There are so many noteworthy aspects to the “first ever” Surgeon General’s Report on Alcohol, Drugs, and Health. For example, it is grounded in the best evidence available to date and it examines issues of neurobiology, prevention, treatment, recovery, and health care systems. It also has educational and promotional materials such as fact sheets and social media ideas and resources. If you have not reviewed it – now is the time. It’s my understanding that additional fact sheets are forthcoming including one on criminal/juvenile justice populations. As such, keep visiting the website for updates and let’s keep talking about this report and its importance to individuals, families, and communities impacted by substance misuse and/or disorders.
In this month’s Reclaiming Futures newsletter, we focus our attention on the question that has preoccupied many of us in recent months: What will be the impact of the new presidential administration on juvenile justice policy? In this uncertain time, the field of juvenile justice should certainly be concerned about funding, but many of us are more concerned about protecting the significant progress we’ve made as a field to humanize and improve juvenile justice policy and practice over the last two decades.
Topics: Reclaiming Futures
On December 13th, President Obama signed into law the 21st Century Cures Act. This sweeping legislative initiative is likely to be the final piece of legislation Barack Obama signs, and it is anything but an afterthought. The act is not without its critics, but some of the provisions of the 21st Century Cures ACT, for example those that pave the way for cross agency coordination, promise to reverberate in positive ways in the treatment field by accelerating the impact of research and innovation and catalyzing more collaborative work across government agencies and professional fields.
For organizations like Reclaiming Futures whose mission includes efforts to bring systems together in the delivery of services to youth and families, this new set of laws is good news. In this month’s Reclaiming Futures Newsletter, we draw your attention to this important piece of legislation and to a new blog post by Reclaiming Futures’ Bridget Murphy that highlights some of the key moving parts and implications that this important piece of legislation has for us in the field of substance use and behavioral health treatment.
Acknowledged as the final signed legislation for President Obama’s Administration, the 21st Century Cures Act is important for behavioral health and juvenile justice. The key components of this Act include provisions for:
- Addressing the heroin and prescription opioid epidemic
- Providing funding for the BRAIN initiative and precision medicine
- Improving mental health care by increasing the availability of treatment and improving justice systems to ensure individuals in need of mental health services - actually get it
- Improving clinical trials
- Expanding cancer research and treatment efforts
In this month’s Reclaiming Futures newsletter, we draw your attention to a new report issued by US Surgeon General Vivek Murthy on November 17, 2016. The report is significant because it marks the first time a United States Surgeon General has taken such a clear and strong position that substance use and addiction should be viewed first and foremost as a public health issue. This is a position many advocates and organizations, like Reclaiming Futures, have taken for many years because we know firsthand the collateral consequences of continuing to view substance use and addiction as a moral failing and as a matter for the criminal justice system, and not the public health system and/or through a racially biased lens.
Collaboration. A word we use a lot at Reclaiming Futures. Why? Because based on our fifteen years of working in jurisdictions across the country, collaboration can be an impactful catalyst for change. While the National Office puts collaboration into action regularly it was recently visibly demonstrated.
As you may know, Reclaiming Futures is part of the Regional Research Institute (RRI) at Portland State University. We are affiliated with such efforts as the National Wraparound Initiative, The Center to Advance Racial Equity, and Pathways Transition Training Partnership (PTTP). A few months ago, Evan Elkin, Christa Myers and I began conversations with Drs. Eileen Brennan and Pauline Jivanjee of PTTP to develop a joint webinar. Both groups understand the importance of collaboration between stakeholders in juvenile justice settings to improve the health and wellness of young people with substance use and/or mental health concerns. However, our focus for the webinar did not become immediately clear. We spent time examining our commonalities to decide the best topic for diverse fields and individuals (e.g., juvenile justice; behavioral health; community members). We decided to emphasize our respective work in the area of evidence-based practices.
In this month’s Reclaiming Futures newsletter, we reflect on President Obama’s proclamation which, for the second year in a row, makes October National Youth Justice Awareness Month. President Obama’s focus on juvenile justice has been impressive, but it is important that the field does not become complacent as we contemplate what the future holds for juvenile justice reform.
