Hello and welcome. My name is Dr. Regina James and I'm the Deputy Medical Director and Chief for the Division of Diversity and Health Equity here at the American Psychiatric Association. I'm pleased that you are joining us today for Striving for Excellence webinar series and today's series is titled Justice Involved Youth and Juvenile Competency. Next slide please. So on this slide you will find the funding and the disclaimer statement and on the next slide the webinar has been designated for one AMA PRA category one credit for physicians and credit for participating in today's webinar will be available for 60 days. Next slide. So the PDF of the slides will also be available and you can find them in the chat tab and next slide and captioning for today's presentation is available. So to enable the captions click show captions at the bottom of the screen click the arrow and select view full transcript to open the captions in a side window. And in terms of questions and answers please feel free to submit your questions through the presentation by typing them into the question area and that's found in the attendee control panel and we'll reserve about 10 to 15 minutes at the end of the presentation for questions and answers. So now our guest speaker I have the delightful pleasure to introduce Dr. Kiana Andrew-Traig. She is an assistant professor within the Department of Psychiatry and Behavioral Sciences at Tulane University School of Medicine in New Orleans Louisiana her hometown. She is board certified in general child and adolescent and forensic psychiatry. She currently serves as the director of the women's unit at the Eastern Louisiana Mental Health Systems. She's also the site director at the Juvenile Justice Intervention Center and she's also co-associate program director for the general psychiatry residency program. She conducts competency evaluations for juveniles and her interests include women's mental health and forensic settings, juvenile competency, juvenile delinquency alternatives, anxiety disorder in teens, and adolescent forensic evaluations. Please welcome Dr. Traig. Good afternoon everyone and thank you Dr. James for the introduction. I'd also like to thank at this time the American Psychiatric Association and the Morehouse School of Medicine for inviting me to speak on this very important topic. In this presentation I'll give a brief history of the juvenile justice system and I'll also give you all some stats on juvenile offending and explain the juvenile competency process. And I have no financial interest or arrangements to disclose. Sorry about that. Okay so the history of the juvenile justice system. We can begin with the Puritan era. This occurred between 18 I'm sorry 1646 and 1824 beginning in the mid 15th century when English colonists arrived they brought with them the English justice system and their juvenile justice system was based on the philosophy of patrios potestas which means power of the father. Fathers held total authority over their children and family members. And then also later on the poor laws and the stubborn child laws were also passed during this time. Under the poor laws children who displayed delinquent behavior were subject to forced labor. Under the stubborn child laws the concept of a status offense for minors was created and enforced. According to how the stubborn child law a child seven or younger wasn't able to be convicted or charged of a felony but once they turned eight they could be formally charged with that same for that same felony that occurred when they were seven or younger and be tried as an adult. Now within the refuge era which occurred between 1824 and 1899 separate institutional settings for juveniles were created which included foster homes group homes and houses of refuge. Social reformers during this time began to focus on rehabilitation leading to the creation of the house of refuge in New York in 1824 and the creation of the first juvenile court system in 1899 in Illinois. Now reformers during this time they believe that delinquent behavior was due to poverty crime and other social stressors and they believe that children were inherently good. Also during this time as you know slavery ended and society was trying to determine how to address these same issues in juveniles of color. Juveniles of color did not have access to these services. Now while the first house of refuge was created in New York in 1824 the first such institution for African American juveniles which was the house of refuge for colored children was not created until 1850 in Philadelphia. Even though these houses were created for you know African American youth scores of deaths of African American children were unaccounted for and that was primarily due to poor nutrition poor living conditions and neglect within these homes. Then there was the progressive era which occurred between 1899 and 1960. Now the Illinois juvenile court act of 1899 was passed designed to regulate the treatment and the control of dependent neglected and delinquent children. This led to the creation of the nation's first juvenile court in Chicago. In addition to environmental factors being considered when addressing delinquent behavior judges began to take on the role of concerned caregiver. Also keep in mind that like all African Americans at this time black youth were considered by the dominant hegemonic society to be inferior and were not seen as innocent or worthy of rehabilitation. As a result it was a commonly held practice to send black youth to chain gangs and prisons while sending white youth to more rehabilitative institutions. Next slide. The history of a juvenile justice system continued. Now during the due process era which occurred between 1960 and 1980 juvenile courts began to kind of deteriorate and their mission was so to speak kind of lost. Juveniles were subject to more punishment and criminal proceedings were civil in nature. As juveniles did not have due process they really didn't have rights. They didn't really have any rights. But this changed because of Henry Gault. Now Henry Gault is a U.S. Supreme Court landmark case. It was decided in 1967. This led to the basically it held that proceedings for juveniles had to comply with the requirements of the 14th