Reclaiming Futures – NC

The Reclaiming Futures Initiative is directed locally be a coalition of leaders from key agencies who will champion and guide the work, including use of data-driven decision-making. An effective team can be one of the most critical ingredients to successfully bringing about systems change.  

Infrastructure Development

Each area must ensure that they have a leadership team with the combination of skills, knowledge and interest in implementing the Reclaiming Futures model to improve the systems that serve juvenile justice youth with substance abuse and/or mental health needs.

The core team for Reclaiming Futures is comprised of five Fellowship roles. While at least one Fellow must be identified for each of these roles, depending on the local dynamics a site may need more than one Fellow to be a part of their change team or additional team roles.

• Project Director – The Project Director Fellowship role is the person responsible for coordinating the local change team, ensuring that the team has leadership from key agencies that work effectively together to champion and guide the work utilizing data-driven decision-making. This person must see the big picture while also keeping track of the details, serve as an effective “boundary spanner” and have the capacity to engage others in shared leadership.
• Judicial Fellow – The Judicial Fellowship role is to utilize their unique capacity to mobilize the attention and support needed to create systems change.  The judge is not only able to directly influence the treatment youths receive, but can also promote change within the judicial system that could affect the way all youths are treated by the courts in the future. A Reclaiming Futures judge must have a strong commitment to convening, engaging and sustaining the entire community in the process.
• Treatment Fellow – The Treatment Fellowship role is to represent the treatment community in its efforts to use effective evidence-based, developmentally and culturally relevant approaches in assessment and treatment of youth with substance abuse, mental health or co-occurring disorders. The treatment fellow must work together with justice and community in the system of care and encourage colleagues to do the same.
• Juvenile Justice Fellow – The Juvenile Justice Fellowship role is critical as court counselors and chief court counselors supervise and guide a young person as they make their way through the juvenile justice system. The Juvenile Justice Fellow helps ensure that youth are being screened with a valid, reliable tool at intake and to guide the development of a comprehensive service plan in collaboration with other service providers.
• Community Fellow – The Community Fellowship role is critical to helping the local change team mobilize the community to support a young person from initial contact, through treatment and juvenile justice plans, and provides ongoing supports for their transition to the community. This is a unique aspect of Reclaiming Futures and considered to be among the most important keys to success. Leaders from schools, faith-based organizations, businesses, families and civic groups advise each project on opportunities for youth in order to reach this goal.

Tips for Your Local Team

• Identify key champions from your community to fill each of the Fellowship roles that have the ability to think both from their unique perspective as well as to look at the overall system of care for juvenile justice youth.
• For large or multi-county districts, ensure your team has representation from all local communities that you are serving. For example, have at least one community fellow for each county in your initiative.
• Consider representation from both treatment provider(s) and the Local Management Entity – Managed Care Organization for your area as they may bring different perspectives on how to bring about changes necessary to achieve More Treatment.  Better Treatment. Beyond Treatment. 
• Establish a clear structure for how your local team will make decisions and how often you will meet. Be sure to establish this before you have to make any hard decisions. 
• Think sustainability from day one!  Look for opportunities to institutionalize the changes you make into policy and procedures for your district(s) and for resources to support long-term implementation.
• Communicate regularly with key stakeholders, including media, about your initiative and issues related to youth, substance abuse, mental health, positive youth development and youth-related crime. 

Coordination

Effective communication and coordination among judges, court counselors, treatment providers, LME-MCO, youth-serving nonprofit agencies, schools and Departments of Social Services with regard to serving the needs of court-involved youth with substance and mental health issues is critical to meeting the needs of youth.

• Establish clear channels of communication to ensure youth are being effectively connected with services.
• Documentation should exist to track youth throughout the process. For more information on information sharing, review the Models for Change Information Sharing Toolkit. 
• Develop and sustain shared priorities that advance the interests of the community while also addressing the interests of each stakeholder.
• Look for ways to connect with others in your area that serve juvenile justice youth, such as:
  • Juvenile Crime Prevention Councils (JCPC)
  • Juvenile Justice Substance Abuse Mental Health Partnerships (JJSAMHP)
  • Juvenile Justice Treatment Continuum (JJTC)

More Treatment.  Better Treatment.  Beyond Treatment. Reclaiming Futures is designed to improve the ability to connect youth with effective treatment for substance abuse, mental health or co-occurring disorders. It is essential that communities build a continuum of treatment services that has the capacity to meet the needs of all youth and that the treatment is using research-based treatment practices, including evidence-based models.

