Review of Services for Alabama Girls Charged with Delinquency

By building on its recent important successes in reforming its juvenile justice system, Alabama stands poised to design and implement a system of care for girls charged with delinquency. With the cooperation of the Alabama Department of Youth Services and with funding from the Public Welfare Foundation, we have studied the services for delinquent girls in Alabama and present the following report and recommendations.

The report concludes that a ripe opportunity exists to develop a model system of care that will better serve the girls, will enhance public safety and may even save money. Development of the proposed system of care will require the participation and support of several state agencies, the judiciary, private providers and advocates.

The Alabama Disabilities Advocacy Program (ADAP), the Center for Public Representation (CPR) and the Southern Poverty Law Center (SPLC) told us that Alabama has made very significant improvements to its youth services. However, the organizations believed that services for girls in the juvenile justice system warranted further attention. Accordingly, ADAP, CPR and SPLC retained us to assist them in their advocacy.

Marty Beyer is a clinical psychologist with an expertise in adolescent development. She has been involved in improving services for delinquents in several states and has assisted the Department of Justice in its investigations of juvenile facilities. She has also been involved in the reform of foster care practices in several states, including in Alabama.

Paul DeMuro has forty-one years’ experience managing staff, programs, budgets and processes designed to improve a wide variety of youth-serving agencies. A former Commissioner of Children and Youth in Pennsylvania and a Vice-President at the National Council on Crime and Delinquency, Mr. DeMuro is now a senior consultant for the Annie E. Casey Foundation and the National Juvenile Detention Association. He has been appointed by federal courts in several states to monitor consent decrees designed to improve services for children.

ADAP, CPR and SPLC asked us to assess what services should be available to help to prevent commitment to Alabama’s Department of Youth Services (DYS) and what services should be available to girls who are transitioning from DYS facilities back to the community.

Our review was not an evaluation of DYS or how it is delivering services. Rather, as is reflected in the recommendations, the intention was to assess what should be done systemically to improve services for girls. By necessity, however, DYS is the focus of much of the report – after all, the girls are in its custody and control. Nevertheless, it is clear to us that most of the identified issues are consequences of events, interventions or the failure to intervene before the girls were committed to DYS. Likewise, because the proposed solutions are systemic, they are not wholly, or even substantially, within DYS’s control. However, DYS has the keys to some important changes and the agency and its leadership have the respect and skills to play a significant role in the process of continued reform.

We very much appreciate the cooperation of DYS staff in assisting with this review. We offer particular thanks to DYS Director Walter Wood and General Counsel Dudley Perry.

ALABAMA’S JUVENILE JUSTICE REFORM

Alabama generally and DYS in particular have made excellent progress reforming many aspects of the State’s juvenile justice system during the past three years. The observations and recommendations in this report are offered in the context of an understanding of how much has been accomplished.

One of the ongoing challenges is for DYS to accomplish its goal to move from an agency that primarily manages juvenile correctional institutions to an agency that assists local communities to develop, manage and assess effective community-based services for youth to assure that as few youth as possible get placed in centralized secure placements.

In the three years since the landmark revision of the state’s juvenile code, Alabama has made great strides in transforming its juvenile justice system. For example, between 2008 and 2010, the number of youth committed to DYS has been reduced by approximately 25%. The daily population in DYS operated and contracted facilities also decreased by 46% from May 2007 to March 2011. The number of females confined in DYS custody has dropped 63% since 2007.

From fiscal years 2009 and 2011, DYS increased by 75% its budget for community non-residential programs. Through the use of a competitive bid process, DYS now awards grant-in-aid money for programs designed to meet the needs of youth in their communities and avoid potential incarceration. In 2010, DYS granted almost a million dollars to six counties committed to developing non-institutional services. For FY 2012, DYS has provided diversion grants in 47 of 67 counties in Alabama. By September 30, 2014 all existing DYS grantees must meet certain benchmarks for commitment levels in order to maintain their grant funding status.

DYS has provided solid leadership in reducing commitments and redesigning its grant-in-aid program, but more needs to be done to coordinate a trauma-responsive system of care.