amendment meaning that juveniles they basically they had to be given due process. These requirements included adequate notice of charges, notification of both the parents and the child of the juvenile's right to counsel, the opportunity for a confrontation and cross-examination at hearings and adequate safeguards against self-incrimination. Now this was decided after an appeal on behalf of a 15-year-old in Arizona. His name was Gerald Gault. He was arrested for allegedly making a lewd phone call to an older elderly female neighbor. Now he was arrested along with one of his other friends. His parents were not notified. He was not read any rights. He didn't have an attorney present and the victim never appeared to identify him in court. And at the end of three hearings Mr. Gault was sentenced to six years at the state industrial school until he reached the age of 21. Now if he had been an adult the maximum sentence would have been basically for the same crime it would have been two months in jail and a $50 fine. See and basically you know went all the way up to the Supreme Court. It was remanded back to the lower courts and his sentence was vacated. There's also the Juvenile Delinquency and Prevention Control Act of 1968 and the Juvenile Justice and Delinquency and Prevention Act of 1974. Now the former was passed to implement programs at the community level to address and discourage juvenile delinquency and the latter was passed to establish the Office of Juvenile Justice and Delinquency Prevention to support local and state efforts to prevent delinquency and improve juvenile justice systems. Then later there was the tough on crime era and this occurred pretty much for the most part during the 1990s and there were increases in juvenile crime. We began to see school shootings you know basically appearing in the news more and the term juvenile super predator was was coined and basically it led to heightened fear and harsher laws. Now the infamous term super predator was coined by a man by the name of John DiLulio. He was a at the time he was a professor at Princeton. He predicted that a wave of callous and violent young offenders was on the horizon. According to Mr. DiLulio quote a super predator is a young juvenile criminal who is so impulsive so remorseless that he can kill, rape, maim without giving it a second thought. He later disavowed this theory. See and then there's the juvenile justice reform era occurring in the 2000s to the present. The Office of Juvenile Justice and Delinquency and Prevention their bulletin they put out in February 2000 entitled Juvenile Justice Bulletin acknowledged that the threat of juvenile violence and delinquency was grossly exaggerated you know in the 1990s. Now pretty much during this time you've had there was a focus on you know rehabilitation. I know in basically 2016 when I came back to Louisiana there was the Raise the Age Act RTA which basically allowed juveniles at the time if you were 17 you could be transferred or you could just be basically placed in adult adult jails but they raised the age of 18. So if you were 17 you could be placed in a juvenile setting instead of an adult jail. And one more thing to keep in mind is that pretty much because of some of the current headlines which I'm going to focus on in my next slide there's been somewhat of a reverse trend. There have been like an increase in laws that have tried to kind of you know basically penalize and enforce harsher you know harsher laws and sentences on adolescents. An example in Louisiana was the basically was HB 321. Now this is a bill it was aimed to make juvenile arrest information public you know basically it was going to make it public through some type of proposed new pilot program. And as you know juvenile arrest records were supposed to be sealed. Now it was a pilot program but it was basically going to target three areas with the state's largest majority of black populations New Orleans, Baton Rouge, and the Shreveport area and it died in committee. And you know if you all you know we all kind of have a foundation of science and if you know anything about a pilot program it should have been within maybe all parishes and a certain percentage applied but they wanted to target you know basically the three largest majority black black cities in Louisiana and it died in committee. Okay next slide. So these are some current headlines around the country and it kind of shows that juvenile crime is you know it's on the rise. On August 27, 2023 a 16 year old female was arrested in the fatal stabbing of another 16 year old female in Washington DC. On May 6, 2023 four teenagers intended to rob an individual but they allegedly murdered a Chicago police officer by the name of Ariana Preston. Three of them were 18 and above and the 16 year old is being charged as an adult. On April 12, 2023 right here in New Orleans an 11 month old girl and her 12 year old brother were forced out of their pork car during an armed carjacking in New Orleans and three teens were held responsible. Okay let's do the numbers. Okay next slide. In 2020 law enforcement agencies in the United States made over 424,000 arrests of persons younger than 18. 29% were of females, 29% were of individuals under the age of 15, 64% were Caucasian and 32% were African-American. 930 arrests were made for murder and non-negligent manslaughter. 8% were female, 10% were under the age of 15, 39% arrests were of individuals who were Caucasian and 58% were of individuals who are African-American. Now arrest of juveniles peaked in 1996 at nearly 2.7 million. Arrests of juveniles have since declined. The number in 2019 was 74% below the 1996 peak. Male and female juvenile arrest rates have declined in the last 10 years. However the relative declines for males, they've been greater for males than for females across many offenses. Next slide. Juveniles and racial disparities. In 2020 the total delinquency case rate was greater for American Indian youth being 7.2 than for white and Hispanic youth being 12.9 and 12.8 respectively. And when I say the delinquency case rate that's basically 7.2 for every 1,000 American Indian youth. That's 12.9 for every 1,000 Caucasian youth. However the case for Black youth which was 36.2 was at least double their rates, the rates that I just mentioned, and nearly 12 times the case rate for Asian youth which was 3.1 per 1,000 Asian youth. In 2020 cases involving person offenses were more likely than other offenses to be waived to adult court for youth of all races. 