently, districts and schools now actively try to locate their students for testing, regardless of the student’s circumstances or whereabouts. For example, for district students in short-term juvenile detention centers and jails, testing all students frequently requires school districts to coordinate testing with the confinement education program staff, to provide testing materials and possibly test proctors. When all students are tested, it creates a more complete and accurate picture of the successes and challenges our confinement schools face and provides evidence to validate the school’s activities. The importance of these individual test scores is a leverage point for facilities to encourage school districts to provide additional services to system-involved youth. Schools and districts now recognize the benefits they receive by addressing the needs of this population.

Unlike students enrolled in the education programs in short-term facilities, students in long-term juvenile or adult corrections facilities are typically removed from their previous public school rosters and assigned to the specific facility school. These schools are often considered part of their own LEA, thus are capable of providing all graduation requirements and directly providing the required state assessments.

Assessment of youth in detention, juvenile corrections, or adult facilities that confine youth encompasses a variety of factors relevant to the assessment’s accuracy and utility. Short-term facilities with high turnover require constant attention and considerable staffing to test youth consistently and collect the data. There is also a need to get the collected information to the teachers in a timely manner. The students are often dealing with significant physical or emotional events when they enter a facility, which can contribute to the challenges of testing. Testing in longer-term facilities needs a more comprehensive overview and consistent follow-up to monitor progress. Student records need to be consistently maintained and accessible to teaching staff. In addition, the students need to be made aware and regularly updated on their progress.

Youth involved in the juvenile justice system often do not test well on traditional tests. The results of standard testing formats often do not represent a student’s true capabilities. Classroom teachers that work consistently with students often have the best comprehensive overview and the most complete understanding of the student’s progress. Varied assessments, both traditional and authentic (real-world examples that students relate to) are crucial to the best understanding of a student’s needs and abilities. The daily life issues in a facility can skew any single piece of assessment on any given day. Balanced and fair measures against established curriculum and standards by highly qualified professional educators offer the best evaluation of these youth.

State Testing

Beyond federal requirements, school districts in many states are required to conduct state-wide standardized tests that must be completed within a specified time frame. State testing allows for consistent scoring across student populations; it is required of any student enrolled in a public school or a school that receives state funding, which typically includes students enrolled in custody education programs. State testing can prove problematic if schools are not consistently aware of the location of their students, or if resources are limited for administering the test (limited proctors or materials). A trend toward computerized testing creates some significant difficulties, including a lack of sufficient quantity and quality of computers and security and internet firewalls. An additional challenge occurs when a youth who has not been tested at his or her home school enters a facility late in the testing window. It is in the best interest of the school to provide all the resources possible to allow the student to complete the testing. With enough advance warning, it is even possible to acquire a court order to make the testing possible.

District-Mandated Testing

Many school districts assess their schools at prescribed intervals during the school year. Strict adherence to this schedule ensures that districts are seeing an accurate picture of how their schools are impacting all students. It also provides a continuous view of student progress from year to year, thus ensuring that students receive the proper classes and services upon return to their home school.

Title I of the Elementary and Secondary Schools Act (as amended by No Child Left Behind, 2001)

Title I testing is mandated if a school receives Title I funds. Every student must be pre- and post-tested in reading and math every 90 days to demonstrate continuous progress and to validate program effectiveness. This data collection is included in the required documentation for Title I services and funding.

Classroom Testing

The use of formative testing (progress) and summative testing (final exams) within confinement facilities is critical to an understanding of student success; it is also a tool to demonstrate to students what they know and are able to do. Students who have not consistently experienced educational success need continuous feedback to comprehend their own capability and build their confidence. Additionally, these classroom assessments provide feedback to teachers about the quality, degree, and effectiveness of their teaching.

Placement Testing

As students enter a facility, teachers should access the students' previous school history to gain insight into their academic capabilities. Title 1 testing requirements will assess their math, reading, and writing capabilities. Any additional district or school standardized testing can also provide information about the student’s position along the continuum of a particular course curriculum and for placement into appropriate classes. Challenges arise in long-term facilities when students have to be placed into already operating classes that have a set curriculum. It is particularly difficult to accurately assess youth entering and leaving short-term facilities to determine the appropriate instructional level and the student’s progress. The traumatic events related to being placed in short-term facilities can make accurate assessments a challenge. Additionally, short lengths of stay or uncertain release dates make post-testing youth almost impossible.

A common solution for individual classes is for teachers to develop standards-based assessments within their subject matter to determine how to place students in their own classes. The teacher should determine the design, focus, and content of such assessments to match the class profile.

Curriculum

Education for youth in confinement encompasses formal (academic) educational instruction, such as language arts, math, science, and social studies, as well as informal (non-academic) instruction, such as learning to follow rules, social skills, and non-cognitive skills such as sympathy, empathy, perseverance.

Core Curriculum

The foundations of any custody education program are the core academic subjects of mathematics, language arts, social studies, and science. The curriculum and assessments for these areas should be based upon a cohesive, clear, and aligned set of standards. These are available through local school districts, state departments of education, or the national Common Core Standards. To date, 48 states have adopted the Common Core Standards. The alignment with a national set of curriculum standards could be very beneficial for youth in custody education programs. No matter what LEA or SEA the youth was previously enrolled in, all instruction in the custody education program is aligned with the same set of national standards. Ideally, the youth’s education reentry and transition process would be much simpler.

Physical Education

Physical education is a requirement for graduation in public schools and a necessary break from the classroom. In a confinement facility, if students are receiving adequate large-muscle activity outside the school day, they may benefit more from staying in the classroom for instruction on health, healthy lifestyles, and nutrition. Students are typically not eligible to receive academic credit for large-muscle activity unless a certified teacher provides the activities using an approved curriculum. When physical activity is included as part of the school curriculum, two key elements—sportsmanship and team play—should be emphasized. These and other social skills and behaviors will benefit youth beyond the classroom and can benefit the overall culture and climate of a facility. When addressed appropriately, consistently, and engrained into the behaviors of students, structured and positive physical activities help reduce behavioral incidents and increase academic achievement.

Access to Computers and the Use of Technology

It is a challenge to use computers with access to the internet in a custody education program to enhance the quality of the students’ education without compromising safety and security. In short-term facilities, a computer-supported curriculum can help students maintain contact with the schools and classes to which they may return to upon release. In longer-term facilities, the computer also provides real-world access to keep students in contact with current information, resources, and alternative learning opportunities not available in the facility. Comprehensive computerized curricula are available from a wide range of quality vendors. For small education programs that need a validated and approved curriculum to meet the Highly Qualified requirement in NCLB, computer-based materials may work well. But students with limited attention spans, multiple learning styles, and a lack of self-motivation often find it challenging when asked to work on computers for long periods of time. By combining blended instruction, proper teacher supports, and supplementary materials to engage students, computer-assisted learning and other digital media can help form a strong academic foundation.

Considerations for Maintaining the Safety and Security of a School Network within a Detention Program

Field Author: David Beatty

David Beatty was raised in Northern Ireland. He earned his Bachelors Degree in Information Management through the School of Informatics at Queen’s University, Belfast. In 2009, he completed his Masters of Education Program in Curriculum and Instruction at Doane College, Lincoln, Nebraska. David uses a variety of instructional and assistive computer and internet-based technologies in the classroom on a daily basis, striving to enhance and empower student learning by incorporating creative uses of technology. David works at the Pathfinder Education Program located within the Lancaster County Youth Services building in Lincoln, Nebraska, serving as the school’s e-Learning Lab Instructor, where he facilitates and administers Apex (online) learning courses for students in need of credit recovery. David also teaches Technology and Business classes to the diverse multi-age level student population at the Pathfinder Education Program.

  • When setting up a classroom for computer use, arrange student seating so the teacher and Juvenile Detention Officer can view all computer screens.
  • Instructors should have clear objectives and plans detailing how the technology should be used in a lesson. This is a key element of instructional planning. Teacher expectations for computer use should be explained to students prior to assigning them to computers.
  • Computer monitoring software that allows teachers or administrators to view all student computers from a single screen and record keystroke histories assists in supervising access. Keystroke logs can be used to track and provide evidence of a user’s activity. Logs can quickly show where usage policy may have been violated.
  • Teachers should be aware of common vulnerabilities that may exist within network web filters, for example entering “https” to hack into a web address bar and refreshing the page multiple times or the use of portable proxy software.
  • Web filters should be set to strictly allow only academic or instructional website content.
  • Many web filters have a database feature that allows a technology liaison or specialist to define undesired or negative key words. Teachers can be notified when the user has typed keywords. This helps to block related web content.
  • Student user privileges to access and change computer settings should be highly restricted. Students should not be able to access system preferences (change the appearance of the desktop, change the screen resolution). This will prevent tampering with hardware settings, which only a computer technician or liaison should alter.
  • The option to authenticate (enter user credentials into a username and password fields) to gain access to a restricted website should not be available nor should the username or password fields be viewable at the student level access.

Additional considerations for maintaining the safety and security of a school network within a detention program:

  • It is beneficial to have an assigned technology liaison within the educational program that has a general knowledge or interest in technology. This person need not have a strictly technical working knowledge of computers, but should be able to work routinely with school technology to understand how it is being used during instruction and maintenance needs.
  • The technology liaison should regularly monitor the school network, frequently check user internet history reports and websites accessed by students, and have knowledge of computer resources available within the school by keeping an inventory.

General Educational Development (GED) or High School Equivalency Diploma

In some instances, older youth involved with the juvenile justice system will have large gaps in school attendance or limited academic success, resulting in a credit deficiency so significant that graduation becomes a challenge. Some students realize that graduation would require summer school or attending school even to age 21. A youth may believe these challenges are significant enough to pursue instead a GED or High School Equivalency diploma. Confinement education programs that incorporate a GED component should include GED pre-testing, skill-specific remediation, and post-testing. There are private organizations that provide study materials and testing. In some districts, students eligible for the GED preparation program cannot also be enrolled in the confinement education program operated by the district because of a dual enrollment status that is against district policy. Upon successful completion of these programs, the student is awarded a certificate recognizing his or her abilities that are expected to be equal to those of a high school graduate. Many employers and vocational or technical schools recognize these alternatives to high school graduation. They allow for entry into many community and junior colleges. In many cases, major colleges accept students with a GED if they also have appropriate entrance exam scores.

Post-Secondary Options

Youth who have completed their high school career, or have achieved a GED should have options to continue their education and become life-long learners. Students can take advantage of many online college classes if they have internet access and funding. Additional options would be certificate-granting programs that improve employability. Food-handler permits can be obtained online in some states. Some may even begin the process for certification in health services, welding, automotive, computer skills. Science, technology, engineering, and mathematics (STEM) fields may be available through community colleges or other sources. Youth who engage in meaningful, continued personal growth by completing a secondary degree will have improved life outcomes.

Access to the Arts

The great artist Picasso claimed, “All children are born artists, the problem is to remain an artist as you grow up.” Creativity expert, British author, and educator, Sir Ken Robinson said, “We don’t grow into creativity; we grow out of it. In fact, we get educated out of it.” Research exists that supports the inclusion of the arts as a critical component of the curriculum of confinement education programs.[23] Mark Hubbard, former art teacher at the Kalamazoo County Juvenile Home Schools (juvenile detention and day school for court-ordered youth) identified the following reasons for including art in the curriculum:

  1. Art is motivating. Often the successes experienced in the art class convince students that they can be successful at learning.
  2. Art supports success across the curriculum. Many studies document the role of the arts in improving the basic skills of reading, writing, and math.
  3. Art fosters creativity. All students have an innate urge and capacity to be artistically expressive. For many of the students in this program, this is their first opportunity to develop their creativity and expressive skills.
  4. Art promotes student engagement and persistence. Art can emphasize creative discovery, which in turn creates an enthusiasm and motivation for all learning, requiring discipline and an effort to achieve excellence as a result of hard work.
  5. Art creates a medium for active processing of information. Learning theory states that learning takes place only when students have had an opportunity to process information actively. Including art in the curriculum enables students to engage in an active expression of concepts.
  6. Art enhances students self-esteem. Through artistic expression, students develop a stronger vision of who they are and how they fit in their community and world.

At the time when Mark Hubbard was the art teacher, the art program at the Kalamazoo County Juvenile Home Schools consisted of basic art, ceramics, painting, stained glass, and photography. All lessons were taught by a certified art teacher with the assistance of a paraprofessional (who was also an artist) and were modified to meet all safety and security requirements of a confinement setting.

The Cook County Juvenile Temporary Detention Center (CCJTDC) took a different approach to bringing arts back to the facility. “Arts Infusion” is a true collaboration between the CCJTDC, the Nancy B. Jefferson Alternative High School (the education program in the CCJTDC), the Chicago Public Schools, the Mayor’s Office of Public Safety, the Columbia College Chicago, and the Chicago Community Trust. By incorporating many media—creative writing and poetry, drama, computer-enhanced music composition, mural painting, keyboarding, clay works, and dance—into facility programming, visiting artists work with youth to achieve the goals of curbing violent behavior in the facility and demonstrating that sustained arts participation will reduce recidivism and promote positive life choices.

Vocational Training

Vocational training activities that result in skill development and certification are highly recommended in confinement facilities that serve youth. The hands-on application of real-world skills and the development of different abilities from academic courses reaches different learning styles, provides job skills, and opens up a variety of opportunities and motivation for additional study and training. These types of activities also teach logical reasoning, practice for mastery and following directions; they build confidence and inspire motivation. Often these types of courses incorporate behaviors appropriate to a work environment, such as time management and safety procedures. The traditional academic skills—writing, reading, measurement, and budgeting—are also woven into these programs. The ability to engage business partners in these programs can create internships, job opportunities, and community service activities.

Vocational training in different settings is quite challenging. Short-term detention facilities require a significantly different approach; they can expose youth to different areas and allow the students to control their own engagement. Longer-term facilities can serve students best by offering engaging and detailed training in a specific area that could lead to certification. Areas such as food service (food-handlers permit), health (certified nursing assistant), welding (skill certification), or construction (safety certification) can provide skills and job access that are immediately useful to the youth upon release.

Social and Life Skills

Youth in facilities often have not had the typical training in basic social and life skills that many people take for granted. Providing this training is the responsibility of each facility. Social and life skills training entails a wide range of activities. The student population, the available time, and the skills of the instructor best dictate the specific content of such training. Youth may need job skills, college application skills, financial planning advice, basic hygiene, or cooking instruction. Advice on sexual health and medical care are crucial to any at-risk population. Engaging outside experts who can provide the most up-to-date and accurate information is highly encouraged. These classes are also an excellent opportunity to work on social skills, team building, and sportsmanship. Instruction in empathy, perseverance, problem-solving, and even anger management would be appropriate as well. There are a variety of prepared programs available such as Arnold Goldstein's Skillstreaming for Adolescents, Barry Glick’s Aggression Replacement Training® (ART®) and Boys Town’s Teaching Social Skills to Youth. The internet offers a continually changing variety of resources for life skills instruction. These updated and youth-focused resources help ensure that life skills are applicable to youth. (See Ch. 10: Effective Programs and Services;Ch. 18: Transition Planning and Reentry)

Instructional Design

Teachers must be proficient in their program and have a clear voice for the vision and mission of their work to design instruction in alignment with this vision. For each area of the curriculum, the instructional design must include a rigorous and relevant set of activities such as probing questions and projects that relate to diverse and meaningful issues that will engage students and staff.

Unlike the traditional public school instructional design, which includes sequential units of study that can last for weeks, confinement educators must accommodate the mobile population in custody settings. This may be accomplished by creating modular, stand-alone, short-term units that correlate with the facility’s average length of stay. Motivation and engagement findings indicate that developing topical units—those relevant to confinement youth and aligned with state and Common Core standards—are most effective strategies for instruction. Examples of such topical units developed at the Maya Angelou Academy in the New Beginnings program include Justice, Ethics, Choice, Change, Power, Systems.

David Dimenici, former principal of the New Beginnings school program and current director of the Center for Educational Excellence in Alternative Settings, stated that teachers should focus on establishing school-wide instructional strategies that prepare students to learn and then provide targeted interventions to support students at a range of levels[24]. This is essential to achieving real, measurable academic achievement. Strategies provided in Doug Lemov’s Teach Like a Champion include 1) all classes starting the same way (Warm-Up), 2) all teachers using the same daily objective/goal (SWBAT, Student Will Be Able To), 3) students transitioning into and out of all classes the same way, and 4) all teachers using the same language and using timers or other devices to encourage a sense of urgency and expectations. All of these techniques have been used successfully in custody education classrooms.