THE REVIEW PROCESS

We (Dr. Beyer and Mr. DeMuro) met with the administrators of DYS’s Chalkville facility and the DYS contracted Working on Womanhood (WOW) program seeking their perspective and input on how to strengthen transition planning for girls served in these facilities. Each administrator provided an overview of her facility along with a walk-through of portions of the facility.

The following individuals met to discuss the Chalkville program with Dr. Beyer and/or Mr. DeMuro: Angie Toney, Campus Administrator; Dudley Perry, DYS General Counsel; and Alesia Allen, DYS Treatment Coordinator.

The following individuals met to discuss the WOW program with Mr. DeMuro: Dr. Virginia ScottAdams, Program Director; Karen Singley, Youth Services Institute (YSI) Director; and Dudley Perry, General Counsel. YSI, a project of the School of Social Work at The University of Alabama, administers the WOW program.

We conducted private interviews with five girls at Chalkville and four girls at WOW and reviewed the individual DYS records of twelve girls before traveling to Alabama.

In addition to student interviews and record reviews, we reviewed the following:

• Survey results completed by girls at Chalkville and WOW;

• Program description summaries of children and adolescent mental health providers, providers of therapeutic foster care and related services, DYS providers for girls, and select Jefferson County community providers;

• List of psychiatric residential treatment facilities for youth under the age of 21 licensed by the Alabama Department of Human Resources (DHR)

• Justice and Mental Health Collaboration Program (JMHCP) planning and implementation guide;

• Montgomery County JMHCP phase II master work plan;

• Abstract and research of ABSOP authored by Dr. Barry Burkhart;

• Data for child care facilities licensed or approved by DHR;

• Alabama Department of Children’s Affairs Children First Trust Fund 2010 Annual Update; and

• Smaller, Smarter, and More Strategic- Juvenile Justice Reform in Alabama, Annie E. Casey Foundation Juvenile Justice Strategy Group, May 2011.

ADAP assisted us to convene well-attended community meetings in Birmingham on November 9, 2011 and in Montgomery on November 10, 2011. Participants at these meetings included providers of intensive in-home services and therapeutic foster care, juvenile probation offices, local mental health authority case managers, juvenile defense attorneys, county child welfare officials, providers of youth mentoring services and DYS leadership. We jointly facilitated these discussions. Participants identified gaps in the community care system and suggested ways community providers could better collaborate to provide trauma-informed systems of care for girls in their communities prior to and discharging from the juvenile justice system.

RECOGNIZING THE CHALLENGES

Further reform efforts directed at Alabama’s juvenile justice system face serious challenges beyond the financial crisis that most states are facing. These challenges were reflected in the comments of the participants at the experts’ meetings with providers, court personnel and advocates in Birmingham and Montgomery and in the discussions with DYS staff and leadership. Our recommendations have been informed by the following observations about Alabama’s service system for delinquent girls.

1. There is no system of care. As is true in many states, services to girls are often more hit or miss than systematic. Responsibility is fractured and dispersed. In some cases, particularly as related to post-discharge care, no one agency is in charge. There are marked differences in service availability based on geography, and rural areas, not surprisingly, having the fewest services. Even where helpful services do exist, they are still inaccessible because too often a particular girl does not meet narrow eligibility criteria.

2. Providers consistently told the experts that there are not enough community-based services to ensure that girls’ needs are met in the community in a way that ensures public safety.

3. Gains made in DYS custody are often lost. No single state agency, including DYS, has responsibility for a girl on her release from Chalkville or WOW. Juvenile Probation Officers (JPOs) are responsible for arranging transition services for girls as they move from DYS to the community. Not surprisingly, even the best JPOs have difficulty finding appropriate services for many girls on their discharge. DYS’s statutory authority is limited and in some cases no other state agency is mandated to step in for a girl, particularly when her time with DYS is complete.

4. Because decisions about girls are made locally, at a county level, there is often inconsistency based on geography.

5. There is a general lack of understanding of the impact of trauma on the girls in the juvenile justice system and about interventions that are effective in working with traumatized youth. Although there are commendable efforts to train staff and develop appropriate programming, the service system still has a long way to go in this regard.