1.2% among white youth, 2.7% among Black youth, 1.7% among Hispanic youth, 1.5% among American Indian youth, and 1.9% among Asian youth. And when I say person offenses that basically means an offense where there's a human involved. And when I say waived to adult court that basically means transferred to adult court. Judges gave Black youth prison sentences that were on average 7.8% longer than the prison sentences they gave to white youth for the same type of offense. And prosecutors are 20% more likely to formally petition in cases involving Black girls than in cases involving white girls. So basically, you know, a kid can be arrested, picked up, and when they're arrested they can, you know, the police can say or the parents can kind of come and pick them up and they don't necessarily have to stay in the detention center. And then also once they get to the detention center within 72 hours they have to have some sort of like a detention hearing. Then at that point, you know, they can just even after that point they can go home. But if they proceed with, you know, like adjudication then that's when it's basically like a formal petition. And that's what that means. That's what that means. Next slide. These are some key terms. Juvenile. A juvenile is one not seen as an adult by the criminal court. And as I mentioned before, in Louisiana, it's now 18 thanks to Senate Bill 324, which is Raise the Age Act of 2016. And it was actually implemented in steps. For nonviolent crimes, it was implemented in March 2019. And for any offense, it was put into place July 2020. A delinquent is a youth who commits an act that if done as an adult would be seen as a crime. A status offender is a youth who commits an act that would not be seen as a crime if the youth were an adult. This includes truancy, you know, basically like skipping school, not coming to school, being a runaway, being deemed ungovernable, meaning that your parents can't, you know, control you, or the underage use of alcohol. Adjudication. Youth are not charged, they're adjudicated. At the adjudication hearing, the judge hears testimony from witnesses and renders a decision. Disposition. Youth are not sentenced, they receive a disposition, they're disposed. If the judge adjudicates the youth, he or she may proceed with disposition or set a disposition hearing for a later date. Okay, next slide. Okay, so competency to stand trial. How does it work? So when it comes to adults and criminal proceedings, anyone, the defendant, the judge, the attorneys, can raise the issue of competency. You know, does this person have the capacity to proceed to trial? This is a picture of former Chief Justice Burnett J. Johnson. She was the first African American Supreme Court Justice for the state of Louisiana. Now, if Chief Johnson were to raise the issue of competency, then she would look to the Louisiana Code of Criminal Procedure, Article 64.1 to 64.8, which dictate how to determine and proceed with a defendant's competency. And with adult, you know, criminal proceedings, when someone raised the issue of competency, there are some similarities between adults and juveniles. There are some similarities between adults and juveniles. And I'll, you know, make like further, I'll make distinctions later on. But the judge has 10 days to appoint a sanity commission, one individual has to be a position, the other individual, the other individual can be a psychologist. And if someone basically if they raise the issue of the defendant not being competent, the judge can send them to the state psych hospital, which is, you know, one of my places of employment where, like Dr. James mentioned, I run the women's unit. So they can be remanded to inpatient psychiatric hospitalization involuntary, of course. Now, if they are in jail, and, you know, the judge feels that they can just kind of stay in jail, and they can receive, you know, competency restoration there, then the judge can say, you know, basically, I'm, you know, remanding you to jail based restoration right where you are. Or if the individual is, you know, out on bond, and they're in the community, the judge can remand them to, you know, order them to community based restoration where they will meet with individuals at a certain clinic or at a forensic aftercare clinic to undergo competency restoration, and also most likely have medication management checkups. And if individual, you know, after any, any type of restoration, after undergoing any one of these three types of restorations, if the individual, the defendant is deemed competent to proceed to trial, then they go back to their local parish, the criminal court, and they proceed with trial, or they proceed with court hearings. And this is just a picture of the current judges at Orleans Parish Criminal Court. Next slide. Okay, juvenile competency to stand trial. What does it mean to be competent to proceed to a delinquency hearing? And when we say, you know, an individual, are they competent? We're basically we want to know, does this individual have a rational and a factual understanding of court proceedings? And can they assist their attorney in their defense? We want to know, does this individual know, like with the judge, the role of the judge? Do they know, you know, the role of the the jury? Can they distinguish between the two different types of attorneys, you know, in the courtroom, the DA and the defense attorney? Do they understand their their charges? And do they understand, you know, can they appreciate the seriousness, you know, of their offense? And the do they understand the consequence, you know, like the maximum sentencing possible? So that's basically what it means when we say does this individual, you know, are they competent to proceed to trial? What factors are considered when determining competency in juveniles? I'll talk about that on the next slide. And why is competency, you know, even raised, competency is raised, because it's, you know, an individual's livelihood, it's, it's pretty