Program Profile: Jefferson County Community Partnership (Birmingham, Ala.)

Offers a wide array of services for youth with serious emotional disturbances to reduce youth's contact with the juvenile justice system. The services are accessible, community-based, individualized, culturally competent, and include an individual’s family in the planning and delivery of treatment. The program is rated Promising. The program was shown to statistically significantly reduce youths’ contact with the juvenile justice system.

A Promising rating implies that implementing the program may result in the intended outcome(s).

A Promising rating implies that implementing the program may result in the intended outcome(s).

Program Goals/Program Components

Using a system-of-care concept, the Jefferson County Community Partnership in Birmingham, Alabama, offers a wide array of services for youth with serious emotional disturbances. The services are accessible, community-based, individualized, culturally competent, and include an individual’s family in the planning and delivery of treatment. Overall, the goal of this collaborative approach is to reduce youths’ contact with the juvenile justice system. This includes reducing the odds of future offending and decreasing the seriousness of offenses, if they were committed (Matthews et al. 2013).

The Jefferson County Community Partnership is not a “program” in the traditional sense. It is not intended to produce a replicable model with a discrete, manualized treatment protocol or a treatment intervention that directly improves child and family outcomes. Further, it is not intended as a single program, but as a collaborative framework that operates within a system-of-care concept. The intent of this concept is to provide guidance to service and delivery systems for children with mental health challenges through a coordinated network of services across agencies. The system-of-care concept has the following core characteristics: 1) it is family-driven and youth-guided, centering on the strengths and needs of the child and family when determining the types of services to provide; 2) it is community-based, with the services and the management system located within a supportive, adaptive network of structures, processes, and relationships at the community level; and 3) it reflects the cultural, racial, ethnic, and linguistic makeup of the target populations to ensure access to and use of appropriate services (Stroul, Blau, and Friedman 2010). Overall, through interagency collaboration and coordination among child-serving agencies, the Jefferson County Community Partnership aims to develop a seamless system-of-care for children with serious emotional disturbances (Children’s Mental Health Network 2014).

Program Theory

Youths with serious emotional disturbances may experience other problems, such as in school or being involved in the juvenile justice system. As a result, these youths typically receive services from a variety of agencies, yet, the individual agencies are not likely to communicate or coordinate with one another. This lack of collaboration causes youths to be placed in more restrictive environments than necessary, where punishment rather than treatment is the primary goal. 

The system-of-care philosophy emerged to address this problem. This approach suggests that service delivery systems offer a wide array of services that are accessible, community based, individualized, culturally competent, and include the family in treatment planning and delivery. These services should be provided in the least restrictive setting possible. In addition, because of the variety of services required to address the needs of youths with serious emotional disturbances, and the number of contacts with various child-serving agencies that they and their families experience, service coordination and interagency collaboration are critical. Thus, agencies in various child-serving sectors (i.e., mental health, education, juvenile justice, and child welfare) should work together to provide the services needed (Grisso, 2008, Hansen et al. 2004).   

Target Population

Youths with serious emotional disturbances include those who have had, in the past year, a mental, behavioral, or emotional disorder that meets the criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Further, as a result of their impairment, major life events for these youths, such as family, school, or community, are negatively impacted (Holden et al. 2005; SAMHSA 1993).

Study

To investigate the effectiveness of systems-of-care in reducing the likelihood of juvenile justice involvement among youths with serious emotional disturbances, as well as the ability to reduce the seriousness of crimes, Matthews and colleagues (2013) used a quasi-experimental design. The treatment group (system-of-care community) comprised 202 youths from the Jefferson County (Ala.) system-of-care program (which was receiving federal funding).The comparison group comprised 189 youths from the matched communities in Montgomery, Lowndes, Elmore, and Autauga counties that are served by the Montgomery Area Health Authority. The treatment group was 62 percent male, whereas 56 percent of the comparison group was male. Further, both the treatment group and comparison group were predominately African American (61 percent and 66 percent, respectively). Youths in the treatment group were older than youths in the comparison group, as the average age of the youths in Birmingham was 13.8 years and the average age of the youths in Montgomery was 11.5 years.