6. Many of the complaints filed against girls are related to problems in school. With some exceptions, providers reported that it was often difficult to engage with schools.

These challenges, of course, are not unique to Alabama. What is unique is that the state has already made significant progress and reforming its juvenile justice system. Therefore, these problems, though very difficult ones, can be addressed in the context of reform by state and private partners who are already committed to change and know how to make it happen.

Working on Womanhood (WOW)

The WOW program at the former Tuscaloosa County Juvenile Detention Center is a secure program for girls operated by The University of Alabama School of Social Work pursuant to a contract with DYS. The program has a capacity for sixteen girls. The WOW program has all the trappings of a high secure facility, with two eight-bed living units. The WOW program has been very slow to develop. Although it has been operating for over ten months, on the day of the site visit only four girls were in the WOW program. The WOW program is heavily staffed and has more than sufficient resources to offer several program enhancements. For example, girls can get their hair done every other week. On the weekend, girls working with staff can prepare and cook special meals. Girls with special needs, like the need for speech therapy, are taken for individual professional consults on the community.

The WOW program is designed to provide intensive residential services to committed girls with severe emotional difficulties. The program is designed to use gender-specific, outcome-driven interventions designed for adolescent females with a history of delinquent behavior and mental health related issues.

Since it began, the WOW program has had problems developing and maintaining a consistent approach. Girls interviewed noted that the program rules seem to change regularly. There also has been a high degree of staff turnover. There is a pronounced unresolved conflict or paradox between a traditional, high-security facility complete with the hardware and security cameras and a staff-enriched, treatment program. When girls leave the facility for medical or other clinical consultations in the community, they are placed in handcuffs and leg irons which they must keep on even during community clinical consults. Like Chalkville, the WOW staff acknowledged that it was difficult, if not impossible, to develop and implement an individualized, trauma-informed treatment program that would support a girl when she returned to the community.

The girls in WOW report feeling relatively safe. However, they complain of inconsistent and everchanging rules. They report feeling “unconnected” to staff and stated they could not trust them. The girls had difficulty identifying the specifics of their treatment program when asked.

Although it was based on a checklist format that did not promote individualization, the Crisis Prevention Treatment Plan at WOW could help a girl recognize the things that upset her (such as feeling disrespected or arguments), what her early warning signs were (such as screaming, crying, cursing), and what triggered her (such as being teased, not being listened to or someone putting their hands on her). These could be used to notify staff of when and how to de-escalate each girl. Discussion with the girl could lead to her tailoring a “How to cope” reference for herself when she gets upset before she escalates, especially if they were connected to her trauma treatment work so she could separate past trauma from present provocation.

Chalkville

Chalkville is a juvenile correctional facility located on 575 acres in northeast Jefferson County near Birmingham. According to the DYS website, Chalkville was founded in 1909 by the Protestant Women of Birmingham, was first known as “The Rescue Home” and later as “The State Training School for Girls.” It became a State facility in 1911. In 1937, after several different locations in Birmingham, the program settled in its present site at Chalkville. The facility is an old, large, traditional training school with many physical plant problems (e.g., rusty water, problems with mold, with impersonal “cottage” like living settings for the girls.) Thus, Chalkville is very costly to maintain.

Chalkville maintains a capacity for sixty adjudicated females between the ages of twelve and eighteen, although the census is, and has been for some time, far below capacity. The Chemical Addiction Program (CAP) provides for intensive drug and alcohol treatment. Dialectical Behavior Therapy (DBT) is the primary foundation for service delivery at Chalkville. DBT is an evidence-based treatment model for individuals who have difficulties controlling their emotions and behaviors. Students attend a school on the grounds.