serious, it's their life at stake. And, you know, attorneys can raise competency if they feel that the juvenile may have a mental illness, if they have a history of a mental illness, if they suspect some type of, you know, cognitive deficit, or if they, you know, for some reason, have a difficult time kind of explaining things to the juvenile, or the juvenile presents challenges in terms of working with the attorney, or they may present with some type of, you know, impulsive behavior. So those are the reasons why some attorneys may raise the issue of competency. Next slide. Next slide. Thanks. So we always have to ask the question, what law or what local, you know, ordinance or statute or bill or act, what's going to guide how I answer this question? What's going to assist me? And first is Dusky v. U.S., which is the Dusky Standard. Now, this is another U.S. Supreme Court landmark case, where it was ruled that in order for a defendant to be deemed, you know, competent, he or she must have, quote, a sufficient presentability to consult with his lawyer with a reasonable degree of rational understanding, and a rational as well as a factual understanding of the proceedings against him. Now, this was decided after an individual by the name of Milton Dusky. He was 33 years old at the time. I believe this was in 1960. He had a diagnosis of schizophrenia, and he was charged with assisting in the kidnapping and rape of an underage female, I believe, across state lines. He was found competent after only being given a brief mental status exam. He really didn't have a clear understanding of his legal situation. And upon appeal, the court ruled in his favor, and his sentence was actually reduced from 45 years to 20 years. Now, in Louisiana, we look to the Children's Code, Articles 832 to 838, and 869 to 869.3. And it's, you know, similar to adult criminal proceedings. Once, you know, an individual raises the issue of competency, the judge has 10 days to appoint a sanity commission. And like I mentioned before, one individual has to be, you know, an MD or a DO or a physician. So once the sanity commission is appointed, we have 30 days to evaluate the juvenile, also to, you know, get additional records and to talk to parents. And I'm going to actually, I'll kind of talk a little bit later about what the evaluation process involves. But as far as the rest of the country, 22 states have juvenile-specific competency laws, and 14 of those 22 states actually factor in developmental immaturity. Okay, next slide. So these are the factors that we take into consideration when we're trying to assess and evaluate and determine competency to stand trial in juveniles. Of course, the mental illness, if the juvenile in question is exhibiting some type of, you know, signs, if they're expressing symptoms, if there is a history, a documented history of a mental illness, if there is an intellectual disability, if, you know, we look at the IQ, if there is documentation, you know, of a cognitive deficit. Also, we look at developmental immaturity here in Louisiana. Okay, next slide. So as far as the assessments, instruments, and data that are used, like I mentioned, we do use a basic psychiatric evaluation. We want to know if anything is kind of going on, if there is a history. And so that's the basic psychiatric evaluation. We also talk to, like, primary caregivers for, you know, when we're doing collateral interviews, and that's important because they are, you know, juveniles. And in addition to collateral interviews, we also use any type of prior assessments, any type of competency reports that may be present that have been done, and also any type of records, school records, or, you know, just mental health records. We also look at IEP 504 plans, if, you know, it exists for the juvenile. And of course, we use competency-to-stand trial measures. Now, the gold standard is the Juvenile Adjudicative Competence Interview, which is the JCJCI, and it's currently, it's the only published structured assessment tool developed specifically for juvenile competency-to-stand trial evaluations. It provides a structured set of questions divided into 12 categories. It's used to help assess a young person's understanding, appreciation, and reasoning of legal proceedings, and it takes about 45 minutes to an hour to administer. Now, there are several other measures. We also use the, we can use the competence assessment or standing trial for defendants with mental retardation, which is the CAST-MR. Now, the CAST-MR consists of 50 questions in three sections. The first two sections are multiple choice. They consist of 25 and 15 questions, respectively, and the last 10 are open-ended questions. Both the first and the second sections require roughly a fourth-grade reading level. Okay, next slide. Okay, competency restoration. So, what is competency restoration? Who conducts competency restoration among juveniles, and what are the possible outcomes? Okay, so if a youth is deemed, you know, not competent to proceed to trial, then he or she has to, you know, undergo competency restoration. After that evaluation is done, you know, the judge makes, you know, a ruling, or the judge says, say, okay, this individual is not competent. They need to go, they need to undergo competency restoration. So, juvenile competency restoration in Louisiana, from what I've gathered, is similar to going to, you know, like it's one-on-one tutoring, and it's administered using a manual, and it's like basically taking a course, and it's conducted by a state-designated psychologist, a licensed clinical social worker, or a licensed professional counselor, and the length of the restoration process depends on the individual, and it can vary from like a few weeks to a few months. It can be done at a detention center. It can be done at a local behavioral health center. It can be done at the juvenile's home, or it can be done at a mental hospital. So, next slide. And once again, just to kind of make a distinction between adults and also juveniles, when adults are, you know, deemed not competent to proceed to trial, they can be sent to the state psych hospital in voluntary hospitalization. They can be remanded to inpatient, an inpatient stay. They can stay at their local