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Mental Health Hybrid System of Care in the Juvenile Justice System: Opportunities and Challenges

By Donna Faranda, Psy.D.

Dec 3, 2010 Back

Issue02_MH

Fire-related crimes and delinquent activity including, but not limited to, arson within the juvenile justice system is a nationwide problem.1 While arson is a legal term typically defined as the crime of deliberate, intentional and malicious fire use, firesetting is a behavior included as a criterion for a diagnosis of both Conduct Disorder and Pyromania.2 Over the past two decades several studies have highlighted the association of firesetting to factors that have commonly been associated with delinquent behavior in juveniles. Studies have suggested chronic patterns of deviant firesetting may be a newly evolving diagnosis of pathology, that firesetting youth typically exhibited a significantly higher frequency of aggressive and total antisocial acts and an earlier age of arrest, and that purposeful firesetting among juveniles may be more an instrument of power used as a weapon rather than an expression of curiosity.3 Delinquent criminal activity has also been related to maltreatment and that maltreated children were more likely to become involved in firesetting out of anger and display heightened emotional and behavior difficulties.4 Other factors that have been associated with both delinquency and increased risk for firesetting include aggression, sensation-seeking behaviors, social skill deficits, deviance and vandalism, covert antisocial behavior, and attention-seeking behaviors.5 In one study, predictors of recidivistic firesetters included: fire history, attraction to fire, and externalizing behaviors while in a second study family environment and placement in foster care were the two aspects that emerged as most relevant to juvenile recidivism.6

There currently exists a need for research and evidenced-based interventions for juvenile justice diversion programs that include the crimes associated with firesetting. Remanding a court-ordered youth to a diversion program is seen as an inherent opportunity to understand the depth and scope of arson’s impact, reduce recidivism, and enhance public safety. Unfortunately, the lack of uniform screening and assessment practices, absence of a universal and standardized typology, low capacity of clinicians trained to inquire about fire use in an initial interview, and minimal reporting of firesetting activity inhibits research, effective case management, and treatment planning within the juvenile justice system.   Compounding the difficulty of firesetting intervention in a diversion program is the lack of information specific to juvenile firesetting and frequent co-morbidity of other mental health diagnosis such as Conduct Disorder (CD), Attention Deficit/Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD).

Broward County’s Hybrid Response

In 2004, the Broward County (FL) Fire Chiefs Association sanctioned the Broward Sheriff’s Office (BSO) to develop and manage a countywide Juvenile Firesetter Prevention & Intervention Program (Program). BSO’s Fire Marshal’s Office is the managing division and receives data – via a referral – on all juveniles involved in firesetting within Broward County, facilitates information gathering, and improves communication efforts among the multiple jurisdictional entities. Referrals are sent from DJJ, probation, mental health professionals, foster care agencies, fire fighters, and law enforcement and do not always result in a charge or violation. Currently, there are two components to the program: fire safety education provided by the county fire departments and a mental health assessment provided by a private practice psychologist under contract to BSO. Follow-up care and recommendations from the mental health provider is sent to the diversion program handling the child’s case.  Fire safety and mental health components are administratively independent of each other – hence the hybrid classification. The decision to implement such a hybrid structure was due to a number of factors including: overall limited agency resources; little resources for initiation of a new program; and the voiding of the necessity of keeping juvenile medical records within a fire department. The entire program remains legally connected since it is administratively managed by the BSO.

As a private practice psychologist I do not formally report to DJJ and psychosocial assessments are considered an off-site outpatient program feature.  My primary function is to conduct a semi-structured, fire–related psychosocial assessment in order to prepare a needs list of recommendations for parents (with parent signature) and DJJ case management staff. However, in order to obtain access to juveniles being interviewed in secure facilities, BSO requires authorized identification badges be worn at all times further providing an impression that the services are merged. Referrals information includes the police report, DJJ history, fire report, and basic family information.  An information gathering call to the arresting officer, fire staff on scene, or probation representative is conducted prior to interview. The program is housed within the case management/probation area, parents have scheduled appointments, and interviews are not conducted at time of arrest.

It has been my experience in providing mental health services to over 1000 youth who were placed into diversion programs for firesetting-related behaviors has provided both professional opportunities and challenges. Briefly, the model provides for opportunities such as: the development of an evidenced-based practice protocol; the ability to assemble a community-based needs assessment tool and conduct efficacy research: improved communication and relationships with fire, police and court professionals within multidisciplinary teams; partnerships and training opportunities with local universities

Challenges include: inconsistency across mental health providers on style of interview, psychological instruments used, and level of training and education; coordinating services and data across multiple agencies; ethical clarification for informed consent, confidentiality, guardianship determination, language barriers; physical safety concerns; and financial and personnel limits of a system that is already overwhelmed.

Despite these challenges the program is looking ahead and will begin administering the Mini-International Neuropsychiatric Interview, Children’s Version (M.I.N.I.Kid) at time of arrest, a brief, structured psychiatric screening instrument.7

In summary, youth who are arrested for arson and other fire-related crimes are often remanded into the juvenile justice system.  How best to deal with the myriad of opportunities and challenges that present warrants both empirically-based formative and summative evaluations to provide guidance towards developing an evidenced-based, best- practice model.  Mental health professionals can play a key role in improving our capacity to meet the needs of these youth and their families.

[1] Federal Bureau of Investigation. (1997). Crime in the United States, 1996. Washington,DC: Government Printing Office

[2](American Psychiatric Association, 2000). American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author.

[3] Stickle, T. & Blechman, E. (2004). Aggression and Fire: Antisocial Behavior in  Firesetting and Nonfiresetting Juvenile Offenders. Journal of Psychopathology and Behavioral Assessment, 24(3),177-193.

[4] Root, C., MacKay, S., Henderson, M.J., Del Bove, G., & Warling, D., (2008). The link between maltreatment and juvenile firesetting: correlates and underlying mechanisms. Child Neglect.  32 (2), 161-176).

[5] Schwartzman, P, Fineman, K., Slavkin, M., Mieszala, P., Thomas, J., Gross, C., Spurlin, B. & Baer, M.  Juvenile Firesetter Mental Health Intervention: A Comprehensive Discussion of Treatment, Service Delivery and Training of Providers. Juvenile Firesetters Intervention Research Project Phase I. Final Report: National Association of State Fire Marshals, Albany, NY. 2000.

[6] Kolko, D.J., Herschell, A.D., & Scharf, D.M. (2006). Education and Treatment for Boys Who Set Fires: Specificity, Moderators, and Predictors of Recidivism. Journal of Emotional and Behavioral Disorders. 14(4), 227-239.

[7] Sheehan, D.V., Sheehan,Y., Amorin, K.H., Janavs, J., Weiler, E., Huegueter,T., Baker, R.,  & Dunbar, G.C. (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry. 59(20), 34-57.

About The Author

Donna Faranda, Psy.D.

Dr. Donna Faranda received her Psy.D. from Carlos Albizu University (Miami, FL) in 2000 and completed post doctoral work in clinical psychopharmacology at Nova Southeastern University (Ft. Lauderdale, FL) in 2005. She holds certification from the Board of Forensic Counselors as a CBT clinician, is an approved instructor for the National Fire Academy, and for 17 years was the Executive Director for the South Florida Chapter of the National Safety Council. Dr. Faranda currently serves as psychologist for the Broward County (FL) Sheriff’s Office, Fire Marshal’s Bureau, and Fire Chiefs Association. Dr. Faranda has been active in research in firesetting behavior, pre-school intervention, and parenting skills work.

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