A Process Evaluation of the Community Youth Court

Executive Summary

Over the last several decades, mental health courts have been developed to help address concerns related to high prevalence rates of mental health problems in justice-involved youth and adults. Research suggests that mental health courts may contribute to reductions in recidivism, yet little is known about the logic behind these programs, how they are implemented and how they facilitate change, particularly in the youth justice system. Because the adaptation of these courts for youth is relatively new, research is needed to understand how these programs achieve change before we can consider their impact. In this report we outline the results of a process evaluation exploring a youth mental health court established in 2011 in Toronto, Ontario called the Community Youth Court (CYC). The CYC is a resolution court for young people charged with an offence who present with a significant mental health concern (e.g., mood disorder, anxiety disorder, schizophrenia, developmental disorder) or substance use problem (Ontario Court of Justice [OCJ] 2011). The goals of the program are to improve access to community treatment services, reduce case processing time, improve general well being, reduce the likelihood of re-offence, and increase community safety.

Objectives

A process evaluation, which looks at program implementation and how a program facilitates change (Rossi & Freeman 1993), was an appropriate starting point for the current study given the lack of research on youth mental health courts and the court’s early stages of implementation. The objectives of the evaluation were to 1) understand and represent the court’s program theory, 2) explore program model implementation within the context of the YCJA, 3) describe how the court operates (with a particular focus on whether it is servicing its intended population), 4) examine what factors predict successful court completion, and 5) examine how the court addresses the mental health and criminogenic needs of its clients.

Methodology

To address these objectives, data were collected from several sources. Interviews were conducted with service users (i.e., youth mental health court defendants and parents; n = 45) and key informants (i.e., crown attorneys, defence counsel, duty counsel, judges, and treatment providers; n = 30) regarding their knowledge of and experience with the CYC. Interviews were conducted following a series of semi-structured interview protocols developed for the current study. Interview data were analyzed using thematic analysis to identify prominent themes within the data. A program theory evaluation was also conducted, which involved the development of a logic model and an evaluation of the model using literature on best practice for treating justice involved youth with mental health needs. Data regarding court operations, the target population, and treatment needs were collected from court files and government databases. Information was collected on 127 youth who were seen in the youth mental health court from June 2011 to August 2013. Descriptive statistics were used to describe court procedures and participant characteristics and a logistic regression was used to explore predictors of program completion.

Key Findings and Implications

While the CYC adheres to the requirements of the YCJA, additional protections may be needed given the nature of the court and the inherent potential to infringe upon young people’s due process and privacy rights.

An important goal of the evaluation was to assess the CYC’s adherence to the legislative requirements of the YCJA. Results of key informant interviews suggest that the CYC adheres to many of the requirements outlined in the YCJA, although further protections could be implemented to better protect young people’s due process and legal rights. For instance, to protect the right to counsel youth in the CYC have consistent access to either duty counsel or a lawyer; to protect privacy rights the CYC does not publish names of youth participants; and to protect the right to consent to treatment the CYC is a voluntary program. Nevertheless, youth in the current study expressed a lack of knowledge regarding the mental health court and over half recalled having no choice in entering the program. In depth and meaningful representation by counsel is necessary to inform defendants of the risk of waiving their right to trial, protecting privacy, and protecting due process (Seltzer, 2005). Further protections are also needed to ensure that youth understand the court process and their options through developmentally appropriate communication at every step of the process. To protect privacy Seltzer (2005) recommends implementing formal rules that limit the information that is spoken on record and the use of case conferencing to discuss sensitive information off record.

Key informant perspectives and data on court operations suggest that the principle of proportionality is maintained in the Community Youth Court. It is recommended that the Court systematically monitor its cases to ensure that this continues – in other words, that youth do not come before the court with charges for which they would otherwise be diverted, do not spend significantly more time under the supervision of the court, and do not receive harsher dispositions than they would in standard youth courts.

