Tailoring Responses for Youth

Introduction

Juvenile Drug Treatment Court (JDTC) teams should individualize comprehensive case plans, incentives and sanctions, treatment approaches, and prosocial activities to help youth make lasting changes in their behavior. Conversely, JDTC teams should also ensure that service delivery is consistent and fair. These recommendations can seem contradictory, and JDTC teams struggle to develop policies and procedures that allow them to tailor responses for youth. Use the tips, questions, answers, and resources found here to effectively tailor responses for youth by developing comprehensive case plans, targeting incentives and sanctions, using adolescent-based treatment, and prioritizing prosocial activities.

Tips for Implementation

Developing Comprehensive Case Plans

Rethink the use of mandated requirements that are listed in phases structures. Instead, concentrate on identifying individualized, youth-specific behavior goals based on a validated risk needs assessment and coordinating service delivery to help the youth achieve goals.
Implement a formal process for case plan development. This can be in the form of sophisticated online software or a pen/paper method, as long as the process is adhered to.
Use validated risk/need assessments to drive case plan development. Use the results of the risk/needs assessment to focus on the potentially changeable criminogenic needs that the assessment identifies as top needs.
Ensure that case plan goals are SMART. Use the table below as a guide to making goals specific, measurable, attainable, relevant, and timebound.

Specific	Address criminogenic needs with a specific intervention (e.g., substance use needs w/ adolescent-based treatment or values & beliefs w/ anger management course) Help build a new skill by engaging in a prosocial activity Ask youth to describe the types of skills they would like to learn
Measurable	Track attendance as a measure of compliance Track certificates or final grades as a type of completion measure Track the reduced criminogenic risk related to the intervention (i.e., reduced risk in the substance use domain after adolescent-based treatment has been completed)
Attainable	Ask targeted questions to determine if the goal is attainable: Consider whether the youth has the capacity to fully participate in the intervention. Consider if the youth is motivated to engage in the intervention or prosocial activity. Determine if there might be any external factors that would be barriers to attending (i.e., transportation issues) and how the barriers could be addressed.
Relevant	Confirm that the intervention / prosocial activity: Determine if an activity for a goal is related to an identified criminogenic risk factor, rather than a standard requirement that all youth have to do. Include voice and choice from the youth and family; for example, selecting an activity to meet a goal, allow youth to choose from a variety of different prosocial activities.
Timebound	Discuss goal achievement expectations and due dates with youth by identifying a period of time to work on a specific goal. Ensure that youth are able to work towards a distal goal (lower probability but higher value) by achieving smaller proximal goals (higher probability with less value) that are directly related to the distal goal. For example: Improving school connectedness is a distal goal Proximal goals related to that include – enrolling in school; completing an individual education plan; finishing a credit recovery courts; etc.

Review “7 (Easy) Steps to Individualizing Your Juvenile Drug Court” in 7 Articles with 7 Easy Steps to Improving Your Juvenile Drug Court (pages 25-30) for more information on developing procedures that lead to individualization.
Use the “Case Planning and Management” tips found on pages 2-4 of the Practical Tips to Help Juvenile Drug Treatment Court Teams Implement the JDTC Guidelines for information about how to use case plans as a team.

Targeting Incentives and Sanctions (Contingency Management)

Review the evidence that supports using incentives and sanctions in JDTCs by reading “Objective 5” in the JDTC Guidelines (pages 28-33).
Present a case study to the full JDTC team as an example of the barriers and solutions JDTC teams face when implementing incentives and sanctions. The case study – “Contingency Management: Goal-Oriented Responses” can be found in Practical Tips to Help Juvenile Drug Treatment Court Teams Implement the JDTC Guidelines (pages 17-19).
Prioritize incentives by using Individualizing Responses to Motivate Behavior Change in Youth: A Four-Pronged Approach to help create a strength-based atmosphere; implement a micro-economy; use short-term contracts, and respond to drug testing.
Reduce the use of detention by using a structured graduated sanctions grid that uses a wide range of sanctions in a strategic way that allows JDTC teams to use types of sanctions over time to determine effectiveness. Review the example on pages 36 and 17 of Individualizing Responses to Motivate Behavior Change in Youth: A Four-Pronged Approach.

Using Adolescent-Based Treatment

Review the evidence that supports referring youth to evidence-based treatment in JDTCs by reading “Objective 6” in the JDTC Guidelines (pages 33-37).
Determine what treatment modalities work for adolescents by reviewing the Adolescent-Based Treatment Interventions and Assessment Instruments for guidance on Intervention Basics, Recommended Population, Special Considerations for JDTCs, Engagement Strategies, and Implementation & Training.
Present a case study to the full JDTC team as an example of the barriers and solutions JDTC teams face when developing procedures that ensure comprehensive case planning – The case study “Comprehensive Treatment Planning” can be found in Practical Tips to Help Juvenile Drug Treatment Court Teams Implement the JDTC Guidelines (pages 12-14).
Conduct community resource mapping to identify services along a continuum of care by using the “Select Treatment Providers” worksheet found in Starting a Juvenile Drug Court: A Planning Guide (pages 178-182).

