Take Control: A proposed mental health treatment program to be implemented in youth correctional facilities around Oregon based on the evidence-based TARGET program

3 A.1 Rationale.4 A.2 Needs Assessment.7 B.1 Trauma Affect Regulation: Guide For Education and Therapy (TARGET) For Change in PTSD in Girls Involved With Delinquency, an Evidence Based Intervention.9 B.2 Adaptations.13 B.3 Mission, Goals, and Objectives.14 C.1 Implementation.15 C.2 Evaluation.17 References.19 TAKE CONTROL IN YOUTH CORRECTIONAL FACILITIES IN OREGON 3 Abstract 70% of youth in state and local juvenile justice systems exhibit symptoms of one or more mental health disorders and are not receiving adequate treatment. Currently, in Oregon, there is no mental health-screening requirement for youth admitted into detention centers or correctional facilities. Though this doesn’t mean kids never get diagnosed, it does mean there is a large delay in time before treatment begins where they could be receiving care. The Take Control program is working to mitigate wasted time and improve mental health treatment for youth inmates through a seven-step treatment program that provides youth with steps and strategies to cope with their mental health disorders, including real life applications of the skills learned. The program will be implemented in the MacLaren and Oak Creek Correctional Facilities and will be available to all inmates in those centers regardless or gender, race or social status. Each participant will receive a baseline mental health screening followed by a formal diagnosis if needed. They will then begin treatment and will be evaluated every month by psychiatrists to keep track of progress as they work through the program. TAKE CONTROL IN YOUTH CORRECTIONAL FACILITIES IN OREGON 4 A.1 RATIONALE One in five adolescents aged 13-18 suffers from one or more mental health condition (NAMI, 2018). Within the population of adolescents in the US, 11% have mood disorders, 10% have behavior or conduct disorders and 8% have an anxiety disorder (NAMI, 2018). Mental illnesses are defined as health conditions involving changes in thinking, emotion or behavior. They are characterized by distress and/or problems functioning in social, work or family settings (APA, 2015). Mental illness, particularly undiagnosed or untreated, accounts for 90% of deaths by suicide, the third leading cause of death for youth in the US (NAMI, 2018). Currently there is an 8-10 year gap between the onset of symptoms and a formal diagnosis for youth with a mental illness (NAMI, 2018). The failure to intervene on a mental illness in youth leads to barriers in social and behavioral growth, educational and occupational deficits, and high rates of substance abuse and homelessness. 50% of students with a mental illness drop out of high school; those who make it out of the school system make, on average, $3500-6000 lower salaries per year than those without a mental illness (NAMI, 2018 & Unite For Sight, 2018). Mental illness is also a major cause of homeless, the two “interact in a negative cycle” that leads to those affected drifting into and getting stuck in positions of poverty. 20% of the homeless population has one or more mental illness (Unite For Sight, 2018). Additionally mental illness increases the risk for abuse, maltreatment and human rights violations (Unite For Sight, 2018). Juvenile inmates are at especially high risk for mental illness. This is due to the adverse risks that come with losing personal control over their lives while in an institution. 70% of youth in state and local juvenile justice systems have one or more mental illness (NAMI, 2018). The two highest security living options for youth in the system are residential programs and correctional facilities; these locations are also where the largest number of youth with mental illness end up. Of youth within the Juvenile Justice System in 2016, 15-30% had depression, 13-30% had ADHD, 3-7% had bipolar and 11-32% had PTSD diagnoses (NCBI, 2016). Depression, the most prevalent mental illness in youth within the system, is characterized by high levels of irritability, meaning juveniles with depressive disorders are more likely to engage in violent encounters with their peers (NCBI, 2016). These violent encounters account for both the arrests and the in custody violence for these youth. The wide range of mental health disorders seen among youth in the juvenile justice system highlights the need TAKE CONTROL IN YOUTH CORRECTIONAL FACILITIES IN OREGON 5 for more than one treatment option. Youth with temporary mental health disorders may only need emergency services for some, but 10% of youth exhibit chronic mental illness that will require continued treatment in various forms for the rest of their lives. (NCBI, 2016). In Oregon increasing rates of youth with severe mental health disorders and multiple traumas are being seen in the system (Judicial Department, 2016). Though only a portion of juveniles are admitted into the care of Oregon Youth Authority, of those who do 54% of females and 50% of males have a diagnosed conduct disorder and 89% of females and 70% of males have a diagnosed mental health disorder (OYA, 2016). These high numbers of diagnosed cases do not account for juveniles who have not yet been diagnosed but still have a mental health disorder; this is especially prevalent in Oregon as there is currently no mental health screening requirements for youth admitted into the system (Judicial Department, 2016). The lack of screening is coupled with the inadequate amount of crisis and residential treatment beds, has led to a large number of youth in detention centers and correctional facilities with mental health disorders and no resources with which to treat them (Judicial Department, 2016). In Marion County, male juveniles are sent to MacLaren Correctional Facility when incarcerated. At MacLaren there is currently a new mental health treatment program for the multiple trauma unit of the facility, but it is not a widespread treatment system. In 2016 the Oregon State Court created a Juvenile Justice Mental Health Task Force assigned to the task of addressing the current mental health treatment system for juveniles and making recommendations for needed improvements. The task force recommends mandatory mental health screening upon entry into an juvenile justice system, a common set of principles for recognition, treatment, and encouragement of participation among all the child service centers in Oregon, and the creation of a government Child’s Cabinet in charge of creating a unified legal framework for information intake and communication between centers and agencies (Judicial Department, 2016). Additionally, they recommend regulation of psychotropic medication usage (Judicial Department, 2016). In Oregon there are some research-based programs that are being implemented and assessed for positive outcomes. For youth that are brought into custody with Oregon Youth Authority, they are required to go through a treatment program that can be customized to their needs and implemented within the first 30 days of TAKE CONTROL IN YOUTH CORRECTIONAL FACILITIES IN OREGON 6 placement (OYA, 2018). The treatments come in the form on one-on-one sessions or group therapy and are often tailored to the type of crime that has been committed (OYA, 2018). Female inmates have access to two specific programs: Dialectical Behavior Therapy (DBT) and Seeking Safety. DBT focuses on teaching kids who have struggled with suicide, self-harm or interpersonal difficulties, strategies for coping and managing emotions and personal interactions in a healthy way (OYA, 2018). Seeking Safety is geared towards youth who have been through traumas or have had substance abuse problems and aims to help them manage their symptoms and develop interpersonal skills (OYA, 2018). This mandatory treatment helps to ensure there is forward progress in the mental health of the youth and to help prevent further arrests or behavioral problems. Though Oregon Youth Authority is analyzing research studies and implementing their findings, without widespread treatment over all programs in Oregon, there is always a road block to progress. Due to the large number of youth in the juvenile system living with mental health disorders that are not receiving beneficial or adequate treatment, a new standardized treatment system coupled with effective health screenings could reduce the affects off such disorders and give youth the resources they need to heal on their own. Trauma Affect Regulation: Guide for Education and Therapy (TARGET) is an evidence-based program that has been proven to lesson the effects of anxiety as well as trauma and stress related disorders and symptoms (SAMSHA, 2017). Additionally TARGET has been effective in providing positive coping mechanisms and reducing internalization of feelings among youth and adolescents (SAMSHA, 2017). With some adaptations, TARGET proves to be a good basis for a program to implement into the Marion County youth judicial system in correctional facilities and residential programs. TAKE CONTROL IN YOUTH CORRECTIONAL FACILITIES IN OREGON 7 A.2 NEEDS ASSESSMENT A planni