Substance abuse by young people in trouble with the law poses a formidable challenge for drug and alcohol counselors and the clients, families, and communities they serve. Overall juvenile delinquency rates may have fallen in recent years, but record numbers of young people are entering the juvenile system on drug- and alcohol-related charges. In one recent 10-year period, for example, the rate of youth ages 10-18 years locked up because of drug involvement increased 291 percent. The figure is staggeringly higher for black youth than white (Schiraldi, Holman & Beatty, 2000).

Even though research shows that treating alcohol and drug abuse reduces crime, saves money, and builds stronger communities, the vast majority of young people in the juvenile justice system receive no treatment at all. Up to 63 percent of teens in juvenile corrections, in fact, do not receive any substance-abuse treatment (SAMHSA, 1997).

Good treatment alone is not enough. Recent federal studies indicate that effective drug and alcohol treatment requires a system of care that encompasses a young person’s transition from an institution back into the community through a range of services. Yet this does not happen. About 40 percent of referrals for adolescent treatment stem from the juvenile justice system (SAMHSA, 2000) — but the courts and community services working with these teenagers often are not coordinating their efforts.

Developing a comprehensive, integrated approach to help teens caught in the cycle of drugs, alcohol, and crime is a complex and time-intensive endeavor. To address this challenge, The Robert Wood Johnson Foundation (RWJF) in 2002 launched Reclaiming Futures. With a national program office located at the Graduate School of Social Work at Portland State University in Oregon, Reclaiming Futures is bringing models of integrated treatment to life — one community, and one teen’s future at a time.

In 2002, RWJF selected 10 locations across the United States to build this new solution: Anchorage, Alaska; Chicago, Illinois; Dayton, Ohio; Marquette, Michigan; Portland, Oregon; Rosebud, South Dakota; Santa Cruz, California; Seattle, Washington; southeastern Kentucky; and the state of New Hampshire. These communities, big and small, are laboratories in a collaboration to create a clear path for young people to permanently leave juvenile justice — and live, work, and contribute to their community.

Each community first invited community leaders to serve as a leadership group: judges, family members, faith leaders, elected officials, educators, probation officers, project directors, and treatment professionals. Since the inception of the project, each group has worked on building partnerships, identifying community strengths, needs and challenges, and planning a juvenile court that can simultaneously require accountability and nurture health in youth offenders.
No matter where you call home, it’s possible to draw on elements of the Reclaiming Futures program to improve the lives of troubled teens in your community.

Beyond clinical excellence: Systems change for success
Problems as complex as delinquency and substance abuse require comprehensive, seamless, and integrated responses. No one actor, provider, or method can solve these challenges — they must be addressed systemically. Alcohol and drug counselors have long recognized that as important as treatment is, it is only one part of what is needed to improve long-term success in the lives of teens and families. Systems need to be changed for integrated approaches to succeed.

What kind of barriers stand in the way? Examples include confidentiality policies and data systems that prevent sharing of information, funding practices that allow few opportunities to pool “wraparound” money, and philosophical differences among treatment providers, courts, and natural helpers. Organizational boundaries also can impede communication about cases involving multiple care providers. Lack of understanding by the public about what it can do to help these young people can create obstacles as well.

“Systems change” means breaking down these and other barriers and creating new integrated approaches. The ability to do this successfully is fast becoming one of the most important skills any youth advocate should master. Accomplishing this takes every substance abuse professional focusing on not only what they must do to increase their own excellence, but what they must do to improve the system overall. Multiple systems, including juvenile justice, mental health, child welfare, education, and informal community helping networks, must increase their ability to work together in unison to reclaim youth — not merely treat them — in order to make increased community safety, quality of life, and improved outcomes a reality.

Building partnerships within and across programs to achieve meaningful systems reform is a critical part of Reclaiming Futures. We have invited communities to reach beyond merely improving the quality of their services and redesign of the infrastructure of such services and instead provide teens and families appropriate, comprehensive and individualized services that are effective and accountable to the community at large. Over a five-year period of time, many professionals and community members in our 10 pilot projects — among them substance abuse treatment providers — are getting a chance to stretch their advocacy muscles at new levels.

So what does a community need to do to start this process on its own? Begin by asking this question: What do teens and their families most need when they face the combined challenge of substance abuse and delinquent behavior?

At the Reclaiming Futures sites, the answers have fallen into three distinct categories that work together to build a collaborative system of care:

1) An opportunity to access effective treatment, no matter where a teen lands in the juvenile justice system and regardless of income level.

