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Program Profile: Connections

Evidence Rating: Promising - One study Promising - One study

Date: This profile was posted on January 17, 2013

Program Summary

A juvenile court-based program designed to address the needs of offenders on probation who have emotional and behavioral disorders and the needs of their families. The approach is meant to be an integrated, seamless, coordinated system of care for children with mental health problems. The program is rated Promising. The intervention youth were significantly less likely to recidivate, commit a felony offense or serve time in detention.

Program Description

Program Goals
Connections is a juvenile court-based program designed to address the needs of juvenile offenders on probation who have emotional and behavioral disorders and the needs of their families. The program’s goal is to connect youths and families with local resources to reduce youths’ risk of recidivating. Connections uses the Wraparound Model to engage with youth, their families and service providers. Youth and family teams are convened to identify needs and coordinate services with multiple service providers for youths and families who have complex needs. Services may include family therapy, clinical therapy, substance abuse treatment, special education, medication, caregiver support, public assistance, housing, and mental health care. In theory, the program treats its target population in a holistic way by participating in cross-system collaboration using Wraparound to ensure youths do not recidivate.

The program was developed in Clark County, Washington. The county applied for and received the Comprehensive Community Services for Children and Their Families Program grant from the Substance Abuse and Mental Health Services Administration’s Center for Mental Health Services. The system-of-care grant supports efforts to design an integrated and coordinated system for children and juveniles with mental health problems. With the grant, Clark County was able to enhance and develop a wide array of mental health services. There was commitment of the Judges, administration and county commissioners. The Clark County Juvenile Court was able to sustain the Connections program after the system of care grant ended, and it operates under the same philosophy and practice as when it started in 2001.

Target Population
The targeted population includes juvenile offenders who are seen as “high risk” or likely to reoffend that also have mental health issues. Youth are referred to the Connections program by any juvenile justice staff member. To be eligible, juveniles must have 6 months or more probation time remaining, have a diagnosed or diagnosable behavioral health disorder, receive services in more than one system (i.e. the juvenile justice system and the mental health system), and they must be assessed as having a moderate to high risk to reoffend. Risk of reoffending is determined by juveniles’ scores on the Washington State Juvenile Court Assessment. All referrals are considered by the care coordinators and the clinical psychologist, who ensure that youth meet the criteria for inclusion in the program. If youth are eligible, an initial wraparound team meeting occurs within 30 days of intake.

Program Activities
Activities provided to youth include crisis stabilization, parent/partners programming, family support and training organization, interagency meetings, and increased access to flexible funding (flexible funds are used for nontraditional services such as general equivalency diploma testing, respite care, clothing, or transportation). The child and family teams meet monthly or as needed, depending on what services are required for youth to be successful in the program. Youth are generally discharged from the program at the end of their probationary period. Three months prior to discharge, youth begin to transition out of Connections, to ensure they are connected with community service providers and other necessary resources.

Key Personnel
Key personnel involved with the program include a mental health care coordinator, family assistance specialist, probation counselor, juvenile services associate, and staff clinical psychologist. All team members hold a number of supportive roles which include facilitating meetings with participants and their families, emotional and practical support, supervision, counseling, and getting in contact with natural support systems. For immediate support, the family assistance specialist and mental health care coordinator are both available 24 hours a day 7 days a week.

Evaluation Outcomes

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Study 1
Any Offense

Pullman and colleagues (2006) found that youth in the Connections program intervention were significantly less likely to recidivate. Youth in the comparison group were 2.8 times more likely to commit any type of offense compared with youth in the Connections program.

Felony Offense
Youth in the comparison group were also three times more likely to commit a felony offense compared with youth in the Connections program.

