Nurses Lead in Linkages for Health and Juvenile Justice Systems

Journal of Child and Adolescent Psychiatric Nursing, Jan-Mar 2004 by Raphel, Sally

The sucking sound you hear is children being drawn into the juvenile justice system, according to judge David Mitchell, executive director of National Council of juvenile and Family Court judges.

Judge Mitchell opened the second National Conference on Children and Adolescent Mental Health, "Linkages for Children's Mental Health," on june 12, 2003, with graphic images of multiple system failures as far as our youth are concerned. he challenged participants to reach for therapeutic jurisprudence. Limiting training to the various preservice areas for those working with youth is wasted. For ongoing success, it is necessary to take the latest in mental health promotion/prevention to the field for those already practicing. Collaboration of all vital players means leaving egos at the door, as judge Mitchell practiced in his decades on the bench.

The two-day conference was hosted by the University of Maryland School of Nursing. In attendance were representatives from law, social welfare, medicine, social work, pharmacy, and nursing, as well as national, regional, and state dignitaries, among them family, municipal, and superior court judges from Florida; Nevada; Washington, DC; and Maryland; and the Maryland Secretary for juvenile justice.

In general, for juvenile justice there are serious concerns of racial imbalance, skyrocketing confinement, assembly-line justice, and growing popularity of a false solution that "adult time for adult crime" will reduce recidivism. Twenty-five studies from 1989 to 2001 document racial disparities in the way youth are treated in our nation's juvenile justice systems. Chances are three times more likely that a minority youth arrested for a violent felony in California will be transferred to adult court and sentenced to incarceration, compared to those for a white youth arrested for a violent felony. Fifty-four percent of youth released from confinement in Minnesota and 73% in Washington State were convicted of a new offense within 3 years of release. A juvenile judge in Cook County, IL, makes 110 rulings on a typical day. Forty-nine states and the District of Columbia changed their laws in the 1990s to make it easier to try juvenile offenders as adults (AdvoCasey Index, Spring 2003).

There were conference reports of a well-established model in Miami reported by judge Cohen; the beginning of a Family Court model in DC by judge Arthur Louis Burnett; and a full-service, court-led model in Baltimore by judge Martin Welch. Each used available expertise (nurses, child psychiatrists, social workers, family nurse practitioners, educators) to assist in making the best decisions for infants and children in the child welfare system as well as focusing on prevention of juvenile recidivism.

The scattered court models using health, social welfare, education consultants, and evaluators under one umbrella of service are gaining a foothold. An important factor for positive results is computers to track adjudicated youth. Each of the nursing-led projects has exciting possibilities for replication and will be examined under the lens of timely measured results.

The Baltimore City juvenile justice Center (BCJJC), a new wraparound model for Baltimore, was unveiled. Since fall 2003, all court activities, educational, healthand mental-care screening and treatment, and social welfare services are housed under one roof. Along with child psychiatrists and nurse experts in substance abuse and child development, this author is working with the planners of the project. The conference presenters were confident that technology already installed will assist in earlier detection of problems, and increase interagency and provider communications. The Maryland administration has recently changed the focus of juvenile justice from punitive to treatment and rehabilitation, at least in name.

The community voice for linkages also was strong at the conference. Prevention efforts for youth, linked with community ongoing efforts, were stressed by Bernardo Rosa of Community Wellness Partnerships Project of Pomona, CA. Clinical and judicial employees must understand the rhythm of the community and its culture. Rosa's recommendation was to go to the community as co-healers. It is critically important to connect with some who already know it, according to Rosa, who is co-founder of Spirit of Manhood, a bilingual program for adolescent males. One of the program's activities has been a media campaign using bus benches and billboards for public service announcements encouraging young men to have a pro-health responsibility in terms of sexuality violence, and general health promotion.

Other nurses highlighted interdisciplinary projects for suicide prevention, cultural sensitivity, computerized case management, and using advanced practice child and adolescent nurses in juvenile court assessments. Education and state health department officials testified that major state and regional fiscal cutbacks and personnel shortages are limiting progress. However, mental health workforce strategies must go forward.