Although the girls had lengthy psychological evaluations and psychosocial assessments after they arrived at Chalkville, all concluded with the same recommendations for the same list of interventions. Services were often not tailored to their individual needs. Despite their multiple trauma histories described in the Chalkville psychosocial assessment, the final psychological evaluation concluded with the same diagnosis of Conduct Disorder for all the girls except one. Most of the girls had prior hospital evaluations with different diagnoses which should have been reflected in the Chalkville diagnostic formulation, at least “by history.” The diagnosis of Conduct Disorder is a descriptor that applies by definition to committed delinquents and is not helpful in designing individualized services.

The Chalkville treatment plans were formulaic, often using identical wording for girls who had different characteristics. Furthermore, the treatment plans were full of jargon and could not have been understood by most of the girls. As a result, the girls have difficulty articulating what they are working on at the facility. For example, one of the girl’s treatment plans, common to many others, listed the following unclear “goals”: “Anger and other feelings; Aggressive behavior; Ability to make good decisions (healthy relationships, substance use).” The typical simplistic Chalkville service plan was: “Anger management (DBT emotion regulation, distress tolerance, mindfulness; thinking errors, coping skills; counseling). Self-esteem. Improve school performance.”

The treatment planning process is an opportunity to educate a girl about the impact of trauma on her behavior to begin the process of trauma recovery and behavior change. Likewise, treatment planning explains learning problems to a girl so she understands what it will take for her to be successful in school.

The girls’ anger, including thinking errors, emotion regulation and distress tolerance, are not just a behavior problem in the present. Their anger comes from being hurt, sad, scared and powerless in the past when they were moved, abused and lost important relationships and were exposed to violence. Unless adults arrange an environment to meet their needs, their predictable reflexive reaction will be provoked repeatedly. Furthermore, girls with a history of trauma have high rates of alcohol and substance abuse to escape bad memories. Substance abuse education emphasizing abstinence not connected to trauma treatment for the feelings they are self-medicating is not likely to be effective. Learning new coping skills will help, but their behavior is unlikely to change if what is emphasized is simple self-control—until they understand it through trauma treatment, they will continue to get overwhelmed with feelings from the past.

An effective program helps a girl identify her trauma-related, learning-related and other needs behind her behaviors and what each staff person will do to meet her needs. Treatment does not occur primarily with the therapist or case manager, but in the school and unit where the girl spends most of her. All the staff must use the same trauma-informed, developmentally-sound words to communicate with the girl and each other. If her behavior continues, discussion of what need might not have been identified and/or what else staff could be doing to meet needs must occur. A trauma-responsive program for girls requires both a therapist trained in providing individual trauma treatment and an integration of the understanding of reactivity, anxiety and depression into the daily unit and school programs. Trauma treatment begins not with the trauma symptom checklist (on which girls often do not give valid answers) but with the girl developing an accurate trauma history. The notes from unit staff in the girls’ Chalkville records reveal that the staff often triggers girls and girls continually trigger each other, and that the staff response is punitive. Trauma terms or DBT coping skills are seldom in the staff write-ups about the girls’ behavior. It was not evident that the Chalkville program helps girls make a connection between past trauma and their reaction to provocation in the present.

The girls at Chalkville reported that they felt safe. Girls complained that when they are on Zero Level they spend most of the weekend in their room, essentially as a form of isolation. Most girls appear to spend week after week on Zero Level which strongly suggests that it is an ineffective intervention. Gender-specific programming around the country recognizes that girls do not benefit from level systems. Instead, programming for girls is relationship-centered, trauma-informed, and emphasizes praise rather than punishment in an emotionally safe environment.

Many of the girls at Chalkville have made educational gains. It was not evident from the records which girls had current individualized education plans (IEPs) at Chalkville and what special education services were being provided. Simply offering instruction at the girl’s actual reading and math level (whether it is 2nd grade or 6th grade or higher) is not sufficient if the girl has processing, organizational or other learning disabilities. Furthermore, behavior problems in school must be treated using the same trauma-informed approach as on the unit. One girl had earned GED at Chalkville and another was progressing in the GED preparation book. Another was frustrated with the lack of a GED program or a GED teacher at Chalkville.

