Mental Health and Juvenile Justice: A Discussion about QUEST Futures

QUEST Futures is a juvenile mental health initiative that seeks to establish a comprehensive, coordinated response
to youth with mental illness involved in the juvenile justice system in Queens, New York. Here, researcher Josephine
Hahn discusses the findings of an impact
of the program. (February 2014)

Sarah Schweig, of the Center for Court Innovation, and today I’m talking with Josy Hahn, the author of new research
about a special program that works with kids with mental illness, who are involved in the juvenile justice system.
The publication, 
Mental Health and Juvenile Justice, records
the findings of the impact evaluation of QUEST Futures. Thanks for speaking with me today and welcome.

JOSY HAHN: Thanks, Sarah.

SARAH SCHWEIG: So, QUEST Futures operates out of a community-based
alternative to detention program. QUEST stands for Queens Engagement Strategies for Teens, so this is in Queens,
New York. And QUEST Futures, specifically, works to engage kids with mental illness and their families in specialized
services. So, now that this program, which was launched in 2008, has been in operation for about five years, maybe
you can start off talking a little bit about the model, what the goal of the program was and the structure, and then
we can get to talking about the evaluation.

JOSY HAHN: Absolutely. So the QUEST Futures program
is so important. We know that youth in the juvenile justice system experience mental health illness at really high
rates, up to 70 percent, and that’s compared to 20 to 25 percent of youth in the general population. There is a huge
need, and yet there are very few resources in the juvenile justice system. So, juvenile detention and jail actually
become the default, which is alarming. Here in New York, QUEST was launched by the Center for Court Innovation—and
it was in collaboration with a number of juvenile justice and mental health agencies—and the overarching goal is
to reduce recidivism among youth in the juvenile justice system by addressing mental health needs. And there are
a couple other key features. One is that they engage with families early on in the case: so pre-adjudication phase.
Another is that really comprehensive individualized treatment plan that provides direct services on-site and also
a vast network of referrals. And then finally, the purpose of QUEST Futures is to increase the capacity of the juvenile
justice system to provide alternatives to detention, which is incredibly important.

Maybe give us an idea of what QUEST Futures looks like.

JOSY HAHN: So, it’s either through a judicial
mandate, so the judge mandates the program, or a voluntary referral. So in our study, all of the QUEST Futures youth
comes from QUEST ATD referrals. QUEST ATD serves youth with juvenile delinquency cases in the Queens family court,
and they are classified as moderate risk of re-offending, or failure to appear in court. And they are deemed eligible
for community supervision, and that can mean anything from curfew checks and school attendance monitoring, to after
school programming and required services in the community. But in terms of QUEST Futures, every single youth is given
a diagnostic predictive scale, and that’s a mental health instrument that screens for 18 different mental health
disorders—mania, bipolar, depression, post-traumatic stress disorder, and anxiety. If they flag on the DPS and meet
criteria for impairment, they are eligible to go to QUEST Futures. So there’s an intake set up with QUEST Futures
staff and youth and families. There’s a full bio-psycho-social assessment, and this includes a psychiatric evaluation
and supplemental information from home visits, and interviews with the youth support system: so, a parent, caregivers,
other family members, teachers, etc. And then, based on all of that information, program staff are working with youth
and families to build trust and collaborate on what works best to meet the needs of the youth. A feature of QUEST
Futures that’s really impressive is how multi-disciplinary its staff is, from the social workers, case managers,
youth developers, court liaison, a consulting psychiatrist and the senior staff, of course. But then also how often
they’re communicating and working closely with the judge, the prosecuting and defense attorneys, and the community
service providers.

SARAH SCHWEIG: There are many moving parts to that. So, maybe you can talk
a little bit about this evaluation. Maybe you can talk a little bit about the kind of data you collected and the
process for that.

JOSY HAHN: Sure. So, there’s very little research on juvenile diversions in
general, and there’s very little research on juvenile diversions in general, and the results are mixed on recidivism,
you know, whether youth in these programs are doing better or not, and there’s even ones on diversions for specialized
programs like mental health. So in this study we wanted to know how effective QUEST Futures was meeting the needs
of youth with mental health diagnoses in the juvenile justice system and we did this by looking at the impact of
QUEST Futures on a number of outcomes. And I’ll mention that we looked at recidivism—that’s re-arrest—at about one
year after program start, and one year after program end, we looked at final case dispositions—so, whether youth
were released into the community or put in a detention facility and placement, and then also the total detention
days served after program enrollment—if they were, and if so, how long? And we looked at data for background information
and outcomes for QUEST Futures youth and also a comparison sample. It was 392 youth altogether. They were all flagged
for some kind of mental health screen, and they were classified as mostly low to moderate risk, according to a risk
assessment instrument that we use in New York City. So, for the 131 youth in QUEST Futures that were compared to
a similar group of 261 youth in three alternative-to-detention programs that are throughout New York City.