Differentiated Instruction

Differentiation refers to instruction that is tailored to meet the learning preferences of different learners.[25] It refers to a variation in the instructional approach or method. “Differentiation is responsive teaching rather than one size fits all teaching.”[26] Differentiated instruction means that the teacher “proactively plans and carries out varied approaches to content, process, and product in anticipation of and response to student differences in readiness, interest and learning needs.”[27] Teachers can differentiate through content (what the student needs to learn), process (the activities the student engages in to master the content), products (the culminating projects to rehearse, apply, and extend what the student has learned), and the learning environment (the way the classroom works and feels). The classroom environment may require the teachers to access multiple versions of an article or book, or to rewrite, summarize, or annotate. Differentiation may require multiple versions of assessments, appropriate supports, and accommodations. Teachers must develop scaffolded notes (note-taking sheet with grids of information to fill in), graphic organizers (knowledge of concept map that uses visual symbols to express a concept or convey meaning), and visual and cognitive clues to support students (checks on the board, color coding, editing strips).

Individualized Instruction

Individualization is another strategy that provides an alternative to the one-size-fits-all approach (critical in a custody education program). Similar to differentiated instruction, individualization recognizes that each student is different, has his or her own learning style, pace of learning, and approach to learning. As distinct from differentiated instruction, individualized instruction allows learners to progress at a pace that is conducive to their learning needs and style. Thus, the learning goals are the same for all students, but the speed at which students complete the work varies. Traditional, general, whole-class education strategies do not recognize these differences in instructional approaches. Individualized instruction is effective with the at-risk, drop-out, and special education populations[28] and is frequently used in custody education programs.[29]

Custody education classrooms also often experience success by blending whole-group instruction with individualized skill-building time that is narrowly tailored to student needs during the application portion of the lesson. The education program may need to provide intensive “pull-out” services to support reading and math instruction for those students functioning significantly below grade level.

Occasionally students in custody education programs are advanced and function far beyond their peers in the facility. Teachers also need to be prepared to challenge these students through peer projects, the use of the internet, and by incorporating choice, creativity, and critical-thinking options into the curriculum.

Remedial Instruction

Many students experience learning problems that prevent them from fully participating in group instructional activities. Specific learning disabilities or problems often hinder the mastery of fundamental educational concepts. Individualized instruction and a variety of learning activities are crucial to meeting the needs of this population. Students who have already been traumatized should not be subjected to more behavioral or educational trauma while in facilities. Students need supportive, adaptable programs that have a capacity to meet their needs, from the initial moments of intake, through transitioning back to their schools. In short-term detention, this means appropriate skill-level activities, and in long-term corrections or adult confinement facilities, it means quality pathways that start at a student’s skill levels and progress forward to graduation. The requirement to provide special education services for all eligible students exists regardless of the type of confinement facility.

Physical Classroom Space

Physical space has a significant impact on the learning environment and is an especially sensitive issue in confinement facilities. Room arrangements, allowable student movement, teacher placement, even the focus of activities have safety and security ramifications. The education of students, their ability to interact with the learning environment and each other, and their ability to interact with the subject matter influence the energy and mood of a classroom, as well as the academic success of the students. The more engaged, the more in control of their learning, the more creative the environment, the more likely the student will stay engaged and not be a safety or security risk. If the physical environment lacks access, control, or inhibits observation, security issues can arise. The educator, in collaboration with facility staff should seek a balance between the security of the facility and the learning opportunities available to students.

Effective Uses of Individual Classroom Space

Field Author: James S. Cudworth

James Cudworth is a retired teacher of over 30 years who worked with at-risk youth from diverse backgrounds including inner city Philadelphia and New York, as well as the backcountry hills of the Blue Ridge Mountains. He is an artist, a poet, and an extraordinary teacher of young adults.

How a teacher organizes classroom space has an effect on the learning that takes place in it. Proactive teachers regularly restructure classroom space, often with student input and assistance. In that scenario, not only do teachers and their students seek to breathe fresh air into the learning environment, but also thoughtfully aspire to enhance the breadth and depth of the student’s learning experience. Of course, classrooms are finite spaces, so arrangements within them are limited, but for most spaces, at least four types of classroom-learning arrangements have proven practical.

The first arrangement—a staple since the beginning of time—places teachers at the front or back of the classroom with students sitting in regular rows front to rear. This model works for the efficient dispensing of material every student needs to know. Typically, teachers present material using a board, perhaps an overhead projector, a smart board connected to a computer, or a device like a video microscope.

In the second arrangement, teachers remove themselves from the center of attention. Abandoning a front desk and instead moving in and among students, taking up residence wherever a student may need assistance, the teacher may speak from virtually any place in the class. Student desks are arranged frequently facing each other to encourage more “cross-talk,” while making individuals more focused on their own learning. Teachers become less visible, emphasizing student assertiveness, opinions, and conclusions they have gained from their study materials.

The third arrangement seeks to eliminate any sense of hierarchy, front, back or side of the room, placing students into a circle. In this format, teachers consciously occupy different locations every day, removed further from the sense of being the center of attention, serving instead as a mere facilitator for discussion or debate. This model strives to enhance the communal–social dimension of learning, all students seated as equals with eye contact established. The arrangement is intended to help students articulate their ideas in an atmosphere of constructive criticism, debate, and consensus.

The fourth use of classroom space seeks to create the sense that there is no locus of authority or single source of learning, only unlimited opportunity. Teachers and students arrange desks to create private and communal space. Areas are thus set aside to allow intense concentration, study, and reflection, as well as collaborative problem solving. The space establishes learning centers, laboratories, and experimental centers. Teachers are seen as mentors or guides and circulate as equals—curious learners, rather than authorities. Students move freely, collaborating with whoever fits best. Problems with complex solutions are the norm, and no single individual (the teacher included) is seen to have a complete answer. In this atmosphere, answers frequently beget more questions.

As teachers and students consciously explore all the ways of arranging their learning space, the process naturally leads participants to ask, “How do we measure our learning?” As learning steers itself away from the teacher-centered “sit and git” model toward the student-centered, “sky is the limit” possibilities, old-fashioned written tests become obsolete. A natural outgrowth of the innovative use of classroom space spurs teachers and students to discuss ways to assess what has been accomplished. This evaluation process enables all to devise ways to value the content and quality of the year’s achievements. In this atmosphere, roles are reversed compared to old models. Students frequently serve as presenters, demonstrators, or models of intellectual pursuit. Classroom space is given over to student use entirely.

Federal Legislation that Impacts Custody Education Programs

(See Ch. 5: Rights and Responsibilities)

Elementary and Secondary Education Act (ESEA) – No Child Left Behind (NCLB, 2004)

Title I of the Elementary and Secondary Schools Act Funding (as amended by No Child Left Behind, 2001)

A significant resource for youth in confinement is Title I funding. The portion of Title I funds designated for youth and programs in confinement is Part D Subpart 2. The federal government distributes funds to LEAs responsible for further distribution, expenditures, and accountability of the funds. Funds can be used to operate programs in local facilities with which the LEA has a formal agreement to provide services. Qualifying services include education programs that prepare youth to complete high school or enter job training or employment and activities that facilitate the successful transition from the institution to community, school, or employment, or that help prevent youth from dropping out of school. In addition, the LEA may use Title I Part D Subpart 2 funds to support programs for at-risk youth in the community who meet specific criteria. Programs within custody facilities that use these funds must 1) ensure coordination with the youth’s home school, specifically if the youth is eligible to receive special education services under the Individual with Disabilities Education Act (IDEA); 2) provide transition services including drug and alcohol assessment, tutoring, and family counseling; and 3) provide support services to encourage youth who have dropped out to re-enroll following release from the custody setting.

Highly Qualified Teachers

All educational providers, whether covered by the Highly Qualified requirements of NCLB or not, should strive to hire only those teachers with the content knowledge and skills required to teach the population of youth in the learning environment in a way that fosters success. As previously noted, a custody education program would require a combination of the appropriate licensure with intangible qualities such as passion and the ability to motivate reluctant learners. Given the current population of youth in custody, an argument could be made for placing the best teachers in custody education programs.

According to the Nonregulatory Guidance document produced in 2006 by the federal government, whether teachers in custody education programs need to be Highly Qualified depends on the funding structure of the program. Section 1119 of Title I of ESEA requires each State Education Agency (SEA) that receives Title I, Part A funds to ensure that all teachers teaching in core academic subjects within the State, including agencies or entities under the authority of the state are Highly Qualified. Section 1119, Part A requirements do not apply to county-operated juvenile detention education programs whose teachers are hired through an LEA.[30]

Adequate Yearly Progress (AYP)

AYP is the measure by which schools, districts, and states are accountable for student performance under Title I. Due to the unique characteristics of custody education programs, such as high student turnover, in-and-out enrollment, and students who have no educational history with the district, the custody education programs may not be able to use the same measures of progress as applied to students in the traditional setting. Custody education programs should develop criteria specific to the program that can be approved by the state department of education to measure program effectiveness and outcomes for students.

Individuals with Disabilities Education Act (IDEA)

Facilities must provide appropriate special education services; failure to do so is a common area for litigation. The guidelines are specific and are backed by case law, so no matter the type of custody setting, providing special education services is required by law.

Child Find and Identification

The Child Find requirement of IDEA compels education programs to identify, locate, and evaluate all youth who are eligible or potentially eligible for special education services. In a custody education program, this means that two processes must be in place: 1) a process to become informed about previously eligible students upon enrollment, and 2) a process for identifying and evaluating students who may be in need of special education services but have not yet been formally identified.

For students previously eligible for special education services, educators have a responsibility to locate and obtain copies of the most up-to-date Individual Education Program (IEPs) and information relating to their students. The communication systems and procedures related to special education transfers vary from district to district. Some districts have networked student information-management systems; others require direct contact. To facilitate this process and avoid potential legal issues, it is important for facilities to retain knowledgeable, special education certified instructors.

Evaluation

Due to factors such as gaps in attendance, multiple placements, and lack of family advocates, it is not unusual for students in custody education programs to enroll with out-of-date IEPs. In this case, educators must initiate the evaluation process, regardless of the facility type. This requirement is particularly difficult for short-term education programs, both because the student in all likelihood will be released prior to the completion of the evaluation, and because short-term education programs typically do not have enough staff or staff with the right qualifications to complete the evaluation.[31]

Timeliness of the IEP

When a youth who is eligible for special education services is enrolled in the custody education program, the program has two options: implement the existing IEP or develop a new IEP. In the second case, the existing IEP must be implemented, to the extent possible until the new IEP is developed. Implementing the IEP includes teaching to goals and objectives, providing required ancillary services (speech and language, hearing or visually impaired consulting services, behavior support services), and communicating the required accommodations and modifications of the general education curriculum to the general educator. The goal is for the student to experience success in the general education classroom. Federal legislation does not identify a time limit for developing the new IEP. However, many state regulations interpret the federal legislation, and accepted practice in the field requires a new IEP within thirty days of the student’s enrollment. Every youth receiving services must be reevaluated for eligibility every three years.

Overlap Between Special Education Services and Facility Services

When a student who is eligible for special education services is confined, several issues related to special education have the potential for overlap with facility services. Students may have goals and objectives written into their IEPs that generalize to the living units. Examples include social skills, independent living, and behavior-based goals.

IDEA requires the inclusion of positive behavior supports in a student’s IEP that could be integrated into the facility’s behavior-management program or the youth’s treatment plan. At the very least, facility staff must be included in the process to understand when a youth’s behavior is a manifestation of the youth’s disability and to respond accordingly. Unlike in the adult facilities, where modifications can be made to the youth’s IEP if there is a “bona fide security or penological interest,”[32] when a youth in a juvenile facility who is eligible for special education services is in room confinement or lockdown for a behavior-related incident, the IDEA legislation does not exempt the education program from providing the full range of special education services.[33]

The reentry and transition process implemented by the justice system should align with the transition process required by IDEA for special education students. Special education transition plans outline goals and objectives in the domains of a youth’s education or training, employment, independent living, and extra-curricular activities or hobbies domains beginning at the age of 14 (earlier if determined necessary).

Finally, depending on the severity of the youth’s disability, his or her IEP may require extended school-year services. This is significant if the youth is admitted to the facility during the summer months and the custody education program operates on a traditional school-year calendar.

Youth with Disabilities Convicted in Adult Criminal Court and Incarcerated in Prison

The age of eligibility for special education services is state specific and thus identified in each state’s regulations. Generally speaking, youth incarcerated in adult facilities, under the age of eligibility, are covered under the regulations of IDEA. There are exceptions, for example, if the student is determined to present a bona fide security or penological concern, the facility may not be able to arrange an accommodation. Additional exceptions include access to state-wide testing and transition services if a youth exceeds the age of special education eligibility prior to his or her release date.

Americans with Disabilities Act (ADA) Section 504

Any student with a disability has a right to an education that is protected by Section 504 of the Rehabilitation Act of 1973 and subsequent amendments. Section 504 is a civil rights law that ensures equal access to education and states, “No otherwise qualified individual with a disability in the United States . . . shall, solely by the reason of her or his disability, be excluded from the participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance…”[34] To be eligible for Section 504, a student must be determined to 1) have a physical or mental impairment that substantially limits one or more major life activities, 2) have a record of such an impairment, or 3) be regarded as having such an impairment. Major life activities include: walking, seeing, hearing, speaking, breathing, learning, working, caring for oneself, and performing manual tasks. Section 504 requires school districts to provide a Free and Appropriate Public Education (FAPE) to qualified students with disabilities, regardless of the severity of the disability. The intent of Section 504 is that educational services must meet the needs of youth with disabilities to the same extent as they meet the needs of students without disabilities. These needs can be met in the general education classroom, by providing supplementary services, and related services in the special education classroom. Similar to an IEP for special education, a student eligible for services under Section 504 must have a “504 plan” that outlines these services. Education programs in custody facilities are required to meet the elements of the 504 plan to the extent possible.

Crossover Between IDEA and Section 504

Both IDEA and Section 504 make eligibility determinations specific to each youth. In both cases, the youth has a disability. A key factor is whether the disability adversely affects educational performance. If the disability adversely affects educational performance, the youth would be eligible for special education services and will be protected under Section 504. If the disability does not adversely affect educational performance, the youth would not be eligible for special education services, but typically would still be entitled to protections under Section 504 (access to education) and may require accommodations or modifications to the general education curriculum. An example of this may be a youth with asthma.

As a condition for funding from a federal government office (such as the Office of Justice Programs), recipients must comply with Civil Rights legislation including Section 504 of the Rehabilitation Act of 1973 in terms of hiring (staff can have 504 plans protecting certain rights to accommodations for employment) and in the delivery of services or benefits (students can have 504 plans protecting their right to education).

Federal Educational Rights and Privacy Act (FERPA)

Timely access to student records is always a critical factor in the delivery of a quality education program for youth in custody. Complicating the process are the varied lengths of stay, multiple out-of-home placements, a highly transitional population having been enrolled in different districts with gaps in their public school attendance and the youth and family’s right to confidentiality. FERPA addresses both the legal backing for the timely transfer of records and confidentiality issues. However, this complex piece of legislation has been subject to various interpretations, which can also complicate the transfer of student records.

One goal of FERPA is to allow for youth to experience a smooth transition into a new educational placement by allowing for the transfer of school records prior to that placement. Additionally, FERPA allows for the sharing of information between placements to improve the youth outcomes in future placements. Recent clarification to the FERPA legislation includes correctional settings and juvenile justice placements among the facilities that educational records can be shared with or without parental release. Simon Gonsoulin provides additional information on the interpretation of FERPA and the transfer of student records.

Simon Gonsoulin

Simon Gonsoulin is the Project Director for the Neglected-Delinquent Technical Assistance Center (NCTAC) and Principal Research Analyst with American Institutes for Research. Mr. Gonsoulin provided access to the following document (produced in partnership with NDTAC and the Federal Interagency Reentry Council) that provides the facts when it comes to understanding the complexities of FERPA related to the transfer of the educational records of youth in custody. A link to this document is included with permission.

Transition and Reentry

Youth involved in the juvenile justice system often have extensive absences from school. Extensive absences may disrupt the student’s normal progression toward graduation and complicate their academic needs, their process through progressive curricula, and their transcripts. The translation of earned credits among various schools and facilities can be confusing. These complex academic and behavioral histories make communication with districts, schools, counselors, and teachers a significant challenge; they are nonetheless critically important.

Additionally, youth transitioning from a juvenile or adult facility to the public schools are not typically welcomed back easily. A student may be trying to re-enroll mid-semester, having already missed a significant number of days. Past behaviors may have them labeled as a troublemaker. The same peer group they engaged with prior to their involvement with the juvenile justice system may continue to be their peer group of choice. There are many obstacles in the way of a successful transition.