Nmerous programs have been proven effective in meeting the unique needs of adolescents with substance abuse, mental health or co-occurring disorders. The Adolescent Substance Abuse Treatment Project at UNCG's Center for Youth, Family and Community Partnerships compiled Evidence-Based Practice for Adolescent Substance Abuse: A Primer for Providers and Families to serve as a comprehensive introduction to several important evidence-based practices for adolescent substance abuse assessment and treatment. Inclusion in this primer does not constitute an endorsement of a specific approach, but to help communities begin the process of identifying which treatment models may best meet the needs of their youth. There are also other websites that can be explored that may assist in identifying evidence based practices including:

• SAMHSA's National Registry of Evidence-based Programs and Practices
• CrimeSOLUTIONS.gov
• The California Evidence-Based Clearinghouse for Child Welfare

Local teams should collect and analyze data on the availability and quality of treatment in their community to ensure that the number of treatment providers in their network is sufficient to meet the service needs of all youth and that the treatment available matches the treatment needed. Work with the network development or management section in your local management entity – managed care organization that is responsible for the development and maintenance of a network of providers who can meet the needs of clients, assuring choice and that quality services are available.  Local Juvenile Crime Prevention Councils may also be a resource to your community if you identify an unmet need related to treatment services.  

Teams must also work with the appropriate funding sources to ensure that not only are services accessible to youth and families, but that there are also funding mechanisms to support training, fidelity monitoring and other expenses related to implementation of evidence-based programs and/or practices. A quick reference for helping the team to identify evidence based programs includes the following developed by SAMHSA: Identifying and Selecting Evidence-Based Programs and Practices: Questions to Consider

Initiation & Engagement in Treatment

Providers in the community must then ensure that youth and families are accessing the treatment needed and that they are actively engaging clients in services in a timely manner. Youths are more likely to have successful treatment outcomes if they can begin and engage in services quickly. The goal of Reclaiming Futures is that they will initiate treatment within 14 days of completing their full assessment and fully engage in treatment (three service contacts) within the first 30 days of their assessment.

Court counselors, treatment providers and other community members can play a critical role in youth engaging in the needed services. Some examples of ways to help remove barriers to engagement include:

• Schedule a client's first appointment while he/she is present for their assessment.
• Help clients solve any logistical problems involved with starting and staying in treatment, such as transportation, childcare, or ability to pay.
• Include family and friends from the beginning so they know how they can support the young person in treatment
• Use positive reinforcement or incentives to motivate the client to attend treatment and work toward treatment goals
• Remind clients about appointments
• Follow-up with clients that don't make an appointment to find out what happened and reschedule.

For more strategies to remove barriers to treatment and recovery, review the NIATx Promising Practices database.

Reclaiming Futures strives to ensure that youth involved in the juvenile justice system have a comprehensive, family and youth-driven service plan that coordinates the work of multiple systems, including juvenile justice, treatment, education and other positive, community-based supports. Service coordination should involve the assessment of youths' strengths and needs to develop a plan that prioritizes and addresses their goals for identified areas. Youth and families should then be connected with appropriate services to help achieve their goals in targeted domains, including:

• Health – Assess and/or treat substance use, mental health, risky behavior and/or health needs

• Safety – Promote community safety and ensure smooth transitions between settings and support or create a stable environment for the youth;

• Support Network – Cultivate positive community connections by identifying sources of pro-social support and involvement in pro-social recreational and leisure activities.

• Personal Accountability – Help youth understand the impact of past actions and behaviors and repair any harm they may have caused; emphasize personal responsibility and accountability;

• Family Functioning – Strengthen the family's ability to support and supervise the youth, including maintain and strengthen family relationships, meet unmet service needs, prevent, manage and resolve family conflicts, and identify strengths that can help them meet future challenges

• Education/Vocation – Support educational development through positive school behavior, participation, and achievement; vocational development, including skills, job shadowing, and/or employment

• Social Competency – Promote social and life skills development

System of Care

System of Care consists of coordinated and integrated community resources, which support children and families with a full network of services and supports to meet their needs based on their individual strengths.

This is accomplished through implementation of a community collaborative effort that seeks to plan needed change at all levels: system, supervisory and practice levels, including involvement from key stakeholders, community and family participants and child-serving agencies. To find out more about the System of Care in your area, talk with your local System of Care Coordinator.

The North Carolina Collaborative for Children, Youth, and Families provides a forum for discussion of issues related to implementing effective systems of care, but is independent of any agencies typically involved in system of care efforts. The collaborative also looks at issues related to training on system of care, including Child and Family teams throughout the state.