2) A common goal of youth success and decreased recidivism. Programs should screen and assess for mental health and substance abuse problems, match services to the youth’s developmental stage, gender and culture, and use approaches that scientific research has shown to be effective for teens.

3) A chance to reconnect with the community in a healthy way. Teenagers need options that include repairing harm caused by delinquent activity, finishing high school, getting a GED, gaining job-hunting skills, finding a job, connecting with a mentor, sharing in a faith community, excelling at a sport, performing public service, and developing new skills (culinary, writing, art, music, the trades). This requires not only the expansion of typical opportunities available to teens in this situation, but also cultivation of new community partners, supporters, and leaders who are willing to provide long-term supports beyond the time when any program ends and a youth is poised to live out the goal of a crime-free and drug-free life.

Excellent treatment that is in short supply will not produce enduring behavior change. Nor will plentiful, quality treatment in a community that is indifferent and even hostile to youth in recovery or coming out of juvenile justice. If you’ve never thought of yourself as a change agent before, now is the time to do so. Reclaiming Futures is paving the way for alcohol and drug counselors to play a critical leadership role in shaping a new generation of services and systems that make a difference.

State-of-the-art services
In 2002, Drug Strategies, a nonprofit research institute that promotes more-effective approaches for reducing the demand for drugs, talked extensively with many national experts about treatment excellence for teens. These conversations resulted in nine key elements defining a new standard of care. The following list further develops these categories to discuss how these nine key elements are best understood in a juvenile justice environment. These items give alcohol and drug counselors serving youth an important “tool kit” for identifying potential areas of both strength and need in developing their own “system change” plan to improve outcomes to the population.

1. Assessment and matching
All youth entering the juvenile justice system should be screened for a substance abuse problem by appropriately prepared justice professionals. Where indicated, they should assess the youth more deeply to understand the problem’s scope, related challenges, strengths, and readiness for change. Furthermore, juvenile justice systems need help identifying the best screening and assessment approaches and finding (and funding) appropriate treatment. In addition, treatment programs need to boost their understanding of the substance abuse/delinquency cycle and create the infrastructure to receive referrals from juvenile justice — a system with significant reporting requirements pertaining to client progress.

2. Comprehensive, integrated approach
The complex needs of young people in juvenile justice defy a solution by any one agency or professional. The goal of a comprehensive and integrated approach is to work across and within systems that are artificially divided by funding and profession. The goal is a system that provides services that meet the needs of the youth and families — not the needs of the system.

3. Family involvement
Successfully engaging and retaining the family is often crucial to a teen’s long-term success. Plan carefully for providing adequate outreach, support, education, and hope to families. Give parents the opportunity to be involved as full partners.

Parents typically enter the juvenile justice system feeling bewildered, anxious, and frustrated. They may have financial challenges, language barriers, transportation problems, their own substance abuse and/or other health problems, and other children and a work life that also require their time. Whatever challenges they face, they also likely possess strengths that should be identified and mobilized to fuel their movement from disorganization to higher levels of functioning.

4. Developmental appropriateness
Adult treatment/intervention models must be adapted for teens or they will hold little value and can even create problems. Every service offered to young people should reflect their developmental stage, perspectives, and strengths — including their ability to learn, grow, and experiment. Involving them as partners in their treatment planning often provides powerful insights. A wide range of opportunities should extend beyond the traditional rehabilitative menu, and include such resources as civic engagement, youth leadership and service learning (Bazemore & Nissen, 2000).

5. Ability to engage and retain
Just because a judge orders treatment does not guarantee the youth will fully participate. Innovative programs that encourage leadership and ownership of the process will help clients engage, build on their strengths, challenge those behavior patterns that have blocked long-term success, and invite their ideas on improving their own lives and the lives of their family and community. The key is to acknowledge, rather than minimize, teens’ disappointment with previous encounters in the juvenile justice system.

6. Qualifications of staff
When compared to many professions, addiction counseling is a fairly young field. This is especially true for adolescent subspecialties within and outside of corrections. Besides liking young people, staff members must be committed to continual professional development. Without staying abreast of advances, staff will likely lean on outdated models that attempt to scare youth straight, that take a disease approach which doesn’t reflect youthful perspectives, or that inadequately address the need for pro-social skill building and developing a substance-free identity.

The best programs widen community opportunities for success beyond the treatment program itself. They ask staff challenging questions: Do terms such as addiction, disease and codependency fit teens? Are 12-Step meetings the only or best place for young people to develop a drug-free and crime-free identity?