Academic Advancement Plan

Custody education programs address these issues by creating an academic advancement plan or some other form of documentation of the student’s school history and needs. The plan should compile previous academic placements, past academic credits earned, requirements still to be met, and a strategy for achieving graduation. Clearly-stated goals and objectives for the time in the facility and any accommodations needed should also be a part of the plan. There should be a regular review process in place to adjust the plan to changes in the student’s status and to identify a process for the plan to follow the student to the next placement. This type of academic plan is separate from the IEP mandated by federal regulations for Special Education students, although there will be overlapping information contained in both documents. All students should have an academic advancement plan. Only special education students would have an IEP. Youth should be familiar with and have access to a copy of their academic advancement plan. By role-playing, youth can practice being a self-advocate for their educational needs to improve their transitions between programs in the future.

Transition Specialist or Liaison

When facilities are doing excellent work with youth and stabilizing their academic and behavioral challenges in confinement, the next critical step is the reconnection with the school the student will attend upon release. Best practice would be to start planning for the youth’s release as soon as he or she enters the facility. School programs in facilities should initiate this process by contacting the previous schools for records and information, as well as informing the school of the student’s current location. A critical piece for students is helping them understand and come to terms with their future options for graduation. Informing students about future placements can also ease their anxiety and help them succeed. Regular and consistent follow-up with students at their new placement will provide staff an opportunity to help youth access resources and to intervene or support any emerging needs, before issues can have a negative impact. A school liaison should be familiar with the school districts, placements, the community, community resources, and the juvenile and adult justice systems. The liaison should be personable, reliable, detail-oriented, and able to quickly establish relationships with adults and youth. When working with school districts, the best person for assisting at-risk youth is not always someone who has been assigned, but instead someone who demonstrates a willingness and an interest. The liaison needs to be able to find these motivated and supportive individuals in the schools and develop working relationships with them. (See Ch. 18: Transition Planning and Reentry)

Transition Services

Transition services are the responsibility of the confinement education program and should include:

  • Informing schools of the location of their student within one day following enrollment in the school program.
  • Welcoming the student into the program and initiating discussions on release.
  • Locating and compiling the student's academic records.
  • Providing the student with an academic road map to graduation.
  • Providing the student with information on future placement and other relevant information.
  • Connecting with the student's family and providing access to needed services.
  • Accessing school counselors and planning for the student’s return.
  • Following-up and supporting a successful transition back to school or placement.
  • Providing for possible post-release assistance with job placement, tutoring services, counseling, food, clothing, and housing.

Transition Examples: Lessons Learned

Field Author: James Bennett

With over two decades of Youth Service experience, Jim Bennett’s career has included working with youth in transition in a variety of different capacities. Jim currently serves as the Program Specialist for Reentry for the Nebraska State Juvenile Probation Administration and is helping to lead Juvenile Justice Reform in the state of Nebraska for youth transitioning from out-of-home placement. Jim’s Youth Service career began at the Menninger Clinic working with youth in a mental healthcare setting. He moved into the juvenile justice realm working in the Lancaster County Attention Center and then shifted to the educational arena as a Transition Specialist with the Lincoln Public Schools at the Pathfinder Program in the Lancaster County Youth Services Center.

Through the evolution of the Pathfinder Transition Program, we learned tough lessons regarding what works when trying to communicate with youth and to get them to take advantage of the transitional help being offered after leaving detention. The first attempts were to give reentering youth a list of community resources and a phone number for the transition specialist at the detention center. We quickly learned that our discharge area trashcans were filling up with informational handouts, and we ultimately received no calls that first year. As we developed new ideas, we gradually found out what worked with youth going through this transition.

We found out that building strong relationships with the youth while they are in the facility gave the transition process a foothold when they returned to school. When a personal connection was made with a youth in the facility, and the youth was aware that someone would be coming to check on their progress and offer them help, it put the youth more at ease when that school visit occurred. That awareness increased the participation in the program significantly. Youth were more likely to participate in tutoring services, participate in community programs, and engage other caring adults in the schools, coordinated through the Transition Specialist.

Those relationships built with the youth in the facility helped to “kick-start” the transition process and allowed the school to begin engaging the youth in a positive way. Many of these youth had burned their bridges with their old schools, and these youth came to school with all of that history and baggage with them. Having a caring adult help them walk through some of those processes and talk with other professionals in the school gave the youth some insulation from that past baggage and helped to establish relationships with other caring adults in the school. Trusting relationships are the cornerstone of all transition work done through the Pathfinder Program.

Another lesson we learned over time is the need to be prepared to meet each of these youth where they are at in the transition process. Our first attempts were to put a program in place that fit the needs of all youth equally. We gave all of the youth the same resources and provided the same service. We also expected the youth to do the footwork and get themselves to those services. Though we did have some youth choose to take advantage of these services and resources, after further scrutiny, we felt we were only reaching those youth who would have probably been fine without these opportunities, those that would have used the school resources provided to them. We were missing most of the youth we claimed to serve, specifically those at higher risk and those less motivated who were reluctant to trust and who feared adult interventions. We decided to change the program.

One of the first changes we made was to go to the youth instead of having the youth come to us. We decided to individualize the program and offer services in the schools during open periods or after school. We offered community resources as well, but we had those community resources also go to the youth and meet with them in the schools to first build trust. In our experience with the youth served through the Pathfinder Program, the very first meeting had an extremely high no-show rate. Once we were able to make the first meetings happen at the schools and set them up ourselves, we were able to establish contact almost every time. From then on, our no-show rate for the second meeting was significantly lower.

Finally, we struggled with communicating effectively with youth. We were having trouble getting youth to remember appointments, getting ahold of them after they missed school, and contacting them to see how they were doing. We began to text. This may seem like a simple change, but it had profound effects on the program and on the quality of the service provided to the youth. Most every youth had a cell phone. Those that did not gave us the number of a friend that had a phone, and we were able to reach them that way. One might think a youth would be reluctant to provide their number but that is a generational misconception. Whereas a 45-year old might not want to give their number out to someone, a 16-year old is less concerned, given the accessibility and technological freedom a cell phone provides. Another benefit of the cell phone is access to the youth throughout the school day. Youth would respond to reminders and check-ins throughout the day, sometimes within minutes of a text going out. When a youth started to not respond to text messages, then it was time for another face-to-face meeting to find out what was going on. The lack of responses to text messages was a sign that something wasn’t going well or the youth was beginning to slip.

These are three of the many lessons learned throughout the process of determining what works for transitioning youth in the Pathfinder program. Nothing proved more beneficial for our transition support than asking the youth what they needed and what they appreciated in this program. Youth-driven direction helped to improve and refine the quality of the Pathfinder Transition Program.

Educational Options

Students will often engage teachers and facility staff in discussions related to the value of staying in school, the educational options available to them, and strategies for completing their education, despite all of the other life struggles they may be facing. Staff should be able to provide support for various educational options depending on the needs of the youth and his or her current legal situation.

Top Five Reasons to Stay in School

Here are the top five reasons to stay in school presented on the National Dropout Prevention Center/Network in 2014.

  1. High school dropouts are four times as likely to be unemployed as those who have completed four or more years of college.
  2. Graduating from high school will determine how well you live for the next 50 years of your life. On average, high school graduates earn $143 more per week than high school dropouts. College graduates earn $336 more per week than high school graduates ($479 more per week than high school dropouts).
  3. Dropouts are more likely to apply for and receive public assistance than graduates of high school,
  4. Dropouts comprise a disproportionate percentage of the nation's prison and death row inmates; 82% of prisoners in America are high school dropouts;
  5. School districts all over the country provide alternative programs for students who are not successful in the usual school setting. The best programs in the country are featured in the National Dropout Prevention Center Model Programs Database.[35]

Diploma vs. GED or High School Equivalency Diploma

The core subjects covered on a GED or a High School Equivalency diploma focus specifically on five subject areas: science, mathematics, social studies, reading, and writing. A traditional high school diploma encompasses a 12-year course of study in the core courses and includes various electives such as social skills, life skills, health, technology, and an array of other state-mandated educational components. A traditional high school diploma is the preferred outcome for any student, as it represents a capacity to complete a comprehensive and rigorous program of study. The benefits of graduating with some type of degree or through some type of high school equivalency program pays financial rewards throughout a person’s lifetime—increased earnings and job opportunities.

The reality of some life situations does not make this possible for all students. A GED or a High School Equivalency Diploma can still provide the foundational skills a student needs to enter the workforce or higher education. In general, employers look more favorably upon a traditional diploma, and some higher education options may be more limited by a GED or High School Equivalency Diploma. However, these are relatively minor barriers compared to not graduating at all.

Life Skills Development, Career Development, and Vocational Programs:

In addition to core academic subjects, educational programs within facilities must address the other significant deficits of the student population in the areas of life skills, career development, and vocational training. The availability and quality of these services, particularly career development and vocational training, are frequently limited by financial resources, physical space, equipment, and safety and security concerns. Often the community can provide resources to assist with these areas. Business partners, state vocational rehabilitation services, or community nonprofit youth groups can supply trained individuals who will voluntarily contribute this type of programming. Programming should be delivered in a prescriptive manner and be based upon individual student or general population trends and the needs specific to the youth in the facility.

Educational opportunities in these areas do not have to be stand-alone programs; they are often integrated across the curriculum of core courses. The benefits of such opportunities are limited to an exposure-level experience or pre-vocational training in short-term detention or jail facilities. These can be extended to career training and vocational opportunities in juvenile correctional or adult confinement settings. Long-term programs that can lead to or provide certifications and licenses (e.g., Food Handlers Permit, Certified Nursing Assistant) offer an incentive for youth to participate and career options upon release. The vocational program at the Lookout Mountain Youth Services Center, part of the Colorado Division of Youth Services, is such an example. Students in the program receive extensive training in landscaping, constructions, culinary arts, printing, computer-assisted design, and—in many cases—competitively-paid employment through their transition programs.

Bridges to Post-Secondary Education

Post-secondary education is not what many youth in facilities envision as a possibility in their future. They often come from homes where higher education is not a norm, not presented as a realistic option, and not a component of their discussions about life. A critical function of youth educational programming is breaking down that barrier and helping students to see additional educational opportunities beyond high school as a viable option. Through regular and consistent expectations of this reality, through presentation of role models who have successfully engaged post-secondary education opportunities, and through showing the specific steps to the process, students will not only see the option, but believe it is a real, viable option. Short-term juvenile detention facilities and adult jails that house youth should continuously present the option of post-secondary education as a possibility. Longer-term juvenile correctional facilities or adult confinement facilities that house youth need to follow through with the steps to qualify for college entrance, such as meeting all college prerequisites and participating in classes and activities focused on post-secondary goals. As a component of transition, students should receive direct assistance related to the actual process of getting registered to attend post-secondary education after their release. This would include appropriate and consistent follow-up services.

Online Educational Programming

The use of computer-based online programs for educational services has been evolving for many years. Initially, these programs were simplistic and repetitive. They were not capable of holding a student’s interest, were susceptible to repetitive strategies used to only learn what was on the test, and did not have solid foundations in the curriculum.

Current versions of online educational services have evolved into blended-learning activities that are engaging, multi-faceted in their learning styles, and based solidly on curriculum. Their use and acceptance has grown tremendously among alternative educators and school districts. The use of interactive instructors and accreditation through reliable organizations adds to the value of these programs.

For certain students a traditional classroom setting can be problematic. Accommodations are and should be available to adapt to student needs. Online classes are one option that has proven to be valuable for some students. Most school districts offer online classes as an option and provide appropriate oversight and supervision of the process. Credit Recovery is also a valuable tool for many youth in confinement education programs.

Currently, a wide range of complete degree programs are available for both college and high school degrees. The University of Nebraska offers an online high school, and Phoenix University offers post-secondary degrees, which are regularly accepted in today’s business community. The Penn Foster high school program is accredited through the Commission on Secondary Schools of the Middle States Association, a well established, highly respected national accreditation organization for many of the country’s top private schools.

Maintaining Gains

Field Author: Carol Cramer Brooks

Carol Cramer Brooks is the Director of the OJJDP National Center for Youth in Custody and the CEO of the National Partnership for Juvenile Services. She is a 20-year educator of youth in custody.

Statement of the Problem

The systems responsible for the care and transition of confined youth are juvenile justice, child welfare, mental health, and education. Many of their efforts are not effective in preparing youthful offenders for their return to community, school, and work. Quantifiable data required to draw an accurate picture of the effectiveness of transition services are not available. However, recidivism data and anecdotal accounts can reasonably lead us to these conclusions. Recidivism rates vary considerably, with estimates ranging as high as 50% to 70% among youthful offenders discharged from secure facilities without the benefit of transition services.[36] Nationally, the data suggest that only 5% to 10% of students exiting the juvenile justice system return to the public school system and graduate. Locally, 20% of the students transitioned from the Intensive Learning Center (the day school at the Kalamazoo County Juvenile Home) at the 2004–2005 semester break have experienced success in the public school system. This is a multi-systemic issue requiring a multi-systems solution. However, for the purpose of this paper, we will focus solely on the roles and responsibilities of the confinement and public education systems in providing effective transition services for detained youth.

Transition refers to a coordinated, outcome-based set of pre-release and aftercare services designed to help youth achieve social adjustment, employment, and educational success upon release from the juvenile justice facility or system. According to the National Center on Education, Disability and Juvenile Justice, transition planning is frequently ignored in confinement education programs, resulting in dismal youth outcomes after release.[37] Exposing the failures of the education system requires us to examine the system from two perspectives: the educational programs inside the walls of the confinement facility and the educational options—primarily the public school system—outside the facility.

Despite a consensus in the literature that education programs containing effective transition components aid in the post-release success of system-involved youth, confinement education programs continue to focus on success only “within the walls.”[38] The flawed design and delivery of confinement education creates a false sense of academic achievement and a reliance on an external behavior control system that does not translate to success in the public school environment. Curricula that focus on awarding credit units, grades, and academic content standards but omit social skills, independent living skills, and school success behaviors ignore the needs of confined youth and consign them to failure in the community, public school, and work environments. Confinement education programs boast of individualized education plans based on the needs of the student, yet they continue to educate youth in a cookie cutter, one-size-fits-all program designed to replicate the public school system, where delinquent youth experienced failure quite frequently.

Transitioning youth from the juvenile justice system to the public school system is rarely successful. There are many systemic factors contributing to this lack of success, including the design and purpose of the public school system, limited educational options and supports within the system, the resistance and attitudes of school personnel toward readmitting these students, and logistics such as credit and record transfers, timing, and attendance.

At the heart of transition failure is the fact that the students who are transitioning out of the juvenile justice system into the public school system are the very students that the public school system is designed to weed out. It was never the intent of the original designers of the public school system to ensure high levels of learning for all students. Opportunity was there for all, but accessed by only some. Alternative routes were available for participation as a citizen—military, industry, and agriculture. Today, all paths toward productive citizenry go through the public school system, and federal legislation is requiring that we leave no child behind. Being successful with all students requires the public school system to do more than just be successful with those students who have the right attitude, background, experiences, support systems, and aptitudes. It requires a transformation of public school practices and the assumptions that drive those practices.[39]

At minimum, students with disabilities transitioning to the public school system have the benefit of a support system, an IEP and a continuum of options (center-based, self-contained classroom, resource room, teacher consultant services). Although this alone does not equate with success, special education students do transition with a support system in place. General education students (50–70% of transitioning students) do not have a legally mandated support system or a continuum of educational options. Despite behavior challenges, academic deficits, and severe gaps in their education, these students typically have one option: general education classes. In some communities, budget cuts eliminated alternative schools. In addition, transitioning students rarely meet eligibility criteria for vocational training programs.

Public school personnel are resistant to having justice-involved students return to their schools. This resistance plays out in the numerous and deliberate obstacles created prior to and during the student’s transition period. Obstacles include delayed enrollment, encouragement of dropping out or signing out, scheduling difficulties, and a refusal to accept transfer credits. Every minor problem in the transition process can result in serious setbacks for this population. Major problems usually translate into failure.[40] Once enrolled, a transitioning student typically carries a stigma, unable to shed a history of poor attendance, and discipline and academic problems. Minor problems, which for most students might result in in-school or after-school suspensions, are expellable offenses for students with a history. According to Suzie Boss in Learning from the Margins: The Lessons of Alternative Schools, 88% of teachers nationwide believe academic achievement would improve substantially if persistent troublemakers were simply removed from class.[41] Our anecdotal experiences in transitioning delinquent youth back to the public school system validate this statement. To maintain the gains students have reached during their involvement in the juvenile justice system, both confinement and public school education programs must make significant reforms.

Statement of Importance

There are three critically important concepts that point to the need for educational systems change:

  1. It is the right thing to do for at-risk youth.
  2. It is legally mandated.
  3. It is fiscally responsible.

There is a widely accepted belief among juvenile justice professionals that if you treat the youth and then return him to his home environment, but did nothing to change that home environment, the individual quickly reverts to old behaviors. The same would hold true for school systems. If we treat the youth—teach social and school success behaviors and remediate academic deficits—but return the youth to the exact same school environment, we are wasting time and energy. School systems have to be responsive to the changing needs of students.