jail, their parish jail, and they can receive jail-based restoration, or they can receive restoration in the community. Now, for juveniles, juveniles, from what I've seen, they can be quote-unquote remanded to go to like a local community behavioral health center. They can, I've seen some juveniles go to Pinecrest Developmental Center, which is a facility for individuals with developmental, basically with cognitive deficits or developmental disabilities. There is no state psych hospital for, you know, juveniles, of course, and I have seen some juveniles be remanded, you know, basically the judge will say, well, you have to go to this, you know, kind of private or civilian, you know, psychiatric, you know, hospital, and you have to receive, you know, kind of see restoration there. So, that's something that I have seen. Next slide. Okay, and this is where it differs when it comes to juveniles, and this is a process that I'm still trying to understand. So, if a juvenile is deemed competent to proceed to trial, then, you know, they'll just kind of, you know, they'll go back to the detention center, or they'll just, you know, they're basically deemed competent, or they have the capacity to proceed to trial. Now, what happens if they are deemed unrestorable for the foreseeable future, and I actually had an individual, I believe it was in East Baton Rouge, who, you know, presented with this. So, if they are deemed unrestorable, and they're an adult, they're, you know, an adult at the state psych hospital, then they're civilly committed, and their care of custody is transferred from the Department of Corrections to the Louisiana Department of Health, and they kind of stay at the state psych hospital until we can find a less restrictive setting for them to go to or to live with the judge's approval. Now, with juveniles, if they are deemed unrestorable, you know, basically for the foreseeable future, then they can come back to court, and the judge can just dismiss the, you know, dismiss the offense, or just dismiss the petition, so to speak. So, that's one thing that can happen. It just kind of goes away, and the judge says, you know, bye-bye, and that, of course, depends on a variety of factors, the offense, the age, so on and so forth. The judge can allow the juvenile to go home with the family, but also place a plethora of recommendations in place, and have the juvenile follow up with the judge in the court system every six months, just to kind of check in on, you know, the juvenile, the youth in question. I've also seen some individuals be adjudicated offense, which is families in need of services, which is like a wraparound sort of, basically, wraparound services, and they can be, you know, basically, quote-unquote, involuntarily committed. You know, the judge can send them to a hospital for treatment, you know, a regular civilian or, you know, kind of private hospital for teens with behavioral issues, so that can happen. And that is the end of my presentation. Are there any questions? I just want to thank everyone for showing up. Dr. James, I think you're on mute. Thank you. I was saying, this is very, very informative. Thank you so much, Dr. Tragen. We do have some questions that came up from the audience. So, the first one is, can you share the name of the Goal Standard Assessment Tool again? It's the Juvenile Adjudicative, I'm sorry, it's the Juvenile Adjudicative Competence Interview. And, you know, if an individual wants to kind of see what it looks like, I can, you know, email them a copy. Wonderful. And it's JC for short, J-A-C-I. Okay, wonderful. Thank you. And then the second question, can you address the use of online restoration to competency programs? Is there any evidence to support online is as efficacious as in-person? Okay, so I'm not familiar with any online restoration programs. I'm only familiar with, like, in-person, because that's basically what's done, you know, here in Louisiana, where, like I mentioned, the LBC, or the social worker, or the psychologist has to actually go and meet with the youth in question over a series of weeks or months. So, I really can't, you know, kind of speak to that in terms of, like, online versus traditional. Okay, thank you. The next question is, I have seen juveniles also be referred to CPS if they were not detained or sent to placement. I worked with CPS and did share case management. Can you just elaborate on that or comment on that? Okay, I am not sure. I know here in, I think maybe, I kind of know what that individual is asking. Here in Louisiana, we have DCFS, which is Department of Children, Department of Children. It's basically, it's like kind of, you know, CPS, Department of Children and Family Services. So, I have, like, I'm not too familiar with it, but I have heard of individuals, teens, who are arrested, they're picked up by the police, and they, you know, the police, they'll call the parents to come and get the youth in question, and they can't really, you know, I mean, they can't get in touch with anybody. So, DCFS has to, you know, has to be called. Now, there are other instances, you know, once the individual is, like, detained, and they're, for example, like I said, I work at the, at JJIC, which is the Juvenile Justice Intervention Center, and DCFS has to, you know, kind of get involved because it's, it becomes pretty apparent that the parent is, there's some form of a neglect or abuse, you know, and there's some type of ineffective parenting. You know, it's unfortunate, you know, I've, you know, seen parents kind of show up to a Zoom hearing, you know, just inebriated, and it's like, okay, we got to call DCFS. So, I'm familiar with those types of examples. That's when DCFS has to get involved, or the child alleges, you know, some type of abuse. You know, we have a, you know, there's a question about the living conditions of the juvenile in question. So, we do have to reach out to what is called here DCFS. Okay, thank you. And the next question is, what is the composition of the competency committee that is appointed, meaning, you know, MDDO and others? I know this can vary from state to state. Yes. So, here in Louisiana, it's, it basically has to be at least, you know, one physician, you know, one psychiatrist, and it has to