Reclaiming Futures is proud to support Youth Justice Awareness Month. As such, we asked Mr. Brian Evans, the State’s Campaign Director at Campaign for Youth Justice to tell us about its history and purpose. Mr. Evans told us:
Youth Justice Awareness Month (YJAM) started back in 2008, when Tracy McClard, a mother from Missouri who lost her son to suicide in an adult jail, organized a 5K race in October to raise awareness about the harmful practice of treating children as adults in the criminal justice system. Each October since then, YJAM has seen more activities and more events highlighting what is wrong with trying kids as adults. Film screenings, panel discussion, art exhibitions, and more ambitious endeavors like Tracy’s bike ride across the state of Missouri last year, have all drawn attention to and helped build a growing consensus that we need to reform the way we approach youth justice.
As President Obama said this year in his second annual proclamation of Youth Justice Awareness Month: “When we invest in our children and redirect young people who have made misguided decisions, we can reduce our over-reliance on the juvenile and criminal justice systems and build stronger pathways to opportunity.”
Since the first YJAM in 2008, we have seen increased awareness lead to concrete action. Over the past decade around 30 states have passed legislation keeping young people out of the adult criminal justice system. So this year, we YJAM is being re-branded as Youth Justice Action Month. More and more it has become apparent that we know what the problems are. Now, it is time for advocates, legislators, and governments to take action
As Reclaiming Futures enters its 16th year of operation, we reflect on our unique contributions to the juvenile justice reform efforts of the past couple decades. What is most concretely evident to the field is our public health oriented approach and the creation of an accessible stepwise model, designed for juvenile justice settings, to organize the way they identify treatment need and then deliver developmentally appropriate and evidence-based treatment responses that are then sustained by community supports. In order to make our six-step approach work at the local level, we partner with jurisdictions to break down silos and build authentic collaboration across a number of systems that serve youth.
Researchers from John Jay College of Criminal Justice (John Jay) have been involved in evaluating Reclaiming Futures since its inception. Beginning in 2002, Jeffrey Butts, PhD and colleagues began studying the relationship between the Reclaiming Futures’ system-level change approach and the way stakeholders across all the inter-connected systems in juvenile justice settings perceive the effectiveness of their system of care and the delivery of services to youth. In his approach, Dr. Butts examined variables in key domains like administration, collaboration and quality. While no evaluation is perfect, the work Butts and colleagues did to begin to quantify system-level change variables in a meaningful way was quite original and generated useful information for Reclaiming Futures and the field. The initial evaluation results were also helpful in guiding subsequent evaluations by The University of Arizona, Chestnut Health Systems, and Carnevale Associates, LLC.
In the current Reclaiming Futures newsletter we focus our attention on Screening Brief Intervention and Referral to Treatment (SBIRT). SBIRT is a public health-oriented framework revolutionizing the way we think about behavioral health and substance use screening and prevention. Buoyed by strong evidence from the adult research literature, there has been a surge in national interest in translating the successes of the adult SBIRT model for youth populations.
As many of you know, Reclaiming Futures was awarded a Conrad N. Hilton Foundation grant in September 2014. The purpose of this grant is to develop, pilot test, evaluate, and disseminate a new version of SBIRT for youth at risk for deeper involvement with the juvenile justice system. As a first step, Reclaiming Futures issued a request for proposals and awarded five sites to help us in the endeavor. The sites selected, through a competitive process, were:
- Chittenden County, Vermont
- King County, Washington
- Mecklenburg County, North Carolina
- Nassau County, New York
- Washington County, Oregon
Reasons why I am proud to write this blog post...
