The Reclaiming Futures Initiative is designed to ensure that youths who enter the juvenile justice system are effectively screened for substance abuse and mental health issues with a valid, reliable tool. If indicated, youths in need of further evaluation should be referred for a comprehensive, valid and reliable assessment to help determine their treatment needs.
As soon as possible, youth entering the juvenile justice system should complete a valid, reliable screening as part of their intake process. The screening used should quickly identify youths that may have a substance abuse, mental health or co-occurring disorder and therefore are in need of a full assessment.
In North Carolina, the majority of juvenile justice districts are using the Global Assessment of Individualized Needs – Short Screener (GAIN-SS), which has been integrated into North Carolina Juvenile Online Information Network (NC-JOIN), the web-based system used by juvenile justice staff to track the progress and placement of youth being served by various programs and facilities. For more information on the GAIN-SS, including training manual, visit the GAIN Coordinating Center online.
In North Carolina, GAIN-SS screenings indicated that 73 percent of youth were in need of further assessment for mental health and/or substance use (based on scoring high on the total disorder). Approximately 21 percent of youth indicate the need for substance abuse assessment/treatment (based on scoring moderate/high on substance disorder).
Other valid, reliable screening tools include the Massachusetts Youth Screening Instrument-Version 2 (MAYSI-2), which is currently used by juvenile detention centers in North Carolina.
Referral to Assessment
- Based on the results of the screening as well as other information collected at intake, each local site should have clearly defined criteria for those who will be referred for a full assessment.
- The referral process should be developed to minimize the time between referral and full assessment. The criteria and process should be documented and integrated into local policy and procedures.
- Local teams should monitor youth to ensure they are completing the full assessment and that any potential barriers have been identified and addressed. When possible, families should be given choice in the provider that will best meet their needs.
Strategies for Connecting Youth with Assessments
Each local team should discuss strategies to help connect youth with assessments, including strategies to ease the scheduling of appointments, how to handle it when the client's needs do not match what's currently available, and to follow-up with clients.
- Encourage referrers to make the first appointment while the client is present.
- Centralize appointment scheduling.
- Establish walk-in hours so that clients are able to see a counselor for an assessment without an appointment.
- Cross-train counselors to both assess and treat clients and assign backup counselors to see clients whenever the number of requests for service exceeds scheduled staffing levels.
- Adjust staff schedules to meet client needs for service, including assessments.
- If client cannot be seen promptly, refer the client elsewhere.
- Remind Clients about Appointments - call clients 24-48 hours in advance to remind them about their next appointment.
- Follow up with clients when they miss an appointment to find out why and to reschedule another appointment.
For more promising practices on removing barriers to treatment, check out the NIATx Toolkit.
Youth referred on for a full assessment should have access to a valid, reliable and comprehensive assessment that identifies substance abuse, mental health and co-occurring disorders. This assessment should incorporate an assessment of the youth's strengths and assets as well.
When adopting an evidence-based tool, it is important to also ensure you have the appropriate infrastructure to support fidelity to the tool, including training, written policies and procedures, ongoing monitoring and funding mechanisms to support the use of the tool and infrastructure.
It is also beneficial to be able to outline the differences between mental health screening and assessment and juvenile justice assessment. A publication that outlines these issues is immediately below:
Below are examples of standardized assessment tools for adolescents:
- Child Behavior Checklist for Ages 6-18 (CBCL/6-18)
- Comprehensive Health Assessment for Teens (CHAT)
- Diagnostic Interview for Children and Adolescents – IV (DICA-IV)
- Diagnostic Interview Schedule for Children-IV (DISC-IV)
- Global Assessment for Individualized Needs – Individual (GAIN-I)
- Practical Adolescent Dual Diagnosis Interview (PADDI™)