be two individuals. So, the other individual can be a psychologist, and usually you'll see like a physician and a psychologist. There are several examples where, you know, I find that the, you know, in an adult court, you know, from some of the parishes, you know, maybe some of the more rural parishes will have a judge, will appoint a sanity commission, and it's two individuals with PhDs, and it's like, nah, you gotta, you know, you have to, you have to have a physician to be one of those. So, thank you. Can you share your email for a copy of that assessment? Also, I am not able to assess the slides. Will they be made available another way? So, we can work with our division of education to make sure that the slides can be available another way. I can share that. Yeah. Okay. Do you want to, you could share it with the slides, or do you want to share it now? I can. I see the one asked. Someone is also asking, so type that in. Wonderful. Okay. Okay, and someone said, I admire what you do and your commitment. Can you speak to what drew you to this specific area with working with youth of New Orleans and the women of Louisiana? Okay. So, well, let me just say, you know, I was born and raised in New Orleans. And to be honest with you, I thought I was never coming back to the state of Louisiana. I was setting up shop in South Carolina, but nevertheless, I decided to come home. I interviewed for the Tulane Forensic Program and it was a great program. So I decided to come home. And actually when I was doing my always, I kinda at first thought I was gonna be a pediatrician and then I was like, I wanna do child psych. And then when I was doing my general residency in Alabama, there was this kid, he was remanded to the Strickland Detention Center. And he just, he did not, he always wanted to keep his back to a wall. And it was later discovered that he was sexually assaulted. And he was, I believe when he was placed in the adult jail, even though he was a juvenile. And so that just like, wow. And then I would see some kids on medications, like Seroquel, just these different medications that weren't necessary for sleep. Like, have you tried Benadryl or Vistaril? So that really drew me to forensics. And in terms of working with the females, they're a challenging population, but those females, they look like me, they look like my mom, they look like my sister. And I just kind of want to, even though they're quote unquote clients and they're remanded by the local judges and their parents, I have to, and the judges in their local parishes, I do have to establish and maintain some sort of therapeutic alliance with them. And they're just a unique population and it's something that I've just grown to enjoy and really love. Thank you, thank you so much. The next question, do you find that malingering is something that comes up in your assessments? If so, is there any sort of testing for this in juveniles? You know what, I find that juveniles are, they're pretty forthcoming. And this is just my experience. And with kind of collateral information, I find that malingering really isn't an issue. It's something that's just, it's something that kind of doesn't pop into my mind. Of course it does for adults from time to time, but not necessarily for juveniles. And I'm not really aware of any malingering tools for juveniles. I can actually try to research that and look that up. But for, I think juveniles and adults in general, and I was just having this conversation with a colleague of mine, with, you can basically kind of, interdisciplinary teams are important because you can get input and feedback from all of the members of the team that are working with juveniles and just patients in general. And they see things that the physician does not see. The nurses at the state psych hospital, we call them CGTs, which is correctional guard therapeutic. At JJIC, we call them JDCs, which is juvenile detention center. I'm sorry, juvenile detention counselors. That's basically security. And so we all see different things and we just document and document and document. And we can kind of see if an individual is saying one thing with this person or behaving this way in front of a different individual. So that's sort of like an informal malingering assessment, so to speak. But I can, Dr. Botwell, I can give you that information once I look it up. Okay, great. Thank you. So just a couple of other questions. So, okay, a couple other questions. So you gave a very nice historical background of the juvenile justice system. And so, you know, studies show that about 60 to 70% of youth held in detention centers have a mental illness. And I was just wondering, at what point in the history of the juvenile justice system dealing with mental illness, did they start actually providing mental health services for children in the system? I don't know of the exact date, but there was, and I'm trying to think of which, I guess, era, if I can maybe. When I talk about the history, let's go back quickly. It was the, let's see. It was during the progressive era, they began to look at, you know, they began to look at juvenile delinquents behavior from sort of like an ecological model. And also they began to kind of consider the medical model. Now, as far as mental services, that really did not begin until like the 1960s and the 1980s, when you had the creation of the Juvenile Delinquency and Prevention Control Act of 1968 and the latter of 1974, when money was being pushed through. Oh, okay. Yeah, you know, and the types of services vary from still from detention center to detention center, because we definitely at JJIC, we've made, you know, strides and gains where we have several child and adolescent and forensically trained psychiatrists. We have a nurse manager, we have a series of nurses and a plethora of nurses and two social workers, and we provide therapy and treatment. And there is, I used to kind of do consulting work at another parish and they don't have any type of, you know, psychiatrist. So if the parents, if a kid is on some kind of medication, the parent has to, you know, kind of bring it in. And if they want to see, if the judge wants to determine whether or not a kid has a mental illness or there's like some type of questioning, or if