There is a legal mandate for school systems to educate all children—even those returning from the juvenile justice system. The U.S. Constitution requires state and local education officials to provide a “thorough and efficient system of free public schools” for the instruction of all children between the ages of five and eighteen. Additional federal legislation—IDEA, NCLB, Section 504 of the Rehabilitation Act, ADA, and Title I, Part D—strengthen the mandate to provide appropriate education for all children. State statutes and local district policies further define this mandate. The design and purpose of the education system must be re-examined must comply with the standards outlined in federal and state legislation.

We have to rewrite the purpose and redesign the delivery of educational services in confinement facilities and in the public schools, because it is our fiscal responsibility to do so. In the U.S., youthful offenders cycle in and out of institutional facilities at an average annual cost of $66,000 to $88,000 per youth.[42] In addition, researchers cite societal costs from lower tax revenue, greater spending on public assistance and healthcare and higher crime rates as a result of higher drop-out rates.[43] Communities all across the country struggle with the social and economic costs of youth with no high school diploma, no support system, and no options in the community.

Proposed Resolution of the Problem

To effectively prepare for the reentry of justice-involved youth to community, school, and work, all related systems involved must commit to a truly collaborative efforts. In their book Building Coalitions, Jackson and Maddy define collaboration as “the process of individuals or organizations sharing resources and responsibilities jointly to plan, implement, and evaluate programs to achieve common goals.”[44] Applying this definition to the role of the education system with transitioning youth requires confinement education and public school education to jointly develop and agree to a set of common goals and directions, to share responsibility for obtaining goals, and to work together to achieve the goals. The public school system cannot abdicate responsibility for their youth simply by virtue of their involvement in the juvenile justice system.

To achieve the mandate of NCLB—specifically that all students will learn at high levels—the public school system must begin a systematic effort to create procedures, policies, and programs aligned with that purpose.[45] This may result in a change in the curriculum scope and sequence. It may result in a change in school structure—class and school size, instructional hours and days, in-school program options, or the physical location of instruction. It may result in a change in course design and choice of instructional strategies. It would most certainly result in the creation of a continuum of educational options—within and in addition to the public school—designed to address the learning needs of a diverse population. Adlai Stevenson High School in Illinois (original Professional Learning Community) created a pyramid of 19 interventions to provide students with options that increased levels of time and support when they had trouble learning.[46] The short-term interventions enabled the student to transition through the difficult time. The Orange County Department of Education in California created an entire division—Alternative, Community, and Correctional Education Schools and Services (ACCESS)—to provide 160,000 students with educational options. Programs in ACCESS provide alternative learning strategies, acknowledging that students learn in a variety of ways. Teachers address the individual learning needs, interests, and abilities of each student. ACCESS is based on the belief that placing students in programs tailored to their individual needs develops their skills and talents and that the community benefits from students with skills and competencies.

Confinement education programs cannot wait for the public school system to change the way it does business. Juvenile justice facilities release about 100,000 youth annually, according to data from the U.S. Department of Justice. The first step is to realize that simply duplicating the public school model in confinement facilities has not increased the successful transition of students. Confinement education is a different entity, serving different students, and therefore must educate in a different way. The second realization is that, for a majority of students involved in the juvenile justice system, the public school is not appropriate. However, as long as the public school system is the only option, the role of confinement education has to be to prepare students for success in that model. Finally, confinement education has to lead the charge, to initiate partnerships with public education, juvenile justice, mental health, the business community, and the community at-large to create opportunities to benefit these students.

Teaching differently can mean any combination of the following scenarios: same content, different instructional strategies; different content, different instructional strategies; alternative program design, different hours in the day, small class sizes. It does not mean a dumbing down of the curriculum. All of the research on educating at-risk youth supports high expectations combined with challenging experiences that connect academic learning to life in the community and the world of work.[47] Ziemelman, Daniels, and Hyde provide us with 13 interlocking principles that characterize best practices in education.[48] These principles have implications for teaching youth in confinement. Programs and curricula should be child-centered, experiential, reflective, authentic, holistic, social, collaborative, democratic, cognitive, developmental, constructivist, psycholinguistic, and challenging. Curricula should be behavior based—teaching the academic and social behaviors necessary for successful transition. Confinement education programs should teach community life skills, including problem solving, communication, daily living, money management, personal hygiene, and housekeeping. Focus should also be on core content, skill remediation, and literacy.

The majority of youth entering the juvenile justice system never successfully return to school. Therefore, it is critical that curricula in confinement education programs help youth prepare for and enter the labor market. “While correctional educators must find better ways to motivate students to return to school,” writes correctional education expert, Robert Gemignani, “they must also provide students with the knowledge, skills and attitudes needed in entry-level jobs.”[49] This would expand the number of transitional options and allow schools to meet the needs of students. Vocational curricula should include job readiness, vocational skills training, and an opportunity to apply knowledge in real-life situations or simulations such as on-the-job training, work experience, internships, apprenticeships, mentorship or job shadowing. Effective implementation of the final component of the curriculum depends on confinement education programs developing partnerships with the business community.

Confinement education programs serve the students most likely left behind and least likely to advocate for their needs. Therefore, it is the responsibility of confinement educators to champion their cause. Crucial to successful transition is the development of an unconditional safety net of support. All service providers must commit to serving any youth under any circumstances and to adapt their supports and services when needed.[50] All students in confinement education programs should have a transition plan—modeled after the special education transition plans—which address the key areas of education, employment, independent living skills and community involvement. Transition planning should begin when the student enters the program—thinking exit upon entry. All of the student’s key stakeholders should have input into the plan. Once a plan is developed, it should guide all curriculum and programmatic decisions.

The responsibility for providing effective transition services belongs to many systems. However, to improve effectiveness, each system must focus inward to evaluate their role in this process. Education, key to the success of transitioning students, should lead the way.

Conclusion

Engagement is the most critical function of a student’s success. No one can make another person learn, they must choose to learn if the learning is to be meaningful and lasting. Educators must create the learning environment that allows students to be successful and must support their progress in a positive manner. Beyond that, educators of youth in custody have to lead the efforts to advocate for change in the systems to which youth are returning to sustain the gains that begin in the confinement settings.

 

Resources

Behavior Intervention Support Teams: Information is available at http://www.bist.org.

CEA Secure Prison Education Tablet: Information is available at https://ceanational.org/.

Common Core Standards: Information is available at http://www.corestandards.org.

EDGAR: To view current versions of the Education Department General Administrative Regulations, visit the U.S. Department of Education website at http://www2.ed.gov/policy/fund/reg/edgarReg/edgar.html.

IDEA: Individuals with Disabilities Education Act. Information is available at http://idea.ed.gov.

FERPA: “Family Educational Rights and Privacy Act.” (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99). U.S. Department of Education. http://www2.ed.gov/policy/gen/reg/ferpa/index.html?exp=8

NCLB: No Child Left Behind (NCLB) Act of 2001, Pub. L. No. 107-110, §115, Stat.1425 (2002). https://www2.ed.gov/nclb/landing.jhtml. Information on individual state requirements may be found by visiting the individual state Department of Education websites.

Positive Behavior Interventions and Supports: Information is available at https://www.pbis.org.

Response to Intervention: Information is available at https://www.interventioncentral.org/.

The National Training Curriculum for Educators of Youth in Confinement: Information is available at https://www.ojp.gov/ncjrs/virtual-library/abstracts/curriculum-training-educators-youth-confinement.

Orange County Department of Education, Alternative, Community, and Correctional Schools and Services (ACCESS): Information regarding alternative education options for youth and adults in Orange County is available at: http://www.ocde.us/ACCESS.

TITLE I: “Title I, Part D: Neglected, Delinquent, and At-Risk Youth: Prevention and Intervention Programs for Children and Youth who are Neglected, Delinquent, or At-Risk (N or D): Non Regulatory Guidance.” Washington, DC: United States Department of Education, 2006. Information related to Title I, Part D, Subpart 2 funding is available at: https://neglected-delinquent.ed.gov/what-title-i-part-d. Depending upon the facility’s program design, different categories of Title I funding may also be available.

 

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Roush, D.W. 1996. “Desktop Guide to Good Juvenile Detention Practice.” Washington, DC: Office of Juvenile Justice and Delinquency Prevention. https://www.ncjrs.gov/app/publications/abstract.aspx?ID=161408.

Rutherford, R.B., H. Griller-Clark, and C.W. Anderson. 2001. “Treating Offenders with Educational Disabilities.” In Treating Adult and Juvenile Offenders with Special Needs, edited by J.B. Ashford, B.D. Sales, and W.H. Reid. Washington, DC: American Psychological Association, 221–245.

Switzer, D. 2004. “Individualized Instruction.” In Helping Students Graduate: A Strategic Approach to Dropout Prevention, edited by F. P. Schargel, and J. Smink. Larchmont. New York: Eye on Education, 225–233.

Tomlinson, Carol Ann. 2001. How To Differentiate Instruction in Mixed-Ability Classrooms.(Second Edition). Alexandria, VA: Association for Supervision and Curriculum Development.

Tomlinson, Carol Ann. 2003. “Deciding to Teach Them All.” Teaching All Students 61, no. 2: 6–11.

Tomlinson, Carol Ann. 2005. “Quality Curriculum and Instruction for Highly Able Students. Theory into Practice 44, no. 2: 160–166.

Tyler, J., and M. Lofstrom. 2009. “Finishing High School: Alternative Pathways and Dropout Recovery.” America’s High Schools 19, no. 1. https://files.eric.ed.gov/fulltext/EJ842053.pdf.

U.S. Department of Education. 2014. “Individualized, Personalized, and Differentiated Instruction.” http://www2.ed.gov/technology/draft-netp-2010/individualized-personalized-differentiated-instruction.

U.S. Department of Education. 2006. “Title I, Part D: Neglected, Delinquent, and At-Risk Youth Prevention and Intervention Programs for Children and Youth who are Neglected, Delinquent, or At-Risk (N or D). Non Regulatory Guidance.” Washington, DC: Author.

U.S. Department of Education. 2006. “Title I, Part A: Improving Basic Programs Operated by Local Educational Agencies,” Section 1119. “Qualifications for Teachers and Paraprofessionals.” https://oese.ed.gov/offices/office-of-formula-grants/school-support-and-accountability/title-i-part-a-program/.

Washington State Department of Corrections. “Education and Vocational Programs for Offenders Policy.” Policy #500.000. https://www.doc.wa.gov/information/policies/files/500000.pdfdefault.aspx.

Wiebush, Richard G., Betsie NcNulty, and Thao Le. 2000. “Implementation of the Intensive Community-Based Aftercare Program.” Juvenile Justice Bulletin. Washington, DC: Office of Juvenile Justice and Delinquency Prevention. https://www.ncjrs.gov/pdffiles1/ojjdp/181464.pdf.

Wright, P., S. Horn, and W.L. Sanders. 1997. “Teachers and Classroom Heterogeneity: Their Effects on Educational Outcomes.” Journal of Personnel Evaluation in Education 11: 57–67.

Ziemelman, Steven, Harvey Daniels, and Arthur Hyde. 1993. Best Practice: New Standards for Teaching and Learning in America’s Schools. Portsmouth, New Hampshire: Heinemann Press. https://www.heinemann.com/shared/onlineresources/e00744/sample.pdf.

 

Bibliography

Cramer Brooks, Carol. 2005. “Best Practices in the Classroom: Highly Qualified or Highest Quality.”Inside Justice, a newsletter of the National Partnership of Juvenile Services 4, no. 1.

Coffey, O.D., and M.G. Gemignani. 1994. Effective Practices in Juvenile Correctional Education: A Study of the Literature and Research, 1980-1992. Washington, DC: The National Office for Social Responsibility.

Dowd, Tom, and Jeff Tierney. 2005. Teaching Social Skills to Youth, 2nd ed. Omaha, NE: Boys Town Press.

Gemignani, Robert. n.d. “Challenge #7 Provide Quality Education and Career Development Services that Enable Youth to Assume Productive Roles in Society.” American Youth Policy Forum. .

Glick, Barry, and John C. Gibbs. 2010. Aggression Replacement Training: A Comprehensive Intervention for Aggressive Youth, 3rd ed. Champaign, IL: Research Press.

Goldstein, Arnold P., and Ellen McGinnis. 1997. Skillstreaming the Adolescent: New Strategies and Perspectives for Teaching Prosocial Skills. Champaign, IL: Research Press.

Griller-Clark, Heather. 2006. “Transition Services for Youth with Disabilities in the Juvenile Justice System.” In EDJJ Professional Development Series, Module 8, edited by S.R. Mathur. College Park, MD: National Center on Education, Disability, and Juvenile Justice.

Griller, H.M., R.B. Rutherford, S.R. Mathur, and C.W. Anderson. 1997. A Model Transition Program for Juvenile Offenders. Paper presented at the 52nd International Correctional Education Association Conference. Houston, TX.

Lemov, Doug. 2010. Teach Like a Champion. San Francisco, CA: John Wiley & Sons.

Leone, P., M. Quinn, and D. Osher. 2002. Collaboration in the Juvenile Justice System and Youth Serving Agencies: Improving Prevention, Providing More Efficient Services, and Reducing Recidivism for Youth with Disabilities. Washington, DC: Office of Juvenile Justice and Delinquency Prevention.

Tomlinson, Carol, and Kristina Doubet. 2005. “Reach Them to Teach Them.” The Adolescent Learner 62, no. 7: 8–15.

 

Endnotes


[1] David Roush, "Desktop Guide Series,” (Washington, DC: 1996): 123.

[2] For the purpose of efficiency in this document, we will refer to the person in charge of education as the “lead teacher,” knowing that people with different jobs may be filling this role.

[3] Randy Farmer, “Welcome to the Pathfinder Education Program,” (Lincoln, NE: Pathfinder Education Program, 2014).

[4] Lancaster County, Nebraska, USA, "Educational Program: Pathfinder Education Program."

[5] Forever Foundation, “Maya Angelou Schools: Mission and Vision.”

[6] Washington State Department of Corrections, “Education and Vocational Programs for Offenders Policy, Policy #500.000.”

[7] D. Domenici, “Designing and Implementing Quality Education Programs in Confinement Settings.”

[8] Audrey Amrein-Beardsly, “Teacher Research Informing Policy: An Analysis of Research on Highly Qualified Teaching and NCLB.”

[9] U.S. Department of Education, “Title I, Part D: Neglected, Delinquent, and At-Risk Youth Prevention and Intervention Programs for Children and Youth who are Neglected, Delinquent, or At-Risk (N or D). Non Regulatory Guidance,” (Washington, DC: 2006).

[10] Carol Cramer Brooks, “Highly Qualified or Highest Quality,” Inside Justice 4, no. 1 (2005): 2.

[11] P. Wright, S. Horn, and W.L. Sanders, “Teachers and Classroom Heterogeneity: Their Effects on Educational Outcomes,” Journal of Personnel Evaluation in Education 11 (1997): 63.

[12] Domenici, “Designing and Implementing Quality Education Programs.”

[13] Family Educational Rights and Privacy Act (FERPA). (20 U.S.C. § 1232g; 34 CFR Part 99).

[14] U.S. Department of Education, “Title I, Part D: Neglected, Delinquent, and At-Risk Youth.”

[15] N.M. Francis, “Program Suggestions for Juvenile Detention Facilities,” 3–4.

[16] S. Norman, Standards and Guides for the Detention of Children and Youth, (New York: National Council on Crime and Delinquency, 1961).; P. Duran, “A Model Education Program for Juvenile Detention Homes in the United States,” (University of Sarasota, 1979).; Francis, “Program Suggestions.”

[17] Judith Irvin, Julie Meltzer, and Melinda Dukes, Taking Action on Adolescent Literacy, (Alexandria, VA: Association for Supervision and Curriculum Development, 2007).

[18] Ibid.

[19] Robert J. Marzano, The Art and Science of Teaching: A Comprehensive Framework for Effective Instruction, (Alexandria, VA: Association for Supervision and Curriculum Development, 2007): 99.

[20] C. Furrer, T. Kindermann, and E. Skinner, “A Motivational Perspective on Engagement and Disaffection: Conceptualization and Assessment of Children’s Behavioral and Emotional Participation in Academic Activities in the Classroom,” Educational and Psychological Measurement 69, no. 3 (2009): 493–525.

[21] Ibid.

[22] Greg Jennings, “An Exploration of Meaningful Exploration and Caring Relationships as Context for Social Engagement,” The California School Psychologist 8, no. 1 (2003): 43–51.

[23] OJJDP, “Arts Programs Help Break the Cycle of Delinquency and Violence,” (September/October, 2010) OJJDP News At A Glance. Washington DC: Office of Juvenile Justice and Delinquency Prevention.

[24] Domenici, “Designing and Implementing Quality Education Programs.”

[25] U.S. Department of Education. “Individualized, Personalized, and Differentiated Instruction.”

