Combining Alcohol and Other Drug Abuse Treatment With Diversion for Juveniles in the Justice System
Treatment Improvement Protocol (TIP) Series 21

Overview

The incidence of crimes associated with abuse of alcohol and other drugs (AODs) among adolescents is a national concern. The prevalence of violent crime committed by youth gang members has increased significantly during the last decade. Children and adolescents are adjudicated as adults in many jurisdictions for a range of violent and nonviolent offenses. Many children and adolescents involved with the justice system commit offenses following their abuse of alcohol, inhalants, marijuana, cocaine, and other drugs -- all of which are readily available in their communities, schools, and often their homes. Parent groups, community leaders, lawmakers, the justice community, educators, and AOD abuse treatment providers are trying to solve the problem.

In many States, juveniles who commit violent offenses are waived into the adult system, tried as adults and convicted. They are sentenced as adults and serve their sentences in adult prisons. They may have virtually no involvement with the juvenile justice system. Therefore, children and adolescents committing lesser offenses, which are often related to their abuse of alcohol and other drugs, require special intervention. Such intervention may prevent them from eventually committing violent or adult offenses. This intervention may include comprehensive substance abuse disorder treatment that, typically for juveniles, includes their family members. The involvement of family members may be enhanced if the systems provide services that recognize the specific cultural and ethnic needs of the affected juveniles and their families.

Justice systems that include interventions that provide habilitative conditions for juvenile offenders and their families can work to divert from the justice system a population of young offenders who are at risk of committing criminal acts associated with their substance abuse disorder. The juvenile justice field has great need for such interventions with youth who are initially status offenders or who have experienced previous adjudication for lesser offenses and are at significant risk of criminal activity. Interventions for this population are complicated by existing State and Federal confidentiality regulations.

Effective treatment of substance abuse disorders among adolescents requires a comprehensive approach that incorporates family and health issues. A holistic approach to the treatment of adolescents may obviate their future involvement in status offenses or other delinquent or criminal activity. The risk-taking behavior typically associated with adolescence is exacerbated in the adolescent who is abusing alcohol or other drugs. This combination of high-risk behaviors and underlying causal factors frequently place adolescents of both genders at of infection and transmission of diseases because of injecting-drug use (IDU), use of unsafe sexual practices, and exchange of sex for drugs.

State systems choosing to provide juvenile diversion services need to address quality concerns within the juvenile justice and the AOD abuse treatment systems. If the systems are to work collaboratively, they need to identify treatment capacity expansion and treatment improvement issues. They also need to agree on the collective measures used to implement and ensure services from each system.

Appropriate treatment placement and incentives are significant issues, especially as they involve the family or guardians. In many treatment situations, the family, rather than only the identified juvenile, is considered to be the client. Other examples of such issues are the appropriate role of the justice system and the AOD treatment system in ensuring the public safety, the differences between the responsibility for the punitive and the therapeutic aspects of the diversion process, the responsibilities of each system for screening and assessment, and linkages among systems that provide collateral services such as Medicaid and social services.

Jurisdictions considering juvenile diversion programs may anticipate incurring implementation costs. However, these costs are less when compared with the costs to construct additional youth correctional facilities or to incarcerate juveniles, even without treatment, for the same period of time. In addition, the combined efforts of the justice system and those of the AOD treatment system send a strong and unified message to the juvenile offender about the community's values concerning juvenile substance abuse and criminal activity. The most successful programs will also send a similar unified message to the public about the long-term financial and other benefits of the diversion program and the ways in which it protects the public's safety.

Audience

This TIP will be for an audience comprised of

• Juvenile justice and family court judges, court administrators, probation officers, prosecutors, public defenders, and youth correctional administrators
• AOD abuse treatment providers such as counselors, social workers, psychologists, physicians, and administrators
• Public health providers and administrators
• State social service or welfare child protective services and foster care social workers, family preservation social workers, public safety planners, and system administrators
• State and local school administrators, school counselors, and school or public health nurses.

Purpose

The Center for Substance Abuse Treatment (CSAT) will convene a consensus panel to develop guidelines for diversion of juvenile offenders who abuse AODs. The resulting guideline, Combining Alcohol and Other Drug Abuse Treatment With Diversion for Juveniles in the Justice System, will build on two extant TIPs on adolescents. They are Screening and Assessment of Alcohol and Other Drug Abusing Adolescents and Guidelines for the Treatment of Alcohol- and Other Drug-Abusing Adolescents.

The TIP will contain guidelines that provide a framework for developing coordinated strategies to assist AOD-abusing juveniles who are involved with the justice system. Systems such as juvenile justice, AOD abuse treatment and public health increasingly provide services to the same individual. This document will assist them in developing comprehensive treatment strategies and resource sharing.

Content

The panel will identify the various types of diversion programs beginning at the prosecutorial level and clarify their differences, programmatic components, supervision requirements, and coordination with AOD abuse treatment providers. In addition, the panel will suggest strategies to engage family members in the treatment of children and adolescents and will identify methods that are potentially useful in creating a support network to supplement or compensate for absent family support. Issues concerning the identification and treatment of infectious diseases will be explored. The panel will address quality improvement issues and provide some specific costs associated with juvenile diversion programs.

The TIP will also include attention to the legal and ethical concerns surrounding Federal and State confidentiality regulations and parental consent. The guidelines will also make suggestions for providing services to special populations such as Native Americans, African Americans, Asian Americans, females, Hispanics, Latinos and Latinas, sexually active minority youth, and others with special needs.

Format

The final product of this activity will be a monograph published by the Center for Substance Abuse Treatment (CSAT) of the Substance Abuse and Mental Health Services Administration (SAMHSA).