there's a history, then they would, you know, call me in or another individual to do those types of evaluations. So it varies from local detention center to detention center. Now, those services are in place in the statewide facilities. So, and just to kind of give you a little bit clarity on that, once an individual receives his disposition and they, for example, receive a juvenile life sentence or they receive two years, then they go from their local detention center to one of the detention, one of the facilities, statewide facilities in Louisiana. And so they, you know, provide mental services. Mental health services, so. Wow, thank you. So another question. So this is from me. Brain development suggests that most people don't really reach their full maturity until about 25. So I was thinking about this in context of the term you use, developmental immaturity. So how do those two correlate? How would you go back and redefine developmental immaturity, thinking about that in the context of the fact that the brain doesn't really develop fully until you're about 25? You know, I can kind of give you some examples and that's something that I've actually had to testify about like the, you know, basically the brain developing, the adolescent brain and how it doesn't develop until the age of 25 with the Louisiana legislature. But I can kind of give you an example. There was recently a high profile crime in New Orleans and four juveniles were involved and three of them, you know, all four of them, they basically had like normal, you know, kind of IQs. They, you know, we felt that they were competent. There was one individual who she, example, would like suck her thumb. She was very kind of childlike. You can tell that she had some regressive behaviors and she actually was deemed, you know, not competent to proceed to trial. The issue of competency was raised and she went to a local hospital where she received a hospital-based competency restoration and she was deemed competent. And, you know, I've had a couple of patients where, you know, they're, you know, patients, you know, they're smart, they're articulate, but you have some patients who just, they have these old souls, so to speak. So I don't know if I'm answering your question, but, you know, kind of providing care to dozens and hundreds of juveniles over the past couple of years, you can definitely tell whether or not this individual has the capacity, whether they're competent, but there are, you know, kind of certain individuals kind of comparing them, you know, to their peers, they just seem more childlike. Okay. And that's, you know, when we say developmental immaturity, that's what we mean. Okay. Okay. And also in terms of factors to consider in juvenile competency to stand trial, you've mentioned mental illness. Is that any mental illness or specifically more like schizophrenia? Could it be depression, anxiety, or like, what is it about mental illness that really can, you could check the box and say, okay, mental illness, they are not competent to stand trial? Well, it's just a factor to consider. So, you know, the judge or the attorney, they, it's not like, okay, this individual has like, you know, ADHD or they have conduct disorders. So, okay, they just don't have the capacity to proceed. If the issue for competency, it is raised if, like I said, if there are certain, I guess, signs that are kind of apparent, if they are, if there are like, I guess, symptoms that are expressed, sometimes if there is a history of a mental illness, you know, if someone brings it up and there's some question about whether or not this person is being medicated or if, you know, if the attorney feels that this is gonna be a factor. And it's basically, you know, it's based on that interaction between the attorney or if the judge sees something that, okay, I need to kind of step on the brakes because something is not quite right. And, you know, when talking to the parents, the parents may reveal that, okay, this person has a diagnosis, they're not on medications. And, you know, that's pretty much when, when we usually see that the issue for competency is raised in, you know, in a juvenile. So, if they have a history of a mental illness, that necessarily doesn't dictate whether or not the issue of competency will be raised. Now, as far as the types of mental illnesses, it's basically, it's, you know, I've seen like all different types of mental illnesses diagnosed in individuals where the capacity is raised. And in the detention center, we see a lot of kids who have a history of, you know, ADHD, not medicated, not treated within the past, you know, three, four years. We also see a lot of kids with trauma. This is the first place where I've worked where so many kids have nightmares of being killed. That is, that is, that blows me away. And, you know, being shot. And also I've seen a lot of kids, you know, depression, quite a few kids. We've only seen a few kids with a true psychosis, you know, like actual schizophrenia, so. Okay. And then you talked about the possible outcomes, dismissal, you know, go home with the family, family in need of services, and involuntary commitment as possible outcomes. Where you sit and in your state is, for young people of color in the juvenile justice system, is there one that tends to happen more often than the other? I mean, is there like most of them are dismissed or not really, but of those four, what would be more common that you see? The two, well, the two that are more common that I see is like FINS, families in need of services. And also what's the, I'm kind of, my mind is drawing a blank. Basically not necessarily dismissal, but that whole kind of follow-up where I've seen the judge kind of check in on the individual every six months. And they, you know, mandate that they go to a community health center and receive certain services. Okay, okay. All right, wonderful. And then another question. So on one of your slides, you mentioned in 2020, law enforcement agencies in the U.S. made over 400,000 arrests of persons younger than 18. And then you said in that category, 64% were white and 32% were black. And then when you talked about the delinquency case rate, you said it was basically for black youth, it was at least double. It