7. Aftercare/relapse prevention
Substance abuse treatment works best when it extends beyond the intervention phase in “aftercare” programming or the term more recently used: “continuing care.” Treatment must continue to support teen as they build a new identity. This can be challenging for young people leaving a locked setting or the periodic monitoring of a probation officer. Of course, it is essential to educate them about relapse and how to prevent it. Equally critical is helping them to build a life that capitalizes on their strengths and provides avenues for leadership, involvement, and success.

8. Gender/culturally appropriate
Youth of color are increasingly involved in juvenile justice due to alcohol or drug-related charges. Invite communities of color to discuss ways to combat the current trends and participate in efforts to decrease or eliminate the disproportionate numbers of their children in the system. Top programs adopt culturally relevant best practices and train staff in dealing with youth of various cultures with a vision that youth of every culture and color have a right to, and a clear path through their challenges to a better life. Girls are today’s fastest growing subpopulation in the juvenile justice system; many have serious substance abuse problems.

9. Outcomes
Advocates need to help communities see that punishment alone is not a solution to a public health need. Successful outcomes must be measured in numbers of teens who are redirected, rehabilitated, and reclaimed — not merely sanctioned. Listen to your community’s public safety concerns. Demonstrate how investments in evidence-based treatment add a measurable value in terms of effective services, increases in public safety, financial savings, and youth and family success.

Pulling it all together
Recognizing and addressing the need for more and higher quality substance abuse services in corrections — especially juvenile justice — is one of the substance abuse counseling field’s most important issues for the 21st century. With budget cuts, licensing and funding requirements and other distractions, what can adolescent treatment providers (administrators and frontline counselors) realistically do to effectively advance a plan to improve their performance in this area? Lots. Table 1 provides ideas to get you started.

Table 1

Evaluation agenda
The Robert Wood Johnson Foundation asked the Urban Institute’s Program on Youth Justice to evaluate Reclaiming Futures. Researchers are working with the 10 communities to evaluate the initiative and examine policy and practice issues as they emerge at each site. Through quarterly online surveys, intensive outcomes evaluations, observation, interviews and analyses of written records, researchers are documenting the implementation of system change and reform activities, evaluating how the approach affects leadership, agency coordination and delivery of integrated services, and comparing service outcomes for Reclaiming Futures youth with similar youth not involved in the initiative. The Urban Institute’s evaluation team, in conjunction with locally based researchers, will publish the results of these studies.

Call to action
Substance abuse counselors providing services within juvenile justice or in programs serving juvenile justice clients is a rapidly growing group. You are invited to keep up with professional developments through the Reclaiming Futures Web site, at http://www.reclaimingfutures.org/. Sign up for our mailing list and stay tuned for involvement opportunities, information updates, and resources. The next few years will be a critical time to mobilize our collective talents, perspectives, and efforts so that reclaiming youth becomes the new norm in every community.

Laura Burney Nissen, PhD, ( This e-mail address is being protected from spam bots, you need JavaScript enabled to view it ) National Program Director of Reclaiming Futures and Associate Professor of Social Work at Portland State University, was a founding member of the Denver Juvenile Justice Integrated Treatment Network and the Center for High-Risk Youth Studies at the Metropolitan State College of Denver.

References
Bazemore, G. & Nissen, L. N. (2000). Building relationships, developing competency: Toward a restorative approach to offender reintegration in a balanced juvenile justice system, A practice monograph. Ft. Lauderdale, FL: Balanced and Restorative Justice Project, U.S. Dept. Of Juvenile Justice and Delinquency Prevention.
Drug Strategies. (2003). Treating teens: A guide to adolescent drug programs. Washington, DC.
Maran, M. (2003). Dirty: A search for answers inside America’s teenage drug epidemic. New York: Harper Collins.
Schiraldi, V., Holman, B. and Beatty. P. (2000). Poor prescription: The costs of imprisoning drug offenders in the United States. Washington, D.C.: Justice Policy Institute.
Substance Abuse Treatment in Adult and Juvenile Correctional Facilities: Findings from the Uniform Facility Data Set, 1997 Survey of Correctional Facilities. Substance Abuse and Mental Health Services Administration.
Treatment Episode Data Set, Office of Applied Studies, Substance Abuse and Mental Health Services Administration, 2000.

Sidebars

This article is published in Counselor,The Magazine for Addiction Professionals, April 2004, v.5, n.2, pp. 69-73.

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