[26] DifferentiationCentral, “What Is Differentiated Instruction?” A quote attributed to Carol Ann Tomlinson (2005).

[27] Carol Ann Tomlinson, How To Differentiate Instruction in Mixed-Ability Classrooms, 2nd ed. (Alexandria, VA: Association for Supervision and Curriculum Development, 2001).

[28] Content

[29] J.V. Hamby, “How to Get an ‘A’ on Your Dropout Prevention Report Card,” Educational Leadership 46, no. 5 (1989): 21–28.; D. Switzer, “Individualized Instruction,” in Helping Students Graduate: A Strategic Approach to Dropout Prevention, eds. F. P. Schargel, and J. Smink (Larchmont, NY: Eye on Education, 2004):225–233.

[30] U.S. Department of Education, “Qualifications for Teachers and Paraprofessionals,” Title 1, Part A. Section 1119.

[31] S. Burrel and L. Warboys, “Special Education and the Juvenile Justice System,” Juvenile Justice Bulletin, (Washington, DC: Office of Juvenile Justice and Delinquency Prevention, 2000).

[32] 20 U.S.C. § 1414(d)(6)(B); 34 C.F.R. § 300.311(c).

[33] S. Burrel and L. Warboys, “Special Education and the Juvenile Justice System.”

[34] 29 U.S.C. § 794; Section 504 of the Rehabilitation Act of 1973.

[35] National Dropout Prevention Center/Network, “Top 5 Reasons to Stay in School.”

[36] S.V. Gies, “Aftercare Services,” Juvenile Justice Bulletin, (Washington, DC: Office of Juvenile Justice and Delinquency Prevention, 2000).; R. Wiebush, B. McNulty, and T. Le, “Implementation of the Intensive Community-Based Aftercare Program,” Juvenile Justice Bulletin, (Washington, DC: Office of Juvenile Justice and Delinquency Prevention, 2000).

[37] National Center on Education, Disability, and Juvenile Justice, “Transition Planning and Services,” (College Park, MD).

[38] R.B. Rutherford, H. Griller-Clark, and C.W. Anderson, “Treating Offenders with Educational Disabilities,” in reating Adult and Juvenile Offenders with Special Needs, eds. J.B. Ashford, B. D. Sales, and Reid (Washington, DC: American Psychological Association, 2001): 221–245.

[39] Richard Dufour, Rebecca Dufour, Richard Eaker, and Gayle Karhanek, Whatever It Takes: How Professional Learning Communities Respond When Kids Don’t Learn (Bloomington, IN: Solution Tree, 2004).; Richard Riedl, “The Failure of American Schools to Change: Innovations that Didn’t Take,” The Newsletter of Western Center for Microcomputers in Special Education, Inc. (2006).

[40] David R. Giles, “School Related Problems Confronting New Jersey Youth Returning to Local Communities and Schools From Juvenile Detention Facilities and Juvenile Justice Commission Programs,” (Trenton, NJ: 2003).

[41] Suzie Boss, “Learning from the Margins: The Lessons of Alternative Schools,” Northwest Education, 3, no. 4 (1998): 2–11. (ERIC Document Reproduction Service No. Ed. EJ566709).

[42] Richard Mendel, No Place For Kids (Baltimore, MD: The Annie E. Casey Foundation, 2011).

[43] J. Tyler and M. Lofstrom, “Finishing High School: Alternative Pathways and Dropout Recovery,” America’s High Schools 19, no. 1 (2009).

[44] D. Jackson and W. Maddy, Building Coalitions (Columbus, OH: The Ohio Center for Action on Coalitions for Families and High Risk Youth, 1992).

[45] DuFour et al., Whatever It Takes.

[46] Ibid.

[47] G. Druian and J. Butler, Effective Schooling Practices and At-Risk Youth: What the Research Shows, School Improvement Research Series (SIRS), (Portland, OR: Education Northwest, 2004).; Alan Baas, “Promising Strategies for At-Risk Youth,” ERIC Digest No. 59. ERIC Clearinghouse on Educational Management, (Eugene, OR: 1991).

[48] Steven Ziemelman, Harvey Daniels, and Arthur Hyde, Best Practice: New Standards for Teaching and Learning in America’s Schools, (Portsmouth, NH: Heinemann Press, 1993).

[49] Robert J. Gemignani, Juvenile Correctional Education: A Time for Change, OJJDP Update on Research (Washington, DC: Office of Justice Programs, 1994): 3.

[50] N. Deschenes and C.B. Hewitt, “Seven Best Practices in Transition Programs for Youth,” Reaching Today’s Youth, The Community Circle of Caring Journal 2, no. 4 (1998): 44–48.

Ch.14 Behavior Management

Ch.14 Behavior Management web_admin Mon, 12/27/2021 - 11:12

Author: Michele Deitch, J.D., M.Sc.

Establishing a Therapeutic Culture that Supports Behavior Management

Setting Behavioral Expectations for Youth and Staff[1]

It is important to begin with a clear understanding of what is meant when talking about behavior management, discipline, and punishment. Behavior management is the ongoing effort by facility staff to implement strategies that elicit positive behavior from resident youth. Ensuring appropriate youth behavior is a never-ending task that requires constant attention from staff; behavior management is not a one-time response to a troubling incident. Seen in this light, it becomes clear that behavior management is about more than the immediate response to aggressive or inappropriate behavior. It involves creating a therapeutic culture within the facility that supports the development of positive relationships between youth and staff, that ensures the safe and humane treatment of the youth, that provides youth with the treatment and programs they need to learn problem-solving skills and overcome thinking errors and past traumas, and that ensures a consistent and clear message about behavioral expectations for both youth and staff. Moreover, the facility should be run in a way that undergirds, rather than undermines, this positive culture—from ensuring a custodial environment that is safe and secure, to hiring appropriate numbers of highly-trained staff, to having clear policies and procedures to be followed when that negative behaviors occur.

The goal of a behavior management system is discipline, if discipline is understood to mean the elicitation of desirable behavior that conforms to acceptable norms.

Too often, behavior management is confused with punishment or the sanctions that should apply when a youth breaks the rules. To be clear, a behavior management system must include appropriate consequences for negative behaviors. But the objective of these consequences should not be punishment, but rather changing the youth’s behavior in the future. Punishment is simply a punitive response to unwanted behavior; it alone does nothing to ensure that the misbehavior will not reoccur.

Expectations for positive behavior must be communicated to both youth and staff from the very start of their engagement with the facility. Those expectations are conveyed in very subtle and not so subtle ways. If youth are locked in run-down cages and yelled at by staff, they are clearly given a message that we expect them to behave like animals. If, in contrast, they are given rooms in homelike settings and are encouraged by supportive staff, they learn that they are expected to treat each other with respect.

The facility’s leadership should also clearly establish other expectations about appropriate behavior on the part of youth and staff in every communication and policy. A healthy environment is one where no abuse of any kind can be tolerated, whether it involves physical assaults, sexual misconduct, or verbal abuse. That rule applies to all interactions between staff and youth and among youth. Moreover, there must be zero tolerance of any behavior that involves bullying, ridicule, or extortion. Youth must feel safe in the custodial environment if they are to be able to work successfully on their therapeutic needs; any sense that they are at risk of harm from other youth or staff will undermine their rehabilitative progress. Gangs and gang behavior must not be allowed to fester in the custodial environment. Not only does gang activity interfere with the therapeutic environment and put staff and youth at risk, it also creates barriers to individual growth and positive interactions among peers.

In short, the culture of the custodial environment must be therapeutic rather than punitive. In a comprehensive analysis of evidence-based juvenile justice programs conducted in 2010, Mark Lipsey and his colleagues found that programs with a therapeutic philosophy are significantly more effective than those with a control philosophy regarding outcomes for youth.[2] The researchers advised that programs with a control approach to managing youth behavior should be avoided in favor of those guided by a therapeutic approach.[3] Ensuring that the culture of the institution is consistent with this therapeutic philosophy is thus critical from the standpoint of improving youth behavior and reducing recidivism rates.

The Need for a Multi-Tiered Approach to Behavior Management

Violence and misbehavior in youth confinement facilities are symptoms of a systemic failure to address the skill deficits of incarcerated youth.[4] These deficits can reduce a youth's ability to address problems in a calm and reasoned fashion, provoking impulsive responses to stressful situations and emotional or violent reactions to perceived disrespect or danger.[5] Because incarcerated youth arrive at secure facilities with a multitude of skill deficits, staff need to shift away from traditional punitive approaches to managing this population. Those punitive approaches and use of increased disciplinary sanctions can simply mask the aggressive behaviors of youth rather than teach them skills that can prevent such behavior in the future. The far better approach is to use a range of strategies for preventing, intervening, and responding to misbehavior that elicit desired behaviors, promote long-lasting behavioral change in youth, and lead to a systematic reduction in violence and misbehavior.[6]

Research has shown the value of using a multi-tiered framework modeled upon Positive Behavioral Interventions and Supports (PBIS), an incentive-based behavior modification system that teaches and strengthens appropriate behaviors and reduces challenging behaviors.[7] The model is designed to prevent the development of new problem behaviors, the triggering of occurrences of problem behaviors, and the exacerbation of existing problem behaviors. While PBIS is typically applied to classroom settings, research supports its effectiveness with students of all ages and in all types of settings, including in secure juvenile facilities.[8]

It is important to understand the logic and structure of the PBIS multi-tiered approach to behavior management, as illustrated in Figure 1. The primary tier provides preventive strategies and behavioral support for all youth across all settings within the institution. According to Brenda Scheuermann, 80% to 90% of all youth in school settings respond successfully to a positive, proactive environment that emphasizes teaching students how to behave and ensuring that attention is paid to appropriate behaviors rather than simply punishing inappropriate behavior.[9] The secondary tier provides more intensive behavioral supports and interventions for those students whose behaviors are not responsive to primary-tier strategies. Another 10% to 15% of youth tend to need these structured and individualized interventions.[10] Finally, the tertiary tier provides highly individualized and even more intensive behavioral supports for students whose behaviors are not responsive to primary or secondary tier interventions. One to five percent of all youth will likely need these intensive services.[11] Youth move in and out of these tiers as their behavior changes, so that youth who were responsive at the secondary tier can move back to the primary tier, removing secondary tier interventions from their behavior management plan.

This framework is especially helpful for juvenile confinement staff, because it shows the importance of across-the-board approaches that, when applied to an entire institution, help prevent behavioral problems in individual youth. Preventing misbehavior is the best way to manage it, and intervening early with minor misbehavior helps keep problems from escalating or becoming chronic.

To achieve and maintain the positive culture described above—and to encourage the safest environment possible for both youth and staff—the multi-tiered approach to behavior management should incorporate best practices in a number of different areas, including the following:

  • Staff training and the building of positive staff–youth relationships.
  • Staffing practices.
  • Physical environment.
  • Small group processes.
  • Classification.
  • Structured daily schedules.
  • Youth empowerment and outlets for complaints.
  • Therapeutic interventions.
  • Strength-based rewards and consequences.
  • Discipline and graduated sanctions.
  • Separation and disciplinary confinement of youth.
  • Long-term behavioral management units.
  • Crisis management—de-escalation, use of force, and restraints.

When implemented comprehensively, improvements in each of these areas consistently lead to a reduction in violence and misbehavior and create a culture of behavior management within a confinement setting. The rest of this chapter describes in detail the best practices that together comprise an effective behavior management system and shows how they fall within this multi-tiered structure, which incorporates elements of prevention, intervention, and disciplinary responses, as well as appropriate ways to handle situations that call for crisis management.

 

Figure 1:
Effective Behavior Management System
Multi-Tiered Structure

 

a pyramid diagram. The base is Primary that works for 80 percent of youth, then Secondary which works for 15% of youth, and the peak is Tertiary that works for 5% of youth

Figure 1 illustrates the behavior management model using a pyramid divided into three tiers of behavioral supports and interventions, with the primary tier at the bottom. The primary tier applies to all youth; the secondary tier applies to some youth; and the tertiary tier applies to a few youth.

Best Practices in the Multi-Tiered Model of Behavior Management

Preventive Elements of the Primary Tier

The primary tier of an effective behavior management system is focused on prevention of misbehavior through system-wide strategies applicable to all youth in the facility, rather than an approach that targets an individual resident. Those proven, across-the-board prevention strategies include: effective staff training on relationship-building, appropriate staffing levels, environmental factors, the use of small groups within the facility, classification, gang management, highly structured daily schedules, and youth empowerment. Most of these operational issues are addressed in more detail elsewhere in this Guide, but are discussed here from the standpoint of how they support an effective behavior management system.

Staff Training and the Building of Positive Staff–Youth Relationships

Staff training is arguably the best avenue to preventing misbehavior in juvenile facilities, and the single most important contributor to the quality of youth confinement services.[12] David Roush and Michael McMillen highlight the links between inadequate staff training and serious problems like youth suicide and youth-on-youth violence.[13] Yet agencies often limit the time and resources devoted to staff training, citing scarce funding and scheduling difficulties. This is surely a mistake. Juvenile detention and corrections staff consistently rank additional training as their highest need.[14] New staff should receive as many hours of training as possible, and ongoing in-service training should be required for experienced staff. (See Ch. 4: Developing and Maintaining a Professional Workforce)

The content of the training curriculum is even more important than the number of hours staff spend being trained. Training on certain subjects is essential from the standpoint of improving facility safety. Roush recommends training youth facility staff in all of the following subjects:

  • Job skills (security procedures, supervision of youth, report writing, key control).
  • Suicide prevention (signs of suicide risk, precautions).
  • Emergency procedures (fire procedures, use of force regulations and tactics).
  • Relationship building (communication skills, social and cultural lifestyles of youth, adolescent growth and development).
  • Youth rules and regulations.
  • Youth rights and responsibilities.

Of these, training in relationship building may be the most important when it comes to preventing misbehavior and maximizing safety in a juvenile facility.

Relationships between youth and staff are considered the primary way in which the behavior of youth is managed; therefore, it is critical for staff to receive training to improve those relationships.[15] Positive relationships are built on a foundation of trust. That trust is developed through active listening, honesty in all interactions, respectful communication, fair and thoughtful responses to the youth’s actions, and concern for the youth’s well-being as demonstrated by caring behavior, encouragement, protection of the youth, and the teaching of problem-solving skills. Staff should always strive to practice these kinds of positive interactions with youth in the facility. Teens are highly capable of seeing through superficial or non-genuine interactions, and inconsistent responses on the part of staff are certain to lead to a lack of trust. Many youth have complicated family and educational histories that already lead them to mistrust adults. Many of them lack positive, caring relationships with adults and have little reason to behave well for those they do not trust. But, where there is a trusting, caring, mutual relationship with an adult, the youth want to succeed and control their behaviors to please that individual.

Through their interactions with residents, confinement staff have the potential to model positive behavior, respectful communication, and strategies for resolving problems or sources of stress. Social learning theory tells us that the behavior of residents in institutional settings is the product of staff interactions, and that everything a staff member does is an interaction and a teaching opportunity.[16] Indeed, one study found that a quarter of the behavioral change observed in youth can be directly attributed to the nature of the relationship formed between the client and the treatment provider.[17] Even the emotions and behaviors of the staff tend to be replicated by the youth who observe them. Through their own behavior, staff can model self-management and reflective action, or they can teach aggression, sarcasm, argumentation, and loss of control. Thus, the ways in which staff talk to youth and respond to negative behaviors are critical elements of preventive behavior management, and the training curriculum must teach staff how to communicate and respond in a positive manner.

Youth that exhibit aggressive behaviors are those most in need of supportive relationships with staff. Yet, they often receive the least programming and fewest opportunities to develop positive adult relationships, because staff typically move into a punishment mode in response to these youth. It is far more effective for staff to shift their approach to one that emphasizes redirection of the negative conduct.

Around the country, juvenile confinement agencies have developed policies and practices to encourage positive staff interactions with youth and to teach staff how they can play a critical role in redirecting negative behaviors on the part of residents through these relationships. At Long Creek Youth Development Center in South Portland, Maine, for example, staff members are required to provide a minimum of ten positive statements to residents each day that reinforce desired behaviors and redirect negative ones.[18] Line staff members are informed of the behaviors that youth learn in specialized programming and are directed to emphasize these behaviors. In this way, line staff are able to build on the foundation laid by treatment staff: both groups are able to help residents cultivate alternative coping strategies when aggressive feelings arise.[19] Although treatment staff specialize in skill training, line staff can provide practical application of these skills.[20] Conversely, line staff can help identify the type, severity, and frequency of a youth’s misbehavior, so that the treatment team can tailor plans to meet the youth’s needs.[21]

Similarly, Mark Steward has coined a phrase—“eyes on, ears on, hearts on”—to describe the level of supervision and interaction with youth that all staff should maintain while on duty.[22] This approach is informed by the notion that, when youth know staff members are there to help them and not hurt them, a change in behavior is more likely to occur.