Days in Detention
Youth in the Connections program were significantly less likely to have served time in detention during the follow-up period (790 days). Only 72 percent of Connections youth served some days in detention, compared to 100 percent of the comparison group. Connections youth also served significantly fewer days in detention compared with the comparison group (59 days versus 102 days, respectively).
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Evaluation Methodology

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Study 1
Pullman and colleagues (2006) used a quasi-experimental design to assess the effectiveness of the Connections program. Participants were court-referred youth in Clark County, Washington. The sample was primarily white (88 percent) and male (72 percent) with the average age of 15.4 years old. The intervention group comprised of 106 youth was compared with a historical data sample of 98 youth. The historical data sample was originally made up of 110 youth who were a part of both the juvenile justice system and mental health system. Out of the 110, 98 did not become a part of the Connections program and were used as a comparison group due to aging out of services, discharge from probation, moving out of the county, or exhibited significant changes and no longer met criteria. The intervention group was formed based on the first 106 referrals that entered the Connections program. There were no significant differences between the intervention and comparison group on age, race, gender, and age at first offense. However, on average, youth in the Connections group had one more prior offense compared to youth in the comparison group.

The intervention sample in Connections received an array of individualized services depending on the needs and circumstances of the youth and their family. The comparison group received no services since data was historical and gathered prior to intervention.

The primary outcome of interest in the study was recidivism, which was measured in two ways: (1) the number of days between identification and any type of subsequent substantiated offense (including probation violations, misdemeanors, and felonies); and (2) the number of days between identification and a substantiated felony offense. Data was obtained from the juvenile justice management information system that contains the records of all juvenile court-referred youth in Clark County. Youth who entered Connections in the first two months of the program were included in the analysis, to ensure for a long follow-up period. This allowed for at least 790 days of follow-up data of both groups.

Analytical methods used included Cox regression time-to-event analysis (also known as survival analysis), chi-square tests, and t-tests. Limitations were present due to use of a non-randomly assigned control group causing a threat to internal validity.
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There is no cost information available for this program.
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Implementation Information

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Staff members received a 3 day training prior to program implementation, and were provided additional trainings bi-monthly or as needed thereafter. Additionally, supervisors and staff on-site provided feedback during implementation. Connections officially began serving youth in October 2001. Project operations began with four teams, each working with 30 families. The number was then reduced to 25 when Connections team members discovered 30 families per team was arduous. During the first year of the program 164 youth received services in Connections (Pullman, et al. 2006).
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Evidence-Base (Studies Reviewed)

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

Study 1
Pullman, Michael, D., Jodi Kerbs, Nancy Koroloff, Ernie Veach-White, Rita Gaylor, and DeDe Sieler. 2006. “Juvenile Offenders With Mental Health Needs: Reducing Recidivism Using Wraparound.” Crime and Delinquency 52(3):375–97.
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Related Practices

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Following are practices that are related to this program:

Wraparound Process for Children with Serious Emotional and Behavioral Disorders
This practice is a team-based, collaborative process for developing and implementing individualized care plans for youth with serious emotional and behavioral disorders and their families. The practice is rated Promising for improving mental health outcomes, but rated No Effects for measures related to youths’ living situations, school functioning, and recidivism outcomes.

Evidence Ratings for Outcomes:
Promising - One Meta-Analysis Mental Health & Behavioral Health - Multiple mental health/behavioral health outcomes
No Effects - One Meta-Analysis Family Functioning - Living Situation
No Effects - One Meta-Analysis Education - Multiple education outcomes
No Effects - One Meta-Analysis Crime & Delinquency - Multiple crime/offense types
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Program Snapshot

Age: 14 - 17

Gender: Both

Race/Ethnicity: White

Geography: Suburban

Setting (Delivery): Other Community Setting

Program Type: Cognitive Behavioral Treatment, Family Therapy, Probation/Parole Services, Wraparound/Case Management

Targeted Population: Mentally Ill Offenders, Young Offenders, High Risk Offenders, Families

Current Program Status: Active

Listed by Other Directories: Model Programs Guide

Program Director:
Pat Escamilla
Juvenile Court Administrator
Clark County Juvenile Court
500 West 11th St
Vancouver WA 98666-5000
Phone: 360.397.2201 ext: 4035
Fax: 360.397.6109