Six of the seven Chalkville residents are prescribed medication cocktails. One takes Abilify (anti-psychotic), Trazadone (anti-depressant), and Prozac (anti-depressant); one takes Seroquel (anti-psychotic), Celexa (anti-depressant), and Focalin (ADHD); one takes Trazadone, Prozac and Vyvanse (ADHD); two take Trazadone and Seroquel; one takes Seroquel and Zoloft (anti-depressant). Medical records were not inspected to determine whether the psychiatrist is prescribing, as required, for diagnoses other than conduct disorder indicated in their Chalkville assessments.

A SYSTEM OF CARE FOR GIRLS

A system of trauma-informed services designed to meet their unique needs was not available for girls before they entered Chalkville and WOW and was highly unlikely to be provided after they left the facilities in their urban and rural communities in Alabama. It appeared that none of the girls had received trauma treatment prior to commitment (except possibly the girl who had multiple long-term residential treatment), nor had their families or other caretakers been included in treatment to learn how to meet the trauma-related needs. Most had been discharged from psychiatric hospitals without adequate assessment of the effects of past trauma or referrals for specialized treatment. It was evident that the girls’ emotional needs from disrupted care giving, abuse, and loss were greater than could be treated with typical outpatient services to which they were referred by the hospitals, DHR and probation. Too often symptoms from trauma were misinterpreted as part of the character of the girl, rather than a guide to what was behind behavior that could have changed.

Trauma typically slows down development in children and can interfere with all aspects of functioning, causing disturbances of emotional regulation, social relationships and attachment. Girls who have been abused or were not protected from violence often blame themselves and have trouble trusting others. Girls who are exposed to disrupted care giving (separation from their families and multiple foster homes) are at risk for continued difficulty in emotional regulation and deficits in cognitive processing. While other children are growing emotionally, girls coping with trauma are distracted from normal developmental tasks and are preoccupied with sadness and feeling powerless. Depression is common but often not diagnosed in traumatized girls. Their behavior problems become the focus rather than their underlying sadness, isolation and loss.

Aggression can be a defense against the helplessness typical among traumatized girls. Traumatized girls may misinterpret and be offended by relatively benign things that others say and react with combative self-preservation. They react negatively to outside controls and are often labeled oppositional. Traumatized girls may not be able to stop these reactions because they see controlling adults as mean and unfair, to which past abuse has made them acutely sensitive. When adults hurt them, they reflexively protect themselves; even if the adults believe they are controlling a situation, the girl automatically reacts as if back in the position of being victimized. When their feelings are hurt they are flooded with anger from the past which they are unaware is out of proportion to the present provocation, and they lack the ability to calm themselves. Multiple placements cause more loss and anxiety, provoking fear reactions and reinforcing sensitivity to rejection and perceived unfairness.

It was impossible to ascertain from the record review which girls had IEPs before entry into Chalkville for learning disabilities or behavior problems. Except for one girl reading and doing math at the 12th grade level, all the girls had substantial discrepancies between their grade level and their reading or math level, indicating the necessity for special education testing. Girls with prenatal substance exposure would likely have processing and organizing problems, which would affect both learning and behavior and require special services.

Several of the girls reported making progress in anger management, emotional regulation, education about substance abuse, and school at Chalkville, but there is not sufficient continuity of care so their gains can continue when they return to the community. Chalkville case managers make referrals for outpatient mental health services and communicate educational needs to probation officers, but girls return to the limited services that were insufficient to meet their needs before they went to the facility. At Chalkville they have learned the jargon of DBT, but in the community there may be no one to remind them of “mindfulness,” “time away” and other coping skills to avoid family and peer conflict. Many of their parents are too far away from Chalkville to have been involved in treatment, and outpatient family counseling is unlikely to be adequate for the family conflict that led to their domestic violence and running away. Some of the older girls want to avoid family conflict by independent living which may not be available or sufficiently supportive given their continuing emotional neediness. Being successful in school is more likely for those girls advanced enough to apply to community college than those who require individual assistance not available in high school. Lessons learned at Chalkville and WOW could be applied to the parenting role of the two girls who are mothers, but they are likely to get insufficient support to cope with stresses associated with their children.