Not only do positive relationships help prevent violence and other forms of misbehavior by providing youth with skills and a reason to exercise self-control, these relationships also provide a foundation that allows staff to intervene when aggressive conduct escalates. Line staff that already have a positive relationship with youth can more effectively use verbal skills to de-escalate a confrontation involving that child. Indeed, it is difficult for staff to defuse a situation without having an existing trusting and positive relationship.

Training in relationship building should cover effective use of authority, expressions of disapproval that redirect a youth’s behavior, and appropriate ways to reinforce problem-solving skills in youth.[23] Staff members who understand how their job influences relationships with youth are most successful at preventing misbehavior among youth. For example, such training might help staff understand that youth want to feel in control and might refuse to respond to a directive if the youth feels it is just another order from an authority figure. Staff members who understand the reason for noncompliance are more likely to effectively promote positive responses.[24]

Staff must learn about adolescent development and the myriad factors that influence youth behavior. They need to understand that youth misbehavior is primarily a product of a still developing brain, poor impulse control, peer pressure, lack of appreciation of consequences, and lack of practice with effective problem-solving skills. They need to appreciate the degree to which mental illness, trauma, substance abuse, and the disruption of a youth’s family life can lead to outbursts and other negative behaviors. And they need to know that youth are still works in progress. The children in their care are highly capable of change, and their characters are still forming. (See Ch. 6: Adolescent Development)

Staff should also be trained in diversity awareness. Staff members and youth offenders often come from different cultures. This difference can result in cultural misunderstandings whereby staff or youth perceive disrespect or inappropriate behavior where none is intended, in turn leading to conflicts between staff and youth. To prevent such conflict, staff training should highlight the differences in culture, socialization, and race that can affect staff members’ ability to relate to youth and to respond to crisis situations.[25] Staff training should help staff members become aware of their own biases and gain an accurate working knowledge about the various cultures of the facility’s residents.[26]

Staff training must also include information about mental health issues, given that the majority of youth involved with the juvenile justice system have special mental health needs. In fact, studies estimate that anywhere between 65% and 70% of youth offenders have at least one diagnosable mental health disorder.[27] Lisa Boesky notes that certain supervision and management strategies are more effective with mentally ill youth.[28] Also, when a crisis situation occurs, staff that do not understand the youth’s mental illness may unintentionally escalate the situation.[29] Finally, staff may inadvertently reward angry outbursts or violence if they have not learned how to reinforce pro-social ways of coping.[30] (See Ch. 11: Mental Health)

The best mental health training makes clinical material understandable, is tailored to staff members’ specific job duties, provides realistic management and supervision recommendations, and includes real-life case examples.[31] Administrators might find it beneficial to send entire staff teams to the same outside mental health training, so the entire team is exposed to the same information. Juvenile facility staff teams frequently report that, after they work together to learn about mental health issues, they experience decreased episodes of self-injury and aggression or violence among confined youth.[32]

Later sections of this chapter will provide further detail on how staff training on crisis-level incidents, use of verbal techniques to de-escalate a tense situation, and avoiding the use of punitive strategies such as physical force, use of mechanical and physical restraints, and seclusion of youth in response to serious misbehavior.

Staff Ratios, Turnover, and Deployment[33]

Though staff training is critical, staffing practices such as staff-to-youth ratios, turnover, and deployment also directly impact staff members’ ability to monitor youth, provide for youth safety, and allow for quality interactions and support.[34] These activities, in turn, affect the likelihood of youth misbehavior, as well as the level and number of violent incidents in a facility. Appropriate staffing practices are key to ensuring a safe environment for all youth and staff members and to promoting positive behavior among youth.

The higher the staff-to-youth ratio (meaning, the more staff present for each youth in the facility), the more that staff interactions will help prevent behavior problems in secure facilities by allowing staff additional opportunity to work with youth and help staff identify and resolve problems before violence escalates.[35] High staff-to-youth ratios allow youth to feel safe, making them less likely to act out.[36]

Roush and McMillen suggest an overall minimum staff-to-youth ratio of one staff person to every 8 to 10 youth; but, ideally, one staff person should directly supervise only about 6 to 10 youth at a time.[37] These ratios are so widely considered an effective measure for reducing violence in secure facilities that the Department of Justice (DOJ) included them in newly issued regulations for enforcing the Prison Rape Elimination Act (PREA). The PREA Standards, designed in part to prevent youth-on-youth sexual violence, mandate that, by October 2017, juvenile facilities maintain staff-to-youth ratios of 1 to 8 during waking hours and 1 to 16 during sleeping hours.[38] These ratios include security or direct-care staff only.[39] Sheila Mitchell believes that high staff-to-resident ratios are so important in preventing violence that her agency increased the number of staff to 1 staff member per 6 youth during the day and 1 staff member per 10 to 15 youth at night. Dr. Nelson Griffis believes the ratios should be even lower for violent or sex offenders. He recommends a 1 to 5 staff-to-youth ratio for this population. (See Ch. 8: Management and Facility Administration and Ch. 17: Quality Assurance: Prison Rape Elimination Act)

Beyond the importance of maintaining appropriate staff-to-youth ratios, avoiding staff turnover is a critical factor in promoting safe custodial environments. High rates of staff turnover can destabilize a facility, contributing to the risk of youth misbehavior and violence. Confinement facilities that experience frequent staff turnover have consistently high numbers of new, inexperienced staff members who are less familiar with the individual youth, security procedures, and crisis de-escalation techniques; these staff are less effective in managing the youth and preventing violence.[40] New staff members often do not have meaningful relationships with the youth, which may contribute to the youths’ willingness to act out, test limits, and assault the staff members.

Staff should be deployed in a way that allows them to maintain a high degree of supervision in housing and activity spaces, because these are the areas where violence among youth most commonly occurs.[41] Research on Texas’s juvenile correctional facilities found that major rule violations overwhelmingly occurred in the housing areas.[42] Staff should always be present to supervise youth circulation between physically controlled zones, to supervise youth in their housing areas, and be strategically deployed to supervise any areas where camera angles, corners, or building layouts might allow youth to hide or engage in negative behaviors. Youth should not be able to conceal themselves in unsupervised rooms or corners.

Roush and McMillen also recommend that staff supervisors remain highly visible; youth are less likely to engage in negative behaviors if they know they are being monitored at all times.[43] Youth should know that, even during periods of low staffing, remote audio and visual monitoring systems are supplementing direct supervision.[44]

Staff seniority should also be taken into account in determining how, where, and when staff will be deployed. Contrary to frequent practice, the most inexperienced staff should not be assigned to what is determined to be the most dangerous shift. Many staff members dislike working the second shift and seek to avoid it, but this is when youth have the most downtime, and the risk of behavior problems increases. Youth often take advantage of inexperienced staff. Thus, wise administrators should seek to assign their most effective and experienced staff members to this shift to assist in behavior management efforts. Similarly, more experienced staff should work with special populations, including the mentally ill. This is a challenging assignment, and inexperienced staff members typically do not have the training or skills to help manage behavioral problems that arise with these populations.

The age and gender of staff members also matters when it comes to deployment. Older juvenile corrections staff should be assigned to work with older youth (17 and older), and managers should aim for at least a three- to five-year age difference between those doing the supervision and those being supervised. To the extent possible, female staff should be assigned to work with girls; this can help reduce the impact of trauma on the part of those youth who have been abused in the past.

Physical Environment and Security Measures

The physical structure and environment of youth confinement facilities have a tremendous impact on the likelihood of violence within that facility. The size and design of the spaces where youth are confined can impact the behavior of youth.[45] Proper design of a facility can help prevent violence across all youth populations, and should be considered a critical element of the behavior management plan of a youth confinement facility. Also, appropriate use of technology can help promote safer interactions among youth and serve as a deterrent to youth misbehavior.

The juvenile justice field widely recognizes the superiority of small, community-based juvenile corrections facilities over larger, conventional training schools.[46] There are two ways in which smaller secure juvenile facilities prevent the development of aggressive behaviors.

First, smaller facilities create an environment more hospitable to treatment. This is important because a severely institutional, restrictive juvenile facility may cause youth to attempt to exert control through aggressive, confrontational behaviors that endanger staff or other youth.[47]

Roush and McMillen recommend facilities with physical settings that project an image of positive expectations for youth.[48] Specifically, they suggest natural lighting and physical access to outdoor spaces to reduce the impression of confinement as well as carpeting, furnishings, and other spatial configurations designed to reduce noise and create the perception of a calm and controlled setting.[49] Will Harrell, also emphasizes the importance of youth access to outside recreation, green spaces, and natural sunlight. He notes that such environmental factors help prevent a youth from becoming institutionalized, which is linked to violent behavior.

Similarly, according to Mark Steward, small facilities are easier to design with homelike features that reflect this type of therapeutic community. For example, Hogan Street Youth Facility in Missouri is the highest security level facility in the state, and yet it looks no different than the state’s other group home settings because it, too, is designed to resemble a home.[50] Dorm rooms at this facility contain comfortable wooden beds and colorful comforters. Walls are decorated with pictures, murals, and craft projects from treatment group sessions. Day rooms have couches, coffee tables, plants, and wooden furniture, resembling the comfort of a home living room. This stands in stark contrast to the typical corrections-based dayroom of white walls and hard, plastic, bus station seating that reflect a more restrictive living environment.[51] Missouri’s use of small, non-restrictive facilities has been successful by many measures. Notably, the frequency of violent incidents and the need for restraints or seclusion remains extremely low, compared to juvenile correctional facilities in other states, and, there have been no suicides during the 25 years since large training schools were eliminated from the Missouri system.[52]

The second way in which smaller secure juvenile facilities prevent the development of aggressive behaviors among youth is that smaller facilities are typically incorporated into a regionalized plan for locating these facilities close to the communities of incarcerated youth. Keeping a youth close to home is important, because families play a critical role in supporting changes in a youth’s behavior, and family members can visit more often if they live close by. With the encouragement of staff at the facility, these interactions can lead to positive behavior in youth and long-term, healthy family relationships. (See Ch. 10: Effective Programs and Services)

For example, the Missouri Department of Youth Services is able to engage the families of confined youth because of its localized regionalization plan for facilities, which allows most youth to stay close to home, in facilities of no more than 50 youth; the secure care facilities hold just 30 to 36 youth.[53] Since closing its large training schools and shifting to this regionalized model, Missouri has experienced an enormous reduction in violence within its juvenile facilities, according to Mark Steward. (See Ch. 3: Physical Plant Design and Operations)

Other juvenile justice systems are beginning to follow suit.[54] North Carolina shifted to housing no more than 25 youth in its facilities, and since restructuring its system, the state’s juvenile justice agency has experienced a very substantial reduction in rule violations and violent incidents, as well as a 73% decrease in re-arrest rates.[55] Louisiana’s Office of Youth Detention is implementing a five-year strategic plan of localized facilities based on the Missouri Model.[56] The state is working to move youth out of large, distant, state institutions with a correctional custodial feel and to instead situate them in homelike settings, with a therapeutic, youth-centered environment. One count found that more than 52 youth correctional facilities have been closed in at least 18 states since 2007, and many others have downsized by closing parts of large institutions.[57]

Paul DeMuro contends that juvenile confinement facilities should be small enough that the facility administrator “can know the life story of every kid in them.”[58] But not all experts agree that facilities need to be smaller than 50 beds to be effective at reducing youth violence. Nelson Griffis contends that facilities with 80 beds or fewer can also accomplish this goal with greater economies of scale, assuming they are well-designed and focus on treatment goals.

It is important to remember that deinstitutionalization, though important, can be destabilizing. Downsizing the number of youth in facilities often requires merging youth from different facilities into new environments. This can lead to culture clashes between youth who are not yet fully equipped with the skills needed to manage this type of change. At the same time, staff members are also forced to transition to different facilities. This can also be destabilizing, because staff are challenged by a learning curve as they enter a new environment at a time in which consistency is most crucial. This instability can lead to increased levels of youth misbehavior.

In short, research and experience strongly suggest a correlation between the size and design of facilities and the level of misbehavior on the part of residents. Keeping facilities small and more homelike can help prevent behavior problems, and help support the therapeutic mission of the facility.

Although the overall size of facilities is very important, so too is the size of the sleeping units. Research has shown that the vast majority of violent incidents occur in dormitory settings, especially those with 11 or more residents in one large sleeping space.[59] David Roush recommends eliminating congregate sleeping arrangements in juvenile detention facilities to reduce youth violence,[60] a view shared by Griffis, who believes that single-occupancy rooms are essential in juvenile custodial settings. This position is also reflected in the American Correctional Association’s standards for juvenile confinement facilities.[61] Will Harrell highlights the special importance of using single-occupancy rooms in reception centers and diagnostic units, where staff have much less information about the youth’s behavior or vulnerabilities at that point, and because the stage of the process is so traumatic for the youth in ways that may cause them to act out.

Even when single-occupancy sleeping rooms are used, it is important that these rooms are not overly institutional or restrictive, or else youth may try to exert control by acting out.[62] The restrictiveness of sleeping rooms can be reduced by, for example, including carpeted floors to reduce noise or windows or lighting that reduce the sense of physical confinement.[63] Single-occupancy rooms must be used in a manner that promotes privacy without becoming a form of isolation or excessive confinement. Allowing youth to decorate their rooms with pictures of family members or craft projects completed in therapeutic treatment groups creates a personalized space for youth that encourages positive behavior. Structured this way, single-occupancy rooms can provide a retreat at the onset of negative feelings. However, when youth retreat to their rooms, staff should keep the doors to the room unlocked so that youth do not associate the space with punishment.

Not all agencies rely on single-occupancy rooms to manage youth behavior. Because of the risk that single-occupancy rooms may promote restrictive living environments, Missouri uses dormitory settings, which provide a shared space so youth learn to live in community with one another.[64] While Missouri’s experience in this regard is clearly successful, most youth corrections experts tend to see Missouri’s housing arrangement as an anomaly and believe that the single-room design is a critical part of an agency’s behavior management system.

It is also important that administrators and staff not overlook the importance of following basic security measures; the security of facility features such as doors, windows, and cameras can affect the staff’s ability to manage youth and can deter youth misbehavior. For example, security breaches often occur when staff members accidentally leave windows or doors unlocked. To minimize security risks, staff should physically check that each door and window is secure each time they walk by.

Surveillance cameras can be especially helpful in supplementing direct supervision of youth by staff.[65] But, unless they are properly deployed and monitored, cameras can also lull staff and administrators into a false sense of security.[66] Administrators need to ensure that there are no blind spots or areas without camera visibility in the facility, because these locations tend to be prime spots for violent incidents or illegal activity.[67] If there are unavoidable blind spots, staff should take additional security precautions in these areas. (See Ch. 16: Behavior Observation, Recording, and Report Writing)

In short, facility design, facility size, and staff attention to basic security measures can have a profound impact on youth misbehavior, and it is critical that staff pay attention to such issues as a key preventive strategy in behavior management.

Small Group Processes

Research shows that youth are better behaved when they participate in small group activities that allow for positive interactions with their peers. In custodial settings, regardless of the size of the facility, youth should be placed into small, family-like groups of no more than 12 youth, and members of these small groups should participate together in every aspect of daily life together during their incarceration. Structured grouping of youth within facilities helps promote behavior management in two ways. First, the cohesiveness of a group is essential to achieve treatment gains and is an important condition for a change in behavior.[68] In every Missouri facility, for example, youth are placed in small groups that participate together in all education, treatment, meals, recreation, and free time.[69] Throughout their stays in Missouri’s youth institutions, youth are challenged in these groups to discuss their feelings, gain insights into their behaviors, and build their capacity to express their thoughts and emotions clearly, calmly, and respectfully—even when they are upset or angry.[70] The consistency of the group does not allow young people to hide or withdraw, and when aggressive feelings arise, a youth’s peers challenge them to confront those feelings in meaningful and productive ways.[71] Based on a similar premise, the Texas juvenile system offers the Capital and Serious Violent Offenders Program, a highly successful and intensive therapeutic program that relies on group support to encourage changes in behavior.[72]

The small group structure uses the concept of peer pressure in a positive way by encouraging youth to reinforce the skills learned in therapeutic programming that youth attend together. In small, family-like groups, youth come to recognize each other’s triggers for aggression, which can prevent violence.