The most common types of charges laid against youth seen in the CYC are largely comparable to national statistics on charges across Canada in 2011/2012 (i.e., theft, common assault, break and enter, and failure to comply; Dauvergne, 2013) and suggest that the mental health court does not include a disproportionate number of youth with more minor charges than those seen in the typical court system. With regards to the severity and intrusiveness of dispositions compared to those in regular youth court, key informants noted that dispositions tend to be similar to or more lenient than those in the regular system, but that the requirements within the disposition could be more intrusive given the mental health treatment component. The principle of diminished moral blameworthiness was largely protected by the court’s use of diversion for cases that would not normally be diverted, and through consideration of a young person’s mental health needs and underlying issues impacting criminal behaviour. Key informants were also asked about how the court holds youth accountable through measures that are proportionate to the seriousness of the offence and degree of responsibility of the young person. Participants noted that these aspects are considered in the same manner that they would be in a regular youth court and that legal professionals are committed to protecting these principles. In addition, youth were thought to take responsibility for their actions through their engagement in treatment. Importantly, many participants felt that the more intrusive treatment component was a beneficial trade off for youth to receive a less serious sanction.

While rehabilitation is an important goal, Seltzer (2005) has cautioned that this approach may lead to increased time within the justice system and increased time under the supervision of the court. However, in the present study, case processing times for clients of the CYC were comparable, on average, to those of several standard Toronto youth courts, suggesting that the rehabilitative focus of the court did not result in longer involvement. In addition, 90% of the cases in the CYC resolved with charges being withdrawn, stayed, or dismissed, compared to a national average of 40% (Dauvergne, 2011), suggesting that clients of the CYC may penetrate less into the youth justice system than the overall population of justice-involved youth. Both rehabilitation and timely intervention are important facets of the YCJA; as such it is the court’s responsibility to balance both and ensure that youth are not spending undue time within the court system for their mental health needs.

In order to successfully meet the goal of desistance from offending, for most Community Youth Court clients, it is necessary to assess and address criminogenic needs as well as mental health needs.

Another objective of the evaluation was to understand the court’s proposed mechanism of change and how this relates to theoretical and empirical evidence for treating justice-involved youth with mental health needs. The key goals targeted by the CYC are to improve well being amongst youth, reduce recidivism, and increase community safety (OCJ, 2011). The logic model developed through this evaluation revealed that the mechanism thought to be responsible for achieving these goals is mental health treatment. Research suggests that mental health treatment may be most effective in reducing risk to reoffend amongst those whose criminal behaviours are directly linked to their mental health functioning. However, in the evaluation only about 20% of the sample had charges that were directly related to their mental health functioning, while approximately two thirds of youth had charges that were indirectly related to their mental health functioning. These findings suggest that there are other important factors that must be addressed in order to reduce risk to reoffend, which is consistent with research that indicates that for most justice-involved individuals with mental health problems, it is necessary to address both mental health and criminogenic needs (factors found to be strong and direct predictors of offending) in order to reduce recidivism (Skeem et al., 2011).

The CYC does not currently assess or systematically address areas of criminogenic need and only about half of youth in the CYC received treatment addressing at least one of the broad areas of criminogenic need that have been identified in the psychology of criminal conduct literature. Assessing and addressing criminogenic need may be an important factor in enhancing the youth mental health court’s effectiveness in reducing future criminal behaviours amongst clients of the CYC. These findings are generally in keeping with interview themes identified by key informants and parents, which suggested that the court could do more to address issues that resulted in the young person’s involvement with the justice system in the first place. Overall, our findings suggest the need to consider the relationship between crime and mental health needs in general, as well as the individually-identified criminogenic and mental health needs of the young people before the court, in order to improve well-being and reduce recidivism.

Mental health screening is an important feature of the CYC model. There are several ways that the effectiveness of this screening can be enhanced, including quicker access to screening and/or universal screening of young people who appear in any youth court, to ensure that youth with mental health needs are identified by trained mental health service providers (such as the Youth Mental Health Court Worker) and can be followed up appropriately. Aside from identifying youth who may be appropriate for the CYC, timely and systematic screening (accompanied by clear inclusion and exclusion criteria for participation in the CYC) will also help identify youth who do not have mental health needs and who should be serviced elsewhere.