Communities were matched on characteristics such as the service delivery approach; rate of child enrollment; child referral patterns; and geographic, demographic, and economic characteristics. Communities were also matched on population size, per capita income, child age distributions, racial and ethnic composition, size of the catchment area, percentage of people living below the poverty level, and percentage of adults with a high school education. Finally, juvenile justice, mental health, and special education services were used in the selection of communities.

Official juvenile justice records were compiled using administrative data from the Jefferson County Family Court and the Montgomery Area Probation Administration Office. Contact with the juvenile justice system was measured whether or not the court officially processed the case. For example, contact was defined as at least one charge including status offenses, technical violations, and property or violent offenses identified in the court record, whether this charge occurred before or after intake into the system-of-care at the treatment site, or with mental health services at the comparison site. The User’s Guide to Alabama Juvenile Justice Case Records was used to classify offenses into Part I and Part II. Part I offenses are generally more serious and include violence and property crimes, such as burglary or aggravated assault. Part II offenses are less serious and may include receiving stolen property; possession of a weapon, drugs, or both; trespassing; and status offenses.

Data was collected 18 months prior to intake and 18 months following intake. A difference-in-differences estimator was used to determine whether contact with the juvenile justice system declined over time as a result of the system-of-care approach. Gender, race, income, physical abuse, sexual abuse, substance abuse, running away, psychiatric hospitalization, suicide attempts, and clinical functioning were controlled for in the study. Clinical functioning was measured through the Child and Adolescent Functional Assessment Scale, which assesses the degree to which a child’s emotional, behavioral, or substance abuse disorder is disruptive to his or her functioning in each of eight psychosocial domains. Caregivers reported on the participants’ functioning during the past 6 months in regard to the following:  at school/work, at home, in the community, behavior toward self and others, moods/emotions, self-harmful behavior, substance use, and thinking. The level of impairment was scored as follows: 0=minimal to no impairment; 10=mild impairment; 20=moderate impairment; and 30=severe impairment. The Behavioral and Emotional Rating Scale (BERS) was also used to identify the emotional and behavioral strengths of the youths. BERS concentrates on the strengths of youths in interpersonal and intrapersonal areas, family involvement, school functioning, and their affective strengths. Caregivers responded to 52 statements on how well the item described the child’s behavior in the past 6 months: 0=not at all like the child; 1=not much like the child; 2=like the child; 3=very much like the child. No subgroup analysis was conducted. 

These sources were used in the development of the program profile:

These sources were used in the development of the program profile:

Children’s Mental Health Network. 2014. Jefferson County Community Partnership Children Overcoming Problems Everyday (COPE).

Foster, E. Michael, Robert Stephens, Anna Krivelyova, and Phyllis Gamfi. 2007. “Can System Integration Improve Mental Health Outcomes for Children and Youth?” Children and Youth Services Review 29:1301­­–19.

Holden, W. E., R.L. Stephens, and R. L. Santiago. 2005. Methodological challenges in the national evaluation of the comprehensive community mental health services for children and their families program. In R.G. Steele and M. C. Robert (eds.). Handbook of Mental Health Services for Children, Adolescents and Their Families. New York, NY: Kluwer Press, 387-401.

Stroul, B., G. Blau, and R. Friedman. 2010. Updating the System of Care Concept and Philosophy. Washington, D.C.: Georgetown University for Child and Human Development, National Technical Assistance Center for Children’s Mental Health.

Substance Abuse and Mental Health Services Administration.1993. “Final Notice Establishing Definitions for (1) Children with a Serious Emotional Disturbance, and (2) Adults with a Serious Mental Illness.” Federal Register 58(96):29422–25.