A number of agencies, including the Missouri Department of Youth Services, the District of Columbia Department of Youth Rehabilitation Services, and the Santa Clara County (California) Probation Department, have found that using small group structures has led to a significant reduction in youth violence and gang activity.[73]

The second way the internal structure of small groups helps promote safety is by maintaining appropriate staff-to-youth ratios. Roush and McMillen suggest that each housing unit should support no more than 8 to 12 residents, because this is the most a single staff person can manage effectively and with a high level of safety. Youth may be separated into even smaller housing groups for programming purposes or for certain categories of youth.[74] Furthermore, it is harder for staff to provide immediate support to individual youth when they are arranged in large groups, and it is more difficult to move large groups from place to place for various program activities.[75] To address this problem, Missouri conducts treatment and education programs in cottages or dormitory settings.[76]

Missouri’s DYS assigns a single case manager to oversee each youth from the time of commitment through release and into aftercare, and it provides youth with extensive supervision and support throughout the critical reentry period.[77] This means there is always a case manager watching what the youth is doing while providing positive encouragement, which serves as a deterrence to misbehavior.

Juvenile detention and corrections administrators should strive to implement opportunities to group youth into small teams, as this is an effective behavior management practice.

Classification Systems

A solid classification system is a key part of any facility’s behavior management plan. Classification systems are the principal tool youth confinement facility administrators have for allocating program resources and for minimizing the potential for escape and violence.[78] Classification systems are commonly considered “the brain” of correctional management, because it allows individuals to be categorized by individual risk to commit violence and their vulnerability to violence. By classifying youth according to risk level, administrators can make appropriate decisions regarding staffing, bed space.[79]

Classification systems are based on the theory that individuals in custody have varying levels of vulnerability and aggressiveness, which can be measured by objective, validated techniques. The classification status determines housing, programming, and recreation within the facility. The staff assigned in each area must be fully aware of the types of youth under their care and be trained in management techniques appropriate for dealing with that group.[80]

Effective classification requires the continual updating and retrieval of information about a youth, especially following any behavioral incidents. This allows management to reevaluate and update a youth’s status if classification needs change. Accurate and reliable data should provide management staff with an improved ability to identify potential safety risks.

The PREA Standards offer useful guidance on the appropriate placement of youth in housing units.[81] The goals of PREA are to reduce sexual violence in correctional facilities, and PREA Standards outline best practices for identifying potential victims or perpetrators of violence during the intake process. PREA Standards require that, at a minimum, staff should attempt to ascertain information about:

  1. Prior sexual victimization or abusiveness.
  2. Any gender nonconforming appearance or identification as lesbian, gay, bisexual, transgender, or intersex, and whether the resident may therefore by vulnerable to abuse.
  3. Current charges and offense history.
  4. Age.
  5. Level of emotional and cognitive development.
  6. Physical size and stature.
  7. Mental illness or mental disabilities.
  8. Intellectual or developmental disabilities.
  9. Physical disabilities.
  10. The resident’s own perception of vulnerability.
  11. Any other specific information about individual residents that may indicate heightened needs for supervision, additional safety precautions, or separation from certain other residents.[82]

To meet PREA Standards, the information gathered should be the basis for housing decisions. This information also should be used for purposes of education, programming, and work assignments to keep youth safe throughout the day.[83]

Although jurisdictions vary in the factors considered during classification and assessment, a national survey by the National Institute of Corrections found that most adult correctional systems screen for some basic inmate characteristics including membership in a gang or security threat group, escape risk, violent behavior, and suicide risk.[84] Similar characteristics should be taken into account during the classification process for youth. (See Ch. 19: Challenging and Vulnerable Populations)

An effective classification system will go a long way toward helping maintain safety in the facility. However, administrators should be wary of the risks that come from having a limited number of secure facilities in which to place a youth. As many states embark on the depopulation and closing of state-run secure institutions, they have limited options for where to initially place a youth to best meet his or her needs and on where to move the youth should his or her behavior warrant a transfer to another campus or another security level. Ideally, there should be a range of available facilities to maximize the ability of the classification system to address a particular youth’s needs and behaviors. This is particularly true now that secure facilities tend to hold a higher concentration of youth who have a history of violence or serious emotional or mental health needs. In such settings, classification systems and accurate data on each youth may become even more important for the overall safety of the facility. Understanding the risk factors specific to these groups and making housing and programmatic decisions based on classification will ensure the youth are housed according to their security needs. As noted earlier, having a larger number of smaller facilities is an approach that allows both for depopulation of state-secure facilities and housing youth safely in these facilities using an effective classification plan.

Gang Management

The presence of gangs in a facility can have a tremendous impact on youth safety and the potential for violent behavior, and can encourage disregard for facility rules.[85] Gangs contribute to poor staff–youth relationships and the likelihood that staff will turn to control methods rather than the therapeutic approaches shown to be most successful.[86] Gangs are highly prevalent in certain juvenile confinement facilities, and in one 1998 study, one-third of youth in custody claimed a gang affiliation.[87] Thus, an important preventive element of the multi-tiered behavioral management system is having an effective gang management plan. (See Ch. 6: Adolescent Development, Ch. 17: Quality Assurance, and Ch. 19: Challenging and Vulnerable Populations)

The root factors leading youth to gang membership are well documented; they include a need for identity, a sense of belonging, protection, feelings of self worth, and money.[88] Staff members can identify gang members—or youth at risk for becoming gang members—knowing these risk factors. Regardless of whether youth are already affiliated with a gang, classification systems can be used to group youth in a way that discourages the reliance on gangs and continued gang activity. By organizing youth in small groups in much the same way that a gang or fraternity uses grouping techniques, youth feel a sense of belonging, and facility leaders and staff can turn that into a very positive mechanism for reducing gang violence.

For instance, Santa Clara County’s Juvenile Probation Department reduced Hispanic gang activity in its detention facility by 78% by placing youth of opposing gangs in the same group to force them to learn to live in close quarters together. Similarly, the Missouri Division of Youth Services integrates gang members from rival gangs in the same small groups. By setting very clear expectations about zero tolerance for misbehavior and continued gang activity, and by providing extensive therapeutic programming to help these youth control their anger and foster healthy relationships, the staff have managed to maintain a safe environment.[89] The approach also appears to have long-lasting effects, as Missouri’s recidivism rate for gang members was reported as below 10%.[90]

Mark Steward indicates that small groups provide youth with a sense of belonging and leadership that gangs also provide.[91] When youth are new to the group, they immediately find their place within the group’s hierarchy and realize that the opportunity to move into leadership positions within the group provides the incentive for doing well in the program. There is pride in being the leader of this type of group and, as a result, youth tend to avoid aggression or behaviors that elicit aggression, such as gang rivalry. Steward has found that the small group process reduces the likelihood of assaultive behavior among youth by a factor of four.[92]

Interestingly, staff at the Tarrant County (Texas) juvenile detention facility use a classification approach to gang management that is opposite the one described above. Whereas the Santa Clara County facility and the Missouri Division of Youth Services both place youth from opposing gangs into the same small groups, Tarrant County puts opposing gang members on what they call DNA (do not associate) status. A youth who associates with those on the restricted list is cited for severe misconduct. Staff members reinforce this classification system by taking preventive steps to ensure the youths’ separation.

Steward cautions that staff-to-youth ratios and positive staff–youth relationships are important in employing both the gang management strategy used in Tarrant County and the opposite strategy used in Santa Clara County’s facility and the Missouri Division of Youth Services. Staff should ensure gang members are not participating in gang-related activity. However, Steward maintains that, in the long run, youth will benefit from small groups with opposing gang members, because they will learn to live in community with one another. Separating opposing gang members from one another can actually perpetuate hostilities along gang membership lines.

Although there are competing approaches to managing gang activities in juvenile facilities, a failure to address the gang problem with proactive strategies can contribute to the staff’s inability to manage the behavior of youth in custody.

Structured Daily Schedules

Many experts believe that a key to preventing violence and managing youth behavior in juvenile secure facilities is daily programming and activities that engage youth at all times of the day. Most violence occurs when youth are idle, as many line staff can testify from experience.[93] Kelly Dedel notes that the value of keeping youth busy with meaningful activities is that they give less thought to harming themselves, others, the building and equipment, and more thought to the skills and insights they are learning through their programs and positive relationships. Furthermore, David Roush points out that programming and activities offer the structure, organization, and predictability that are important in reducing situations of conflict and stress for both youth and staff, preventing the need for subsequent physical interventions.

Education is the primary vehicle for a structured schedule for incarcerated youth, even for those who are confined in disciplinary settings. It may also be the single most important programming that institutions can provide, because so many youth in institutions are behind in their studies or have dropped out of school.[94] (See Ch. 13: Education)

Beyond education, staff members need to provide other forms of structured programs or activities that keep all youth busy and safe from harm. Will Harrell notes that the federal court in Ohio issued a consent order stipulating that structured programming must be provided to incarcerated youth in disciplinary confinement.[95] The order defines structured programming as “adequate, structured Rehabilitative Services, including an appropriate mix of physical, recreational, or leisure activities, during non-school hours and days…at each facility from the end of the school day until youth go to bed, and on weekends.”[96]

After-school hours and weekends present particular challenges when it comes to keeping incarcerated youth engaged in activities. Therefore, staff members should be creative in finding activities for youth, for example, scheduling routine and specialized cleaning of the facility during those times. This behavior management strategy requires that staff engage with youth in a positive manner throughout their shift.[97] Consistent and continued staff involvement—and minimal down time—will help prevent aggressive behavior, as the Missouri juvenile agency has found.

Recreation is another important activity that provides youth access to fresh air and exercise, which are useful for preventing misbehavior. Youth should have access to fresh air for at least one hour every day, and they need to have large-muscle exercise as a part of their daily routine, for normal health and development and for relieving tension and frustration that otherwise might result in aggressive behavior.

According to Orlando Martinez, other activities that staff members can provide include vocational training; religious or other spiritual opportunities; individual and family counseling; medical, dental, mental health services; and substance abuse treatment, AIDS counseling, and sex offender treatment. However, David Roush points out that staff should take caution in transitioning youth from activity to activity, when there is a greater likelihood of instability. Staff should also ensure routine daily activities so that youth know what to expect during the day; routine helps to prevent physical altercations. Programming tailored to meet each youth’s needs, should be considered a fundamental part of the primary (preventive) tier in a behavior management plan at any facility. (See Ch. 10: Effective Programs and Services)

Youth Empowerment and Outlets for Complaints

Youth misbehavior is often the youth’s response to a perceived lack of control and autonomy in a tightly regulated environment.[98] Youth often feel that they have no effective outlets to express their grievances against facility policies or certain staff members. Meaningful opportunities for youth to advocate for themselves help staff to learn from the youth and adjust facility practices in ways that better meet their needs and help manage youth behavioral. Youth dissatisfaction can be channeled into a pro-social vehicle that emphasizes effective communication strategies, acceptable advocacy tools, and fundamental fairness. This is consistent with the positive youth development model that uses a strength-based approach.[99] Also, numerous studies about therapeutic correctional communities emphasize the value of empowering individuals in confinement in ways consistent with the therapeutic and security missions of the agency.[100]

Will Harrell strongly recommends creating Youth Councils, in which youth are selected to represent their peers in bringing concerns about facility conditions or practices to administrative attention and advocating for systemic changes. This respectful approach to communication about concerns becomes a model for all the youth about how to seek redress, and it creates real leadership opportunities for youth as an alternative to gang leadership. For this approach to work as a behavior management tool, however, staff must be willing to listen openly to the concerns raised by the residents, and make reasonable changes that do not compromise the safety or mission of the agency. Participation on Youth Councils should be limited to youth who have reached a designated level of achievement within the facility and whose behavior fits with this privilege.

Closely related to the notion of youth empowerment is the importance of establishing a well-functioning grievance system in every confinement facility—youth and adult. Like all people, youth want to feel capable of expressing their concerns, to be heard, and to feel that they have some ability to affect their environment and what happens to them. They have an acute sense of fundamental fairness, and when legitimate complaints are ignored or are not remedied sufficiently, they harbor resentments that are often released as misbehavior. Confinement facility administrators should ensure that their grievance system is easily accessible to youth, that youth know their rights, that there are clear procedures for receiving, investigating, and responding to complaints, and that the agency’s responses are truly responsive rather than dismissive. A well-designed grievance system can be an extremely effective outlet for redirecting a youth’s anger and demonstrates that concerns can be resolved in a peaceful manner, making this strategy an important preventive tool on the first tier of a behavior management system.[101]

Intervention Elements of the Secondary Tier

The secondary tier of the three-tiered behavior management system provides interventions for students who do not respond well to the preventive approaches on the primary tier. Research on the use of PBIS in the classroom suggests that approximately 5% to 15% of youth will need these more individualized interventions to address their rule-breaking and violent behaviors.[102] While most youth in the facility should be receiving specialized treatment or programming, these secondary-tier interventions are intensified to prevent negative behaviors.

Of particular importance at this stage is helping youth manage their anger, teaching them appropriate responses to peers and authority figures, and identifying any potential mental health issues. Although consequences for misbehaving youth are important, it is also critical to understand why misconduct is occurring and how to prevent it with effective therapeutic strategies. Youth must be given the opportunity to practice positive behaviors and decrease negative behaviors.

The secondary tier of the behavioral management system, then, has two critical elements: intensified therapeutic interventions based on cognitive-behavioral methods, and a strength-based system of rewards and consequences that emphasizes positive reinforcement.

Therapeutic Interventions

Youth arrive at secure juvenile facilities with a myriad of challenges, but none are as prevalent or present as great a risk for aggressive behavior as cognitive skill deficits.[103] Of all therapeutic interventions, the most effective are those that specifically target the cognitive deficits that lead to violent behavior. Nelson Griffis asserts that a good treatment program changes the thinking patterns of the youth through cognitive restructuring and that this impacts behavior more than a behavior modification system, though both elements are necessary. These cognitive interventions teach youth to monitor their thought patterns in situations that would otherwise lead to antisocial behavior and violence. On average, evidence-based cognitive-behavioral programs reduce recidivism by 25% to 30%.[104] (See Ch. 10: Effective Programs and Services)

It is important that staff rely upon evidence-based programs that focus on cognitive-behavioral interventions to help youth identify and change their dysfunctional thinking patterns and behaviors. Examples of effective programs grounded in cognitive-behavioral therapy include Family Functional Therapy (FFT), Multi-Systemic Therapy (MST), and Aggression Replacement Training (ART).[105]

In a multi-tiered behavior management system, cognitive-based therapeutic interventions should be provided to all youth to prevent violence from occurring, but should also be intensified as needed as a mechanism for individual interventions when misbehavior occurs. Kelly Dedel notes that the therapeutic interventions must be individualized and tailored to the unique needs of each youth.

Behavior Modification through Strength-Based Rewards and Consequences

An effective facility-wide behavior management plan has clearly established rules, as well as a mechanism for applying meaningful rewards and consequences designed to increase desirable behaviors and to diminish negative behaviors. This is a form of behavior modification, and the theory holds that if good behavior is not consistently recognized and rewarded, then unwanted behavior is simultaneously encouraged. Reinforcement comes from following desirable behavior immediately with an outcome perceived as a reward in direct response to that behavior, so that the behavior is encouraged in the future. This strategy teaches the youth self-regulation, and is based on Social Learning Theory.[106] Reinforcement can either be positive (a tangible benefit that the recipient desires), or negative (the removal of an ongoing but temporary negative condition). Parents and animal specialists use these techniques widely; they have obvious application in the confinement setting as well. The key point is that a consistent response to youth behavior encourages positive behavior and discourages negative behavior, which is critical to the overall success of a behavior management system.

Rewards (or “reinforcers”) can take many forms: they can be material in nature (food, clothes, or toys); they can involve activities (sports or movies); they can be social rewards that make a person feel valued (verbal praise, public recognition ceremonies, attention, or helpful feedback); or they can rely on tokens (a points-based system in which the recipient gets to choose the form of the reward).[107]

Although staff should apply rules consistently to all youth in the facility, each youth should have an individualized behavior management plan that identifies and documents the specific behaviors that are targeted for change so that staff members understand where to direct their reinforcement efforts. The plan should also identify strength-based rewards and disciplinary consequences specifically applicable to that youth. The individual youth must perceive the rewards and consequences as desirable or undesirable. Not all people will respond the same way to the same benefit or loss of benefit. For this reason, Griffis recommends use of a token system, so that the youth can use accumulated points for positive behavior to choose a reward to his or her personal liking.

To provide a practical example of a strength-based incentive, if a youth is motivated by recreational activities, that youth should have increased opportunities to participate in sports or an extra hour of recreation time for appropriate behaviors or for using a new behavioral skill he or she has learned. Other effective incentives could be movie nights, pizza parties, dinner with the Superintendent, or extra time in the game room. Rewards based on the strengths or desires of the individual youth helps motivate the youth to behave well.

As with rewards, the most effective consequences in a behavior management system are defined by the individual youth’s strengths and motivations and should be determined by his or her behavior plan at intake. Orlando Martinez believes that defining the consequences in this way ensures that the disciplinary measures are meaningful to the individual youth. Consequences should involve a loss of privileges that are uniquely applied to an individual youth based on his or her strengths or interests. For example, an effective disciplinary technique for a sports-oriented youth may mean not allowing the youth to play basketball with friends.

