On March 18, 2015, the community leaders who constitute the College of Medicine Advisory Board were presented with a plan for an initiative to help reduce the number of children who become embroiled in the juvenile justice system.
Seventy percent of children in the system meet criteria for a mental health disorder. Often, it’s not the severity of their crime, but a lack of appropriate community-based treatments, a condition that goes unrecognized, or a poorly coordinated service delivery system that lands them in court.
The plan was the result of a discussion at a previous board meeting regarding how the community could best make use of UTHSC’s capabilities – a real-world example of the College of Medicine collaborating with community partners to help deal with areas of critical need in Memphis and the Mid-South.
“The state is not adequately capturing the data needed to avoid the revolving door of juvenile incarceration,” says Tennessee Senate Majority Leader and Advisory Board member Mark Norris, “and it is not impacting the underlying causes of juvenile delinquency, which often stem from the neurological consequences of the toxic environments too many Tennessee children find themselves
The UTHSC Center for Health in Justice-Involved Youth
The plan was presented by Altha J. Stewart, MD, a psychiatric consultant, health care administrator and nationally recognized expert in public sector and minority issues in mental health care. An invited participant at the historic 1999 White House Conference on Mental Health, Dr. Stewart is the recipient of numerous awards and honors.
The subject was the creation of a UTHSC Center for Health in Justice-Involved Youth. When the idea was conceived, Dr. Stewart, a native Memphian, was the first choice to head the organization. Dean David Stern believed her experience as director of Systems of Care in the Office of the Shelby County Public Defender and Administrator of the Just Care Family Network made her the ideal candidate. In July, Shelby County and UTHSC worked out a unique public/private partnership. Dr. Stewart was employed part-time by the public defender’s office and part-time by the College of Medicine. She is now at UTHSC full-time.
The Juvenile Court of Memphis and Shelby County has a variety of tools and resources to identify and treat youth with behavioral health issues within the system, but the system lacks the necessary coordination to translate effective interventions and programs into real-world solutions. The Center for Health in Justice-Involved Youth, in collaboration with the juvenile justice system, will divert eligible juveniles from the justice system into existing services provided by community partners or services and programs developed by the center and its clinical partners at the university and in the community. More and better programs are not the solution to the challenges of juvenile justice. Success requires a coordinated system that places the right youth into the right program for the right reasons.
The Addiction Factor
The center’s primary focus will be the general needs of justice-involved juveniles, but the population being dealt with has a high incidence of mental illness, and that includes substance abuse disorder. Problems of dependency are often a factor and will be one of the circumstances that will need to be dealt with.
“We are tasked with addressing both the needs of child and family. It’s a triage concept,” says Dr. Stewart. “People think of triage as a purely medical concept, when in fact, triage has a much broader meaning. A child does not exist outside the family unit, whether that’s biological, adopted, extended or foster. The child alone cannot be the focus of our intervention. If we don’t deal with the issues of that child within the context of that family, we are not really helping that child.
“Children are now exposed to drugs at an earlier age, everything from prenatal exposure to earlier use of various drugs. We know that because of the unique developmental challenges of children, the brain is developing. What we believe happens is that drugs make the brain development supersensitive to changes and rewiring, some of which becomes irreversible as the child ages.” Dr. Stewart concludes, “If we don’t deal with addiction problems in childhood, we are likely producing adults with an inadequate ability to deal with the things that they will face in life.”