Reason 1: My former colleagues (and friends) at The University of Arizona, Southwest Institute for Research on Women (UA SIROW) (UA SIROW) have been leading the efforts on the national evaluation of Juvenile Drug Courts and Juvenile Drug Courts blended with Reclaiming Futures (JDC/RF). UA SIROW collaborated with Chestnut Health Systems and Carnevale Associates, LLC to implement a comprehensive evaluation that included data from Juvenile Drug Courts, Juvenile Drugs Courts blended with Reclaiming Futures, and non-justice related intensive adolescent outpatient programs. The purpose was to examine processes, outcomes, and costs.
It is widely known that arrest rates for adolescents have steadily declined over the past two decades. During this time, we’ve also seen a gradual shift in the nation’s juvenile justice practices away from the use of out-of-home placement for minor, non-violent offenses and toward more treatment-oriented, trauma-sensitive and community-based responses.
This, unfortunately, has not been the story for girls involved in the juvenile justice system. In fact, the proportion of girls involved at all stages of the juvenile justice continuum increased over this time period. Experts and policymakers agree that the system remains insensitive and ill-equipped to serve the needs of girls – particularly girls of color – at all levels of juvenile justice continuum.
While we are pleased to see the recent report by the Office of Juvenile Justice and Delinquency Prevention, meaningful reform focused on girls in the system is long overdue. In this month’s Reclaiming Futures Newsletter, we focus our attention on girls in the juvenile justice system and feature a new blog post by Bridget Murphy as well the latest Reclaiming Futures Data Brief, focused on gender trends in juvenile drug arrests.
In 2008 my colleagues and I wrote for and were awarded a recovery-oriented systems of care grant from the Substance Abuse and Mental Health Services Administration (SAMHSA). The primary goal of this grant was to develop and implement a trauma-informed and recovery-oriented system of care for adolescent girls. My colleagues and I were concerned about the increasing juvenile justice involvement and substance use rates among adolescent girls with little to no increases in their rates of enrollment in treatment. Our previous research highlighted the significant levels of trauma and other co-occurring mental health problems among girls. In addition, we found girls had higher rates of “harder” drug use such as cocaine, amphetamines, and heroin/opiates as compared to boys. And on the positive side, we also found that girls who accessed treatment responded really well and made significant behavioral improvements over time.
Other juvenile justice and behavioral health policy makers and program developers have recognized the importance of responding to these increased rates of behavioral health and substance use problems among adolescent girls. We now have a better understanding that while males and females are equally vulnerable to addiction, that from a physiological standpoint, females can have lower tolerance and may progressive to physical dependence at different rates. We also have a better understanding of the critical role played by trauma in substance use and addiction as well as a broader range of available approaches for providing gender-specific and trauma-informed treatment. The positive news is that we have seen the rates of illicit substance use significantly decrease for girls from 2008 to 2014 (26.5% versus 23.7%) and decreases in comparison to boys.
On June 1, 2016, our Reclaiming Futures national executive director Evan Elkin spoke at Red Emma's in Baltimore for Open Society Institute-Baltimore's second event in their "Talking About Addiction" series. Elkin was accompanied on the panel by Dr. Hoover Adger from Johns Hopkins Children's Center and by Carin Callan Miller, who founded Save Our Children Peer Family Support. The conversation was moderated by Scott Nolen, director of OSI-Baltimore's Drug Addiction Treatment Program. A full room of community members joined them for the evening, including families affected by adolescent addiction.
Youth, Addiction and the Juvenile Justice System
Whereas the first "Talking About Addiction" event explored alternative law enforcement approaches to addiction, this event focused on youth, addiction, and the juvenile justice system. Despite public acknowledgment of the failures of the "War on Drugs," and an increased understanding of addiction as a public health issue rather than a criminal justice issue, OSI-Baltimore recognizes that research and policy around adolescent addiction are slow to reach the mainstream. Indeed, during the discussion, some attendees expressed frustration with how long addiction treatment reform is taking; OSI moderator Nolen suggested reassurance that the addiction paradigm is finally shifting.