One of the strengths of the program model is the mental health screening that is typically conducted prior to youth involvement in the court. Mental health screening is an important aspect of evidence-based practice and has been identified as one of the key factors in treating justice-involved youth (Borum, 2003; Grove & Meehl, 1996; Grove, Zald, Lebow, Snitz, & Nelson, 2000; Hoge, 2008) and particularly within the context of treatment courts (Hills, Shufelt, & Cocozza, 2009). Screening is important for identifying those who are at risk of having mental health needs that require intervention or more comprehensive assessment (Grisso & Underwood, 2004). Findings from the current study suggest that there are several areas of improvement to enhance current screening procedures within the court. For instance, it was found that, on average, youth spent approximately 2.5 months in the regular court stream before being transferred into the mental health court and that almost a quarter of youth were not assessed prior to their first court date. Key informants also highlighted the fact that certain mental health disorders may be difficult to detect by legal professionals who are typically responsible for making referrals into the mental health court. To remedy these difficulties, systematic screening procedures may be necessary to help ensure that eligible youth are provided the opportunity to participate in the mental health court and are properly screened before being admitted into the program. Screening methods that allow for early identification of eligible participants could also help to reduce the lengthy wait times for referral. Ultimately, this would assist with reducing overall case processing times, a goal that was identified by the court, and would improve adherence to legislative requirements regarding timely intervention.

Another area for improvement with regards to mental health screening is the need for formal acceptance and decision-making criteria based on screening results. That is, the need for specific guidelines on how to process youth based on screening results (Hills et al., 2009). Within the current study, findings revealed that there was a small proportion of youth (7%) who were admitted into the court without identified mental health needs. More importantly, these youth were the least likely to complete their court requirements. Formalized criteria are needed to screen out individuals without mental heath needs to ensure that these youth are not spending undue time in the program and to reserve the service to those who need it most. Furthermore, accepting participants who do not have mental needs to begin with may significantly impact the potential outcomes of the program.

Screening needs to be followed up by comprehensive assessment of young people’s mental health needs, related needs (e.g., trauma), criminogenic needs, and responsivity considerations by trained and knowledgeable professionals.

While screening is an important first step, comprehensive assessments are also needed to better understand the multitude of needs impacting youth (Borum, 2003; Hills et al., 2009; Hoge, 2008). Findings from the study one indicate that in addition to mental health diagnoses, approximately a third of youth reported one or more significant stressors related to a lack of parent involvement in court proceedings, involvement with child welfare agencies, school disengagement, and unstable housing. Furthermore, almost half of youth reported experiencing significant traumatic events. These are important areas of need that must be understood and considered within the context of treatment. Comprehensive assessments would allow for a more detailed look at criminogenic needs and the areas highlighted above.

Comprehensive assessments can and should inform evidence-based treatment plans that address youths’ identified mental health, criminogenic, and responsivity needs. Formalized relationships with appropriate community agencies and mechanisms for initiating and monitoring such treatment plans should enhance the CYC’s ability to meet its goals.

Treatment is an essential component in the rehabilitation of youth mental health court defendants. Interviewees reported confidence in the court’s ability to connect youth with treatment services within the community. Despite this, there appears to be little structure in how the court assigns treatment placements for youth and monitors treatment plan adherence. Just over half of youth received services that addressed their mental health needs and close to 40% received services in which it was unclear the degree to which their needs were being met (e.g., general counseling). As noted above, only half of youth had areas of criminogenic need matched during treatment. These findings are not overly surprising given that youth receive only a brief screening of their mental health needs. Comprehensive assessments are needed, not only to understand the needs of youth, but also to help inform treatment. The literature highlights the need for empirically informed treatment for justice involved youth including the use of highly structured programs that involve a cognitive component, engage families, and address a variety of risk areas (Guerra, Kim, & Boxer, 2008). The CYC would benefit from formalized mechanisms in place for the development of formal treatment plans, the selection of treatment agencies, and the monitoring of treatment adherence within services.

Incorporating evidence-based practice into the CYC can help improve program outcomes, but must be balanced with legal rights and the YCJA. Within the literature, concern has been raised regarding the inherent risk with mental health courts in infringing on legal rights (Seltzer, 2005). To help protect these legal rights it will be important for the court to ensure that each young person who enters the court has access to comprehensive legal representation to assist them in navigating the system and protecting their rights at every stage. Special attention should be given to ensuring that youth are not spending extensive time under the jurisdiction of the court in the name of treatment. Formalized privacy regulations are also needed to protect young people within the context of the mental health court and particularly for those who undergo mental health screening.

The CYC is one of the first mental health courts for youth to undergo an evaluation looking closely at program functioning and mechanisms of change. The findings provide insight into important areas for program development that focus on implementing evidence-based practice to enhance the program’s effectiveness in reducing recidivism.

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