It is estimated that 65-70% of youth in the juvenile justice system have a mental health diagnosis, and approximately 20% have a serious mental health disorder. Increasingly, the juvenile justice system in the United States is recognizing the need to treat mental health disturbance among youth detainees in order to reduce the risk of recidivism and to improve well-being of children in the juvenile justice system who have mental health needs. While receiving such services in the institution is important to improving behavior and adaptive functioning, youth may face difficulties in maintaining these gains when they are released. As they return to their communities, they may encounter a variety of risk factors that challenge their skills to maintain sobriety and avoid illegal behavior, including troubled family environments, exposure to friends or family members who use substances or engage in illegal behaviors, unstructured time, problems with school or occupational performance, and lack of reinforcement for improved behavior. Research supports the importance of providing support during this critical transition period.
Family Integrated Transitions (FIT) provides individual and family services to juvenile offenders with mental health and chemical dependency disorders during the period of transition of the youth from incarceration back to the community. The goals of the FIT program include lowering the risk for recidivism, connecting the family with appropriate community supports, achieving youth abstinence from alcohol and other drugs, improving the mental health status of the youth, and increasing prosocial behavior.
The FIT approach combines three evidence-based interventions with the goal of targeting multiple determinants of antisocial behavior. The overarching framework of the intervention is derived from Multisystemic Therapy (MST), a treatment model that targets systemic factors that create the context for problematic behavior. MST is a scientifically-validated, cost-effective, intensive family preservation model for community-based treatment that has been shown to be effective with youth with antisocial behaviors. Intervention targets the various systems that are involved with the child, including schools, probation/parole, religious groups, and other community supports, in order to create an environment that supports positive behavior in the long term. Since parents are recognized as the key to the youth’s long term positive outcomes, MST places a strong emphasis on parent empowerment, both with systems that affect their family and with their children. Therapists coach parents on establishing productive partnerships with schools and probation/parole, and developing skills to be effective advocates for their children. Therapists also work intensively with parents to bolster their family management skills, including monitoring, contingency management, conflict resolution, and relationship enhancement. The objective is to help the parent to create a home environment that holds the youth accountable for his/her behavior and makes prosocial behavior more rewarding than antisocial behavior.
While environmental contingencies are key factors in behavioral control, internal factors also underlie problematic behavior. Poor impulse control, uncontrolled anger, mood swings, and other types of emotional and behavioral dysregulation are hallmark symptoms of a range of mental health diagnoses common among youth in the juvenile justice system. These problems are often a primary contributing factor to a youth’s criminal behavior, poor functioning at home and in the community, and substance use.
Emotional dysregulation within a family can also have an indirect effect on the youth’s behavior, since such problems can interfere with a parent’s ability to effectively monitor a youth and consistently implement contingency management plans. Recognizing that enhancing the ability of both the youth and the parent to manage impulses and distressing emotions is pivotal to a behavior intervention, FIT incorporates elements of Dialectical Behavior Therapy (DBT) into the intervention. DBT is an empirically validated treatment designed to replace maladaptive emotional and behavioral responses with more effective and skillful responses. Clients are taught a series of skills aimed at enhancing capacity to monitor emotional state, control emotional arousal, tolerate distress, and interact with others in a more effective manner. In Washington State, DBT skills are taught to youth who are incarcerated in Juvenile Rehabilitation Administration facilities. FIT therapists build on the skills that the youth learns in the institution and coach the youth in using these skills in real-world settings. Therapists also teach these skills to parents so that parents can both use these skills themselves and support the youth in maintaining the skills in the long term.
Youth involved in the juvenile justice system and their families are often reluctant to participate in therapy, and have a high probability of dropping out of treatment. Even if a family signs up for treatment and sticks with it through termination, treatment is unlikely to have lasting positive outcomes if the family is not committed to change. Thus, engagement and retention of families in treatment by enhancing their motivation to change is a cornerstone objective of the FIT intervention. FIT relies heavily on the techniques of Motivational Enhancement Therapy (MET), an approach developed by Miller and Rollnick to engaging clients in treatment with the objective of increasing their commitment to change. It is a focused and goal-directed approach, with the overarching objective of helping clients to explore and resolve ambivalence about change. In FIT, change happens at several levels: the parent’s monitoring and contingency management practices, the parent’s and the youth’s interactions with the school, peers, and the community, the youth’s criminal behavior and substance use, and the parent’s and the youth’s ability to regulate emotions, tolerate distress, and interact with others in a respectful, effective manner. All of these changes require sustained effort and commitment if they are to be maintained in the long term. The FIT therapist uses MET techniques to develop initial engagement of all parties (the youth, parents, school personnel, probation officer, and others) and maintain commitment to the changes that are being made. MET permeates every aspect of the FIT intervention: the MET principles and therapeutic techniques are intended to be woven into all components of the intervention.
Youth and families who participate in FIT are assessed to determine their unique treatment needs, and services are tailored to meet those needs. Treatment focuses on family strengths, and goals are set by the family. Services are provided in the family’s home with a minimum of one scheduled appointment per week. Therapists are available on a 24 hour per day, 7 days per week basis to respond to crises, and provide between-session skill coaching by telephone as needed. Treatment begins approximately two months before the youth is released and continues for a total of approximately six months.
FIT Eligibility Criteria
- Any youth 17 ½ years or younger, being released from a residential commitment to four months or more of parole supervision; WITH
- any current or history of Substance Abuse or Dependence Disorder; AND
- any AXIS 1 Disorder ( excluding those youth who have only a diagnosis of Conduct Disorder, Oppositional Defiant Disorder, paraphilia, or pedophilia) OR
- currently prescribed psychotropic medication, OR
- demonstrating suicidal behavior within the last three months, AND
- residing in one of the counties currently served by the program
- S. Aos, M. Miller, and E. Drake (2006). Evidence-Based Public Policy Options to Reduce Future Prison Construction, Criminal Justice Costs, and Crime Rates. Olympia: Washington State Institute for Public Policy. http://www.wsipp.wa.gov/rptfiles/06-10-1201.pdf
- Eric J. Trupin, Suzanne E. U. Kerns, Sarah Cusworth Walker, Megan T. DeRobertis & David G. Stewart (2011): Family Integrated Transitions: A Promising Program for Juvenile Offenders with Co-Occurring Disorders, Journal of Child & Adolescent Substance Abuse, 20:5, 421-436
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- Skowyra, K.R. & Cocozza, J.J. (2005). Blueprint for Change: A Comprehensive Model for the Identification and Treatment of Youth with Mental Health Needs in Contact with the Juvenile Justice System. National Center for Mental Health and Juvenile Justice.
- Bullis, M., Yovanoff, P., Mueller, G., & Havel, E. (2002). Life on the “outs”—examination of the facility-to-community transition of incarcerated youth. Exceptional Children 69, 7-22.
- Trupin, E.W., Turner, A.P., Stewart, D.G., & Wood, P. (2004). Transition planning and recidivism among mentally ill juvenile offenders. Behavioral Sciences and the Law 22, 599-610.
- Henggeler, S.W., Schoenwald, S.J., Borduin, C.M., Rowland, M.D., & Cunningham, P.B. (1998). Multisystemic Treatment of Antisocial Behavior in Children and Adolescents. New York: The Guilford Press.