SARAH SCHWEIG: What were some of your findings in looking at the group that did go through QUEST Futures
versus the sample that did not?

JOSY HAHN: So overall, the sample was mostly male and black or
Latino, and the average age for both groups was between 14 or 15. They were eighth grade on average. Both actually
had similar mental health screens, they were mania, post-traumatic stress disorder, and any substance abuse—so that’s
alcohol or any drug. And this related to about a third or more kids in the sample flagging for these issues. We use
propensity score adjustment and that is a great technique to balance any differences between our QUEST Futures and
our comparison group so that they would be similar. We also ran a number of tests to make sure what we were seeing
was the true effect of the QUEST Futures program. What we found was that QUEST Futures youth are significantly less
likely to commit felony offenses. It’s actually about a 12 percent difference compared to their counterparts. And
this is at about one year after program start. And this difference held mostly for one year at program end. The significance
was marginal, but the difference was still 10 percent, and so this was a really promising finding. It means that
the goal of QUEST Futures to reduce recidivism did occur. And then we also found that QUEST Futures youth were actually
less likely to receive a probation disposition when their case had closed, but they were more likely to receive other
kinds of dispositions, where they would still be released into the community. So that’s—it was mostly adjournment
in contemplation of dismissal, or conditional discharge. And then we also found that QUEST Futures youth and their
comparison group were equally likely to be detained after they were in program ATD enrollment but when they were
detained, QUEST Futures youth were actually more likely to spend more days in detention, so about five more days,
and that was a significant difference. So that’s definitely not ideal and something we have to look at in terms of
practicing and policy implications. A couple of the reasons might be that this might indicate a greater awareness
of the judge and other court stakeholders in knowing about the complex mental health needs of youth, and so that
contributes to longer detention stays because they might not have the appropriate care in the community. It might
show a potential supervision effect and this means that closer monitoring by the program and also by the court might
lead to longer detention stays. But in general we actually don’t know why the youth were detained in both groups,
we don’t know the reasons for them—whether they were a program violation like breaking curfew or not going to school,
or if they are new arrests after the program end. We also did an exploratory analysis to see if anything else predicted
outcomes of recidivism and detention days, and we did find some results that weren’t that surprising. Females are
less likely to be rearrested about one year after the program. Youth who flag for any substance abuse are more likely
to be rearrested. That’s not too surprising. But an interesting thing was that youth who flagged for suicide risks,
they were more likely to spend more days in detention, but they were less likely to be rearrested. So that actually
gives some support to the fact that more complex mental health needs, like suicidal ideation might mean that youth
will be in detention for longer. It’s still an issue.

SARAH SCHWEIG: Right, just because there
aren’t resources to deal with that?

JOSY HAHN: Right, not immediately given—even in New York with
such a vast network of quality providers, they might not always have the ability to meet the needs of a youth with
an emergency issue. So I just provided a very brief overview of the complex model that QUEST Futures is, but Kelli
Henry wrote up a process evaluation and some initial results for the outcome evaluation where she describes thoroughly
the planning process for the QUEST Futures model—so how the collaborations occurred, what happened in terms of implementation
and program launch—and she also wrote six very thoughtful case studies around different youth and their paths through
the QUEST Futures program and the juvenile justice system. So, a big plug to Kelli’s process evaluation, Kelli Henry,
on the Center for Court Innovation website as well.

SARAH SCHWEIG: Okay, so maybe just as a last
takeaway, what are some of the lessons that you can see from some of the findings?

Well the main goal of QUEST Futures to reduce recidivism, especially for more serious offending was met, and so these
are findings that give support to collaborative models for specialized diversions and ways to meet youth with mental
health needs in the justice system, which is fantastic. This does add to a small but growing base of evidence around
specialized youth diversions, and it’s critical because the juvenile justice system is definitely looking at alternatives.

SARAH SCHWEIG: Well it was great speaking with you today. I’m Sarah Schweig and I’ve been speaking with
researcher Josy Hahn about mental illness and the juvenile justice system. To find out more about the Center for
Court Innovation, or to download Josy’s report, visit our website at Thanks for listening.