Child and Family Teams

In North Carolina, the Child and Family teams are at the center of how we implement the system of care framework. A youth's service plan should be created with the child and family team, which is a team of individuals who care about the child, including the youth, family members and other formal and informal supports involved with the care of the youth. The plan incorporates strengths, goals, needs and strategies for the identified life domains and clearly defines roles and responsibilities for all parties involved. The plan should reflect the level of supervision and related expectations for compliance with their juvenile justice involvement.

Child and Family teams should monitor engagement in services, address any barriers to youth or family involvement, evaluate progress toward achieving outcomes, discuss any unmet needs, and plan for transition out of formal services.

Two primary trainings are focused on Child and Family Teams in North Carolina:

• An Introduction to Child and Family Teams: A Cross System Training From the Family's Perspective
• Child and Family Teams from the Family's Perspective: Part Two—A Cross Systems Approach to Facilitating Family Driven Meetings

The Behavioral Healthcare Resource Program at the School of Social Work, University of North Carolina at Chapel Hill links current research to initiatives in mental health and substance abuse systems.  Find out more about the Child and Family Team trainings and trainers available to support your local Child and Family Team efforts.

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.

Screening

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.

Assessment Tools

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: Screening and Assessment in Juvenile Justice Systems: Identifying Mental Health Needs and Risk of Reoffending

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™)

The Reclaiming Futures Initiative strives to tap into those natural resources in local communities that can help a youth build positive supports for long-term success. All youths need access to opportunities to foster their skills and interests through mentoring, arts, recreation, leadership development and other pro-social youth development activities.

Local teams should look at the array of these types of supports – both formal and informal – that are available to work with juvenile justice-involved youths and how they go about matching youths to these supports. These supports can be used to help a youth achieve goals within their service plan, such as increased interaction with peers or adults that will have a positive influence, or improved interpersonal skills. The ability to participate in these pro-social activities or learning experiences can also be used as motivational incentives to achieve other goals. For example, youth that are actively engaged in treatment and have abstained from substance use may earn the opportunity to participate in a specialized learning experience. Family and youth should have a clear voice in the development of these strategies to ensure they match the needs, strengths and interests of the youth.

This approach is being used by state-level juvenile justice professionals in efforts to implement Graduated Responses and Rewards, a research-based strategy to help youths achieve their short- and long-term goals while reducing future offending behavior.

Community Engagement

The Community Fellows for local Reclaiming Futures teams should be a central part of the planning process for the development of these pro-social supports, including the mobilization of additional community resources (formal and informal) as needed. They can also advocate for the inclusion of the family and youth voice in all of your planning efforts. Family partners, families who have previously been involved with the system, are also be a great advocate to engage in your efforts.

North Carolina is very fortunate to have so many great youth-focused organizations and efforts that could partner with your local efforts. In addition to local resources, such as parks & recreation departments, YMCA, Big Brothers Big Sisters,

• Youth Empowered Solutions - YES! is a nonprofit organization that empowers youth, in partnership with adults, to create community change. It equips high school-aged youth and their adult allies with the tools necessary to take a stand in their communities and create change that will positively impact adolescent health.
• Youth M.O.V.E. - North Carolina Families United hosts a leadership series geared to youth/young adults, ages 15-21 who have struggled with mental health, and substance issues including trauma-based experiences. The leadership series unites the voices of traditional and non-traditional leaders with lived experiences in various systems including mental health, juvenile justice, education and child welfare. Youth/young adults who successfully complete the Young Adult Leadership Series are encouraged to join Youth M.O.V.E (Motivating Others through Voices of Experience), a statewide youth-led leadership group
• Strong Able Youth Speaking Out (SaySo) - Strong Able Youth Speaking Out, is a statewide association of youth aged 14 to 24 who are or have been in the out-of-home care system that is based in North Carolina. This includes all types of substitute care, including foster care, group homes and mental health placements. Its mission is to work to improve the substitute care system by educating the community, speaking out about needed changes, and providing support to youth who are or have been in substitute care.
• Juvenile Crime Prevention Councils – These county-level planning committees conduct an annual needs assessment to help identify gaps in services for youth at risk of juvenile delinquency. These players represent the myriad of agencies and organizations within the county who work with and interface with youth, families and the agencies who work in various capacities with those youth and their families, including social service agencies, the judicial system, local education entities and law enforcement as well as the faith and business communities.
• Local Community Collaboratives - A Community Collaborative brings together decision-makers (people responsible for services) and stakeholders (people using the services) to "drive," manage and monitor the local System of Care. The local collaborative finds and builds common goals, promotes concrete ways to collaborate and supports effective services. The local collaborative promotes teamwork and change in the broader community that is necessary for Child and Family Teams to succeed in their work with children and families.