Prioritizing Prosocial Activities

Equalize the importance of participation in prosocial activities with substance use treatment by ensuring that the JDTC team has a wide variety of activities to refer to. Use the “Identify other service providers” (pages 183-187) and the “Explore enrichment opportunities” (pages 188-192) worksheets found in Starting a Juvenile Drug Court: A Planning Guide to identify possible community resources and opportunities for youth and families.
Improve educational linkages by presenting a case study to the JDTC as an example of the barriers and solutions that JDTC teams face when working with schools. The case study “Educational Linkages” can be found in Practical Tips to Help Juvenile Drug Treatment Court Teams Implement the JDTC Guidelines (pages 27-29).
Implement a structured mentoring program within your JDTC. Use Mentoring in Juvenile Treatment Drug Courts to better understand the key components of mentoring programs within a JDTC.

Frequently Asked Questions

Why doesn’t the JDTC Guidelines address phases?

The main reason is that there isn’t any research to support the use of phases in JDTCs. The structure was adopted from the adult model. The use of pre-determined requirements is not informed by adolescent development or adolescent brain science so they may not serve juvenile drug treatment court programs as well as they serve adult drug court programs. Instead, comprehensive case plan development and management, driven by validated assessments, are much better at “…engag(ing) and retain(ing) clients whose circumstances make it difficult to follow a regimented program schedule.” This means that JDTC teams should rethink the use of phases entirely and consider revising JDTC program structure to focus on and align with effective case planning activities. Begin by:

Following the in-practice tips under “Program Structure and Management: Using Phases Effectively” found in Practical Tips to Help Juvenile Drug Treatment Court Teams Implement the JDTC Guidelines (pages 47-51).

How can drug testing policies and procedures be trauma-informed and developmentally appropriate?

JDTCs should ensure that drug-testing procedures are developmentally appropriate, trauma-informed, and fair, and drug testing services and locations are made accessible regardless of where in a community youth reside. NCJFCJ recommends:

Staff who administer drug tests are trained on trauma, cultural humility, and implicit/institutional bias.
Staff who administer drug tests look like the youth they serve (in terms of race/ethnicity/sexual identity).
Drug testing processes and staff emphasize respect in interactions with youth and families.
Drug testing-related processes give youth voice and choice.
Drug testing-related processes are transparent (i.e., state the why, how, what & who).
When youth have positive tests, they are referred to culturally appropriate treatment services and support.
When youth have negative tests, they receive meaningful and positive reinforcement.
Drug testing, when deemed necessary, is just one tool in the process for assessing and treating youth who have a substance use disorder.
Youth are not denied acceptance into JDTCs because drug testing or treatment services do not exist in their community or neighborhood.

What does the research say about requiring a consecutive number of negative drug tests to advance from phase to phase OR graduate from a JDTC?

JDTCs commonly mandate a specific number of consecutive, negative drug test results for youth to advance from phase to phase or graduate; however, research does not exist that establishes a requirement of a specific number of consecutive or cumulative days of negative drug tests results is associated with higher graduation rate or a lower, post-program recidivism rate. The following is a summary of the available research/information regarding using drug test results to define remission or consistent non-use of substances:

APA’s DSM-5 defines remission as three months without “symptoms” (including craving) – but is noticeably silent on actual “use.”

The DSM-5 may be the basis for specialty court rules that call for 90 days of consecutive sobriety for graduation. This is a questionable application of a clinical yardstick/concept to a court/legal mandate. Clinicians may look at physiological symptoms – like craving. Such symptoms/conditions do not exist as a phenomenon/concern in the realm of the law/courts. People cannot be arrested or locked up based on whether they have cravings.
There is no research that states that 90 consecutive days are required for behavioral change of the sort that juvenile drug treatment courts are legitimately concerned with – not just taking drugs, but how the young person functions (or is not functioning) that shows recovery-related capacity. Youths could have 90 cumulative days (with a slip-up or two) and function in desired ways – like going to school, making progress in school, going to treatment, making progress in treatment, getting along better with parents, having positive peers, etc.
Treatment experts/clinicians might find behavior change proceeds better when young people have sustained sobriety (i.e., when they aren’t struggling with coping with cravings that may get in the way of these other capacities and growth). But there isn’t any definitive support in the treatment field that establishes that 90 consecutive days of sobriety is associated with lowered substance use, lowered illegal behavior, or increased prosocial activities, for adolescents.
Statistically, the first big cut point comes from reducing use to less than one time a week (5/30 days or 13/ 90 days).

In sum, and as relevant to JDTCs, a set number of consecutive days of negative drug screen results are not required. For purposes of a JDTC program completion requirement, cumulative days are a sufficient standard, and with only minimal use within the period – for example, out of 30 days, only 5 with non-sobriety, and no more than 2 sequential ones.