was like 32.6 out of a thousand cases. Is that what I, so how, so case rate, how does that differ? The delinquency case rate, how does that differ from this number? Because when I look at the first piece of information you shared, I'm thinking, okay, so young people, 18 and younger, it was primarily white, 64%. But then when I look over at the delinquency case rate, it seems like it's higher for black youth. Yes, so pretty much when I say like an arrest, that's basically just being picked up. That's just, you know, that's an arrest. And when I say delinquency, that means that, you know, they're going before the judge, they're being petitioned. That's when the charge kind of, you know, that like the legal settings, kind of the legal situation takes place. It becomes apparent. So yes, yeah. Thank you, thank you. All right. And then we have a question from Jordan Brown. Hi, thank you for this presentation. In juveniles who have a serious mental illness, do you often see an accurate diagnosis, history for their illness, or are these juveniles being processed and then receiving diagnosis for SMI? I can say that the diagnoses, they, what I see, I think that the diagnoses are accurate. What I do see also, I see that they have not been diagnosed with PTSD or the trauma has not been addressed because, you know, we ask, you know, you have like acute trauma, traumatic events. We have chronic trauma. So we ask about, you know, you know, have you witnessed a shooting? Have you been shot at? Do you have like bullets still lodged in you somewhere? You know, like, have you been shot at? And have you actually received like, you know, gunshot wounds? We ask about witnessing domestic violence, the sudden death of a close friend or a family member, being separated from a parent, you know, incarceration, of course, you know, Louisiana natural disasters. So, you know, and it always just kind of sort of, I'm always astonished when my patients tell me that, you know, they had a 15 year old individual, like a friend, their best friend was murdered. So I feel that trauma definitely is under diagnosed, not diagnosed. Yeah. Oh, absolutely, absolutely. And then, so this whole presentation was just so really, just, it was great. I learned a lot. Now you mentioned the criminologist, John DiIulio and his theory. Can you just speak a little bit more about the impact? Because he later retracted this, but the damage, it seems, was already done. Yes. After that juvenile super predator. You know, and I really didn't have time to look into that too much. I remember reading an article maybe a couple of days ago about an individual who was, you know, he basically said that that term, he thought that that term kind of, you know, just like ruined his life. You know, I can't give you any numbers. I can't speak really to the impact, but I just remember this, you know, individual was saying that they were wrongly, you know, accused of a crime. They didn't do it. They spent X number of years in jail and, you know, they were just arrested. And it's just because of the heightened attention that that term, you know, kind of, because of that, you know, the heightened attention to that term and what was going on, you know, in the environment, you know, at that time, you know, he felt that he was, you know, accused of something that he didn't do as a lot of other people. And they were, you know, kind of incarcerated for things that they did not do, you know, and precious years were taken, you know, kind of away from their, you know, their lives and their livelihoods were lost. So I really didn't have the chance to kind of follow up with the whole Delulio kind of aftermath, so. But yeah, that was just an interesting piece. I didn't know about that until you actually mentioned it in your presentation. And so I guess we're coming to a close with my last question is I guess my shock and awe with the chain gangs of very young black youth. Now we see pictures of chain gangs and I don't think I've seen a picture with kids on a chain gang, but apparently this was something more common, I guess 1800s, you know, early 1900s. So I just wanted to just put that out there. I don't know if you have any other comments about that, but I was really actually shocked at that. Yeah, yeah, and that's actually, I believe that that article referenced was, it was actually written by a group of social workers and they cited this book, I think that was published in the 1980s. And so I actually want to kind of go and, you know, read, you know, read about, you know, look into the book and read it. But there are a couple of books. You've probably heard of Bryan Stevenson, Just Mercy. And there's also this book by, How the Word Was Passed by, his name is Clint Smith and he's a New Orleans native. This is a book that I read not too long ago. And he kind of talks about just, you know, one of the topics is, one of the chapter focuses on Angola and they kind of talk about the history of, you know, kids being, you know, this one kid being sentenced to death and just the whole electric chair and all that other stuff. So, you know, because of that sort of incident, you know, I'm more than sure that there are countless other examples of kids, you know, in that setting, kids of color in that setting, you know, way, way back then. But I can, I can definitely, it's something that intrigues me also. So I can definitely look more into that and, you know, share what I learned. Thank you, thank you, thank you, Dr. Trey. It's just a phenomenal presentation. I've just learned so much today and I'm sure all those who are gonna come and listen will learn a lot as well. Thanks to everyone for joining the webinar today. Our next Morehouse School of Medicine webinar will be on Tuesday, September 19th from 12 to one Eastern Standard Time. The title is Black Perinatal Mental Health, Current Evidence, Gaps and the Road to Equity, where our speaker will be Dr. Crystal Clark. We hope you can join us for the webinar. Thanks again, and take care. ♪♪

Dr. Kiana Andrew-Treg

Department of Psychiatry and Behavioral Sciences

Tulane University School of Medicine

Justice Involved Youth

Juvenile Competency

Juvenile Justice System

Competency to Stand Trial

Developmental Immaturity

Mental Illness