According to Martinez, the consequences provided in a rewards-based behavior management system help deter negative behaviors, such as aggression and violence. Consequences have to be meaningful, but that does not mean they need to be punitive. Rewards systems must include things that can be taken away from the youth so that they feel the consequence of their negative behavior by either not receiving the reward or having the reward taken away. Privileges that can be taken away to produce a change in behavior include extra phone calls or visitation, though it is important to note that denying a minimum of these could violate the youth’s constitutional rights.

According to Kelly Dedel, the most effective rewards systems are based on the give and take of a certain number of points for every observed behavior. Youth acquire points for displaying a good or acceptable behavior and points are simply not given when there is negative behavior. Points can be calculated over a week or points can be totaled for the day, but incentives and consequences must happen immediately and in a meaningful way. Waiting to apply disciplinary measures even a few hours after the incident will not be as impactful as immediate consequences for undesired behaviors.[108] Swift and certain rewards and consequences help youth understand the impact of their behavior. Similarly, youth are more likely to repeat and adopt pro-social behaviors—as opposed to antisocial or aggressive behaviors—when those behaviors and attitudes are recognized, acknowledged, and affirmed in an immediate and meaningful way.[109]

In addition to being strength-based and immediate, disciplinary measures ought to match the severity of the misconduct.[110] Minor violations should typically result in the misbehaving youth not accumulating points towards a desired reward, whereas more serious violations could receive more serious and direct consequences, such short timeouts. However, timeouts should occur in the open, where youth are not locked behind a cell door and where staff and peers remain visible. Overly harsh responses, such as the lengthening of a youth’s sentence, are counterproductive, because such responses are not cognitive-based—they do not address the feelings or thinking errors that led to the misconduct, and thus the behavior could easily reoccur.[111]

Finally, a key to the success of any consequence that is imposed for misconduct is that the youth must be able to earn back the removed privilege by demonstrating positive behaviors. The consequence must have the potential to be a negative reinforcer—the removal of this negative condition in response to desirable behavior acts as a motivating reward, and encourages the youth to continue to act in positive ways that are consistent with the behavior management plan.

For most youth, then, the intensification of treatment programming and cognitive-based skills training—combined with an effective strength-based system of rewards and consequences—is enough to redirect their behavior in ways that support a therapeutic, non-punitive culture in the facility.

Intensive Intervention Elements of the Tertiary Tier

The premise of the multi-tiered behavior management model is that most youth exhibit appropriate behaviors when exposed to the across-the-board preventive measures described earlier. A small proportion of youth—about 10% to 15%—need some additional interventions and supports to adjust their behaviors,[112] And only a very small number of youth—estimated by experts at about 1% to 5%—are so challenging or violent that they require the most intensive and individualized level of interventions available.[113] This most intense form of intervention is the tertiary tier of the behavior management model.

Most youth that need this third level of support receive intensified versions of the therapeutic interventions of the secondary tier. However, the disciplinary consequences associated with third-level of misconduct also need to be enhanced, and the facility may need to implement operational changes to address the misbehavior and keep other youth safe. These disciplinary consequences and operational approaches must reinforce a culture of nonviolence and must continue to offer the opportunity for youth to practice positive behaviors. The discussion here will focus on these disciplinary and operational approaches, differentiating those that have been shown to be effective from those that have been found to be counter-productive in addressing youth violence.

Discipline and Graduated Sanctions

Effective discipline in a juvenile facility requires a continuum of responses to misbehavior, also called “graduated sanctions.” These graduated sanctions should incorporate appropriate, proportionate, and immediate consequences for serious misbehaviors while still providing youth a space in which they can practice positive behaviors. At the low end of the continuum, responses to minor misbehavior—such as failure to make the bed or follow staff directions—should include lower-level consequences or removal of privileges for the youth. At the upper end of the spectrum, there should be more significant responses to and consequences for aggressive or violent behavior.[114]

Whatever the response, it should be applied immediately. The longer the time between the youth’s actions and the resulting sanction, the less the two events will be linked in the youth’s mind. Some particularly serious misconduct may warrant a response that requires a due process hearing, which should occur as soon as possible and within any required timeframe. That due process hearing should be much more than a pro forma event: the youth must feel like he has a meaningful chance to be heard and to share his version of the incident. Will Harrell notes that perceived fairness goes a long way towards helping the youth appreciate the consequences of his or her actions, whereas a sense of injustice can simply reinforce the youth’s hostility.

Even more critical is the need to ensure that the sanctions do not end up reinforcing the negative behavior by being overly punitive or devoid of an educational component. According to Andrea Weisman, graduated sanctions are most effective when additional programming is applied at every level, so that youth can learn more appropriate skills for managing aggressive behaviors. Youth who rely on aggression to solve problems need to learn more appropriate problem-solving skills and also need the space to practice those skills. This requires continued interaction with staff and peers even after engaging in an aggressive encounter with other youth. Thus, isolating the youth in a highly restrictive setting without access to programming tends to be counterproductive in reducing behavioral problems. Similarly, punitive measures such as adding time on a youth’s sentence provide no opportunity for the youth to learn or practice new skills and should therefore be discouraged, notes Will Harrell.

The most aggressive and violent youth can be removed from the general population as a safety measure, but the goal remains to teach them how to behave appropriately and to conform to facility rules rather than to punish them. Natural consequences, such as being unable to participate in a dormitory’s activities as a result of misbehavior on the dorm, sends a much more meaningful message to the youth than does the imposition of a punitive sanction.

The use of restorative justice measures such as talking circles (also known as group conferencing) can also be helpful in the context of graduated responses to misbehavior.[115] In a small group, youth can discuss how an act of aggression affected everyone as well as interfered with their group dynamic. Often, group members build up resentment towards the misbehaving youth without any opportunity to express those emotions. Knowing how one’s actions affected the community can be a deterrent to further misbehavior. Missouri’s juvenile institutions routinely address youth misbehavior through small group discussions,[116] and Ohio’s juvenile facilities are considering implementation of this approach, according to Will Harrell.

It is also important to remember that most serious misconduct does not arise in a vacuum, but follows numerous lower-level incidents of nonconformity with the rules. If minor misbehavior is ignored or if the consequences imposed are meaningless to the youth, it is likely that the misbehavior will escalate. Thus, the need for immediate responses and interventions that teach positive behaviors is essential at the earliest signs of noncompliance with facility rules. The question should not be, “What do we do with a youth who is seriously aggressive?” but “What have we done (or not done) before now that allowed the youth’s behavior to escalate to this point?” Having an effective system of graduated responses is key to effective behavior management.

Separation of Youth and Disciplinary Confinement

An effective system of graduated sanctions may require the separation of an aggressive youth from the general population when he or she fails to respond to initial or subsequent interventions following violent incidents. These sanctions may range from an immediate separation of aggressive youth, to disciplinary confinement, to longer-term separation and placement in special housing units.

Most physically aggressive conflicts start small and simply require an immediate separation of the youth.[117] At this point in the conflict, the use of cool-off rooms or temporarily placing youth in their rooms may be a sufficient intervening response, requiring no additional discipline.[118] The length of time youth spend in room restriction should be based on the youth’s behavior. Staff should guard against the risk that cool-off rooms easily become used in a punitive way by prolonging the time apart from peers. Once calm and ready to talk about feelings, the youth should be released from his room and provided the space to talk about his aggression. For example, the Gardner-Betts juvenile detention facility in Travis County, Texas, uses a cool-off room for youth who start to exhibit aggressive behavior. According to the detention center’s lead psychologist, the cool-off room is used to prevent youth’s behavior from escalating and is used for only a short period of time.

The very short-term use of room confinement for cooling off purposes is often appropriate at the start of a violent incident or in its immediate aftermath, but should not be confused with disciplinary confinement or punitive seclusion. Disciplinary confinement of a youth in his or her room is often used as a formal sanction for misbehavior, but its use must be carefully monitored and should be limited to no more than a few days at most. Some experts contend that youth should never be placed in a restricted room for 24 hours or more as a punishment method.[119] This approach should never be used with youth who suffer from mental illness, who should be placed in a treatment-oriented environment.

Juvenile corrections expert Paul DeMuro highlights the fact that the New Orleans juvenile detention facility sets a maximum of 8 hours that a youth can spend in disciplinary isolation, while the Mississippi youthful offender unit ensures that youth on disciplinary status are out of their cells receiving programming for 4 out of every 24 hours.[120] Both of those limits arose out of consent decrees following federal lawsuits, but administrators in both facilities have recognized the benefits of this approach.

Although isolation can provide a relief for staff who often need a break from aggressive youth, it may also be emotionally damaging to youth who already have experienced much trauma in their lives.[121] There is a great deal of research finding that placement in corrections-style isolation settings can further traumatize the youth and can lead to mental health problems and suicidal behavior.[122] A national study found that over half the youth who committed suicide while in secure confinement were in disciplinary lockdown situations when they died.[123] The courts and the federal government are starting to take notice of these concerns about the solitary confinement of youth. In 2013, a federal court in New Jersey approved a settlement of a civil rights case dealing with disciplinary seclusion of youth with mental health issues due to the harmful effects of such placements, awarding $400,000 to the youth.[124] And the U.S. Department of Justice has recognized that “isolation of children is dangerous and inconsistent with best practices and that excessive isolation can constitute cruel and unusual punishment.”[125]

Not only is seclusion of youth in tightly restricted settings, without access to programming, potentially harmful, it is also counterproductive when it comes to stopping misconduct. The approach is ineffective at identifying the underlying causes of the youth’s misconduct, and the setting offers no opportunities for the youth to learn to improve his or her behavior or to practice new problem-solving skills. Thus, use of punitive seclusion as a consequence cannot serve as a reinforcement mechanism for positive behavior as described above. Studies have repeatedly shown that youths’ behavior gets worse when they are locked up in punitive settings.[126] For example, one study found that the practice in Texas juvenile corrections facilities of referring misbehaving youth to security units (essentially, short-term disciplinary cells) following an incident actually correlated with an increase in misconduct.[127] Youth in that study were found to be referred to the security units an average of 48 times, with 93 youth referred over 300 times during their confinement in state custody.[128] Clearly, referral to this punitive setting did nothing to stem the likelihood of further serious rule violations.

In another study, Human Rights Watch reported on the widespread use of seclusion to manage the behavior of incarcerated youth. The report found that the longer teenagers were kept in isolation, the less they participated in activities and programs.[129] Not surprisingly, with less to do in those settings, the youth got into more trouble.[130] As noted earlier, one of the essential elements of the primary tier of the effective behavior management system is ensuring that youth have a full day with structured activities and programs. Removing opportunities for programming and increasing idleness as a sanction tends to have the opposite effect of leading to misconduct and deprives youth of the benefits of programs designed to help prevent such misbehavior.

Undoubtedly, staff rely on punitive isolation as a way to interrupt or punish misbehavior, but evidence shows it is not an effective behavior management tool. Contrary to common assumptions, youth do not tend to view placement in these settings as a deterrent to breaking major rules, and placement in these restrictive settings can increase misbehavior. In short, punitive seclusion of youth is counterproductive as a behavior management tool in the juvenile confinement setting and its use should be firmly discouraged by child-serving agencies. The research provides strong evidence that there is a need for non-punitive interventions if the goal is to effectively manage youth behavior.

To guard against the risk that separation of youth from their peers may amount to punitive seclusion, a number of entities have established strict time limits and other restrictions on the use of disciplinary room confinement.

  • The Juvenile Detention Alternatives Initiative (JDAI) opposes the use of room confinement for discipline, punishment, or convenience, among other purposes.[131]
  • The American Academy of Child and Adolescent Psychiatry (AACAP) has a policy statement opposing any use of solitary confinement and calling for a mental health evaluation of any child who is confined in a disciplinary setting for more than 24 hours.[132]
  • Standards developed by the Institute for Judicial Administration and the American Bar Association (IJA-ABA) state that best practices for juvenile facilities should include limiting isolation to eight hours and prohibiting room confinement for suicide risk, as well as limiting disciplinary confinement to five days for minor infractions and ten days for major infractions.[133]
  • The ABA Task Force on Youth in the Adult Criminal Justice System recommended that room confinement for any purpose, even in adult facilities, should never exceed ten days.[134]

However, even if agencies adhere to these time limits, there is nevertheless a substantial risk that referrals of youth to disciplinary settings can be overused and may still have deleterious effects. The far better approach is to ensure that separation of youth from peers is minimized, that it be a last resort to allow for relief of immediate tensions or to stabilize an emergency situation, that these youth continue to have access to programming and services, and that the youth can earn their way out of these conditions by displaying appropriate behavior. In lieu of any form of disciplinary confinement, staff should intensify behavioral interventions targeting the needs of a particular youth.

Behavior Management Units

Longer-term management of violent youth may require ongoing separation of these teens from their peers in the facility through use of special housing units. The risk of these units, however, is that they may become forms of punitive segregation rather than a therapeutic housing placement designed for safe operation of the facility. For example, the Ohio Department of Youth Services operates a Special Management Unit (SMU) in its secure juvenile facilities for sanctioning youth who engage in violent behaviors. When originally created, the SMU was intended to be an extension of a cool-off room, using an entire wing of cells for youth who needed temporary separation from the general population. However, over time, the unit came to operate more as a punitive segregation unit, similar to those commonly seen in adult prisons; this practice led to oversight by the federal court.

Under the guidance of a court monitor, Ohio reworked its SMU based on the best practices of various juvenile systems around the country related to managing the behavior of the most violent and disruptive youth in secure custody.[135] Now, the SMU, operating under a 2012 Consent Decree, must provide structured programming even to youth in closed-cell environments. This structured programming must be designed so that it modifies behaviors, provides rehabilitation, addresses general health and mental health needs, and is coordinated with a youth’s individual behavioral and treatment plans. Finally, youth may not be confined in locked cells during waking hours, and placement in the SMU must follow an adequate disciplinary hearing.[136]

Specialty units should be created to house and treat youth with acute mental health issues who present behavioral problems. These youth may need to be removed from the general population, but also need to have their mental health issues addressed directly.

In short, youth removed from the general population and placed in special housing units to better manage their behavior should spend most of their day engaged in activities or treatment rather than in seclusion. This prevents the unit from deteriorating into a lockdown setting in which youth spend significant lengths of time locked in their rooms. Even if these are considered units for longer-term separation of youth, there should be a clear plan and path for the youth to be returned to the general population. Administrators should have a clear vision and purpose for the SMUs, which should be a vehicle for delivering more intensive programs and interventions. Staff should be adequate in number and qualified to deal with this challenging population.

To the extent that behavior management units—or any other kind of housing unit that separates troublesome youth from their peers on a long-term basis—become punitive in nature, they do not have positive outcomes, and youth commonly exhibit more aggressive behavior under these conditions. A report about youth violence in the Texas juvenile justice system found high rates of violence and misbehavior in a unit specifically designed to separate assaultive youth and keep them housed under highly restrictive conditions on a long-term basis.[137] Thus, agencies should take special care in designing and operating their behavior management units so as to support rather than undermine an effective behavior management plan for the facility.

Crisis Management

Comprehensive implementation of the three tiers of the behavior management system should lead to a significant reduction in aggressive incidents that require immediate staff involvement. But in rare instances, crises arise that require staff to take immediate control of a situation to avoid a significant risk of harm to youth or staff. Proper use of crisis management techniques should support the therapeutic culture of the confinement facility and the overall behavior management system by defusing dangerous situations and protecting youth safety.

Verbal De-escalation

Amanda Yurick has found that verbal techniques are important tools for use in the early stages of violent episodes. Counter-intuitively, though, verbal tools should not be used to intervene once violence has occurred, because such comments may inadvertently cause an escalation in aggressive behavior. The timing of the use of these techniques is important and should be clearly defined for staff during training sessions.

Yurick emphasizes that staff must continue to maintain positive interactions even as they intervene in a confrontation between youth. Often, well-intentioned staff may respond to misbehavior with phrases such as “calm down” or “be patient” or by using gentle reminders for youth to use breathing techniques they were taught in anger management. However, when youth are showing signs of aggression, these verbal commands tend to heighten the aggression. The better strategy is for staff to reflect the emotions of what the youth is communicating by first validating the youths’ emotions with phrases such as, “yeah, you’re right, that is terrible,” and then investigating the source of the incident with phrases such as, “tell me what he did.” Responses need to be authentic and not contrived, which requires extensive training.

Throughout any incident, staff need to remain in control of their emotions, and must see their objectives as to neutralize risks and redirect youth behavior. Any resort to punitive responses will undermine the positive relationships they have worked so hard to build up. A staff member’s calm yet firm approach can still be perceived as positive on the part of youth and will help teach them how to manage their own behavior.

The Use of Force Continuum

“Use of force” is a catch-all phrase that encompasses the use of hands-on physical force against a