- Compromise reached on "Second Chance" legislation; raising the age debate now closed. Gov. Dannel P. Malloy argued to raise the age of youth in the state juvenile justice system, but the debate ended last weekend in a compromise with Democratic leadership on bail reform for non-violent, misdemeanor offenses. [NBC Connecticut]
- White House deletes FDA's planned policy and rationale for restricting flavored e-cigarettes. After demonstrating the appeal of flavored products to youth and young adults, the Food and Drug Administration (FDA) submitted a tobacco regulation on flavored e-cigarettes to the White House Office of Management and Budget (OMB). The FDA policy and rationale for the restrictions were deleted by the OMB; no comments on why at this time. [NBC News]
America is facing a heroin and opiate crisis. Heroin is increasingly popular – a report by the federal Substance Abuse and Mental Health Administration indicates that first-time heroin users doubled between 2006 and 2013 and data from the National Institute on Drug Abuse indicate that deadly heroin overdoses increased sixfold in the years between 2001 and 2014. More than ever before, this crisis is addressed as a public health issue more than a public safety or criminal justice issue. This shift has sparked much public debate about why this is the case. Have we finally reached a tipping point as a society in our views of addiction as a health concern? Have irresponsible pain management prescription practices contributed to opening our eyes to one of the epidemic’s root causes? Some argue that race is a critical part of the story and feel that the shifting demographic - with an apparent increase in the proportion of white heroin and opiate users - is what has changed the perception of heroin abuse and finally mobilized policy makers. In this month’s Reclaiming Futures newsletter, we focused our attention on the issues surrounding the opiate crisis and featured a new blog post by Reclaiming Futures Program and Policy Analyst Bridget Murphy.
We’re very excited to announce the launch of Reclaiming Futures Data Briefs, a new series of brief reports developed in partnership with the John Jay College of Criminal Justice’s Research and Evaluation Center and the Center’s Director, Dr. Jeffrey Butts. The series will highlight current data trends at the intersection of the fields of criminal and juvenile justice, law enforcement and the epidemiology of behavioral health and substance use. The reports are intended for a wide range of youth justice and treatment stakeholders including practitioners, policymakers, advocates, researchers and juvenile justice professionals. The reports are designed to be clear and concise and to provide useful information that will help readers to put our efforts to reform the juvenile justice systems and improve outcomes for youth in a broader, more data-driven context. Dr. Jeffrey Butts from John Jay College says: “I’m pleased to be a part of the new series of data briefs because the goal of Reclaiming Futures is to distribute data in focused and accessible ways.” The first Reclaiming Futures Data Brief examines trends in drug-related arrests within adolescent, young adult and adult populations across both the juvenile and adult justice systems. We hope you find this new series useful in your work.
Deadline Approaching: Review and comment by April 11, 2016
Have you seen the Substance Abuse and Mental Health Services Administration’s (SAMHSA) proposed changes to 42 CFR Part 2, Confidentiality of Substance Use Disorder Patient Records? If not, we recommend taking a look and commenting as an individual, agency/organizational, or community collaboration. Feel free to share praises and/or critiques about the proposed changes with SAMHSA.
Here are some key highlights:
- Rewind time to more than four decades ago - 42 CFR Part 2 was conceptualized and approved to provide individuals seeking substance use disorder treatment with protections for privacy and confidentiality. It was acknowledged that stigma and fear of potential repercussions (familial, employment; criminal) prevented people from seeking treatment.
- The last “substantive” update to 42 CFR Part 2 was in 1987 (approaching three decades ago).
- There have been substantial changes in the way substance use disorder treatment is provided including a greater number of integrated health care centers (primary and behavioral health) and greater use of electronic health records. As such, modernizing 42 CFR Part 2 is necessary.
- The proposed regulations will continue to apply to federally-assisted “programs“ which “holds itself out as providing, and provides substance use disorder diagnosis, treatment, or referral for treatment.” General medical facilities have always been included as a “program”, but the proposed change adds “general medical practices” to the definition.
- It proposes if agencies and organizations that have “general designation” on consent form(s) they must provide patients a list of where their information has been shared.
- Proposes agencies and organizations must have policies and procedures in place to sanitize paper and electronic records.