The Maryland Department of Juvenile Services wanted to amplify the voices of youth and families and ensure services provided reflected the latest research and best practices. This commitment drove DJS to apply for and participate in the Length of Stay Academy. For over a year, DJS worked with national experts, staff, youth, and families to explore ways to optimize outcomes for youth committed to the agency and to identify factors that contribute to their length of stay.
A review DJS data on lengths of residential treatment programs showed that in many cases youth at a higher risk for recidivism with more intensive treatment needs had shorter stays than lower risk youth with more modest treatment needs. The lowest risk youth in DJS treatment programs spent on average 55% longer in placement than the highest risk youth. This data and other information led DJS to create a new Comprehensive Treatment Model (CTM). The overarching goal of CTM is to ensure Maryland youth committed to out-of-home placement experience lengths of stay that are:
- Determined by a youth’s assessed risk and identified treatment needs
- Equitable and racially, ethnically, gender and developmentally responsive
- Guided by best practices
- Informed by youth, family, and staff
Optimizing Treatment and Methodology: The How
The DJS Comprehensive Treatment Model is guided by key juvenile justice research findings indicating that positive outcomes are achieved by:
- Using a therapeutic approach to develop skills for sustained behavior change
- Delivering quality services at the appropriate intensity based on youth risk and need
- Using treatment protocols and procedures for monitoring fidelity
- Promoting positive program experiences for youth
CTM integrates principles and practices from Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), Positive Youth Development (PYD), and Trauma Informed Care (TIC).
- CBT – An evidence-based intervention that focuses on understanding and addressing the connections between thoughts, feelings, and behaviors to promote behavior change.
- DBT – A specific cognitive-behavioral intervention that teaches youth skills to manage negative emotions, reduce negative behaviors, and improve relationships. DBT focuses on mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance skills.
- PYD – A pro-social approach that recognizes, utilizes, and enhances youth’s strengths, and focuses on engaging youth within their communities, schools, organizations, peer groups, and families.
- TIC – A service delivery approach that takes into account past trauma and the resulting coping mechanisms when attempting to understand and respond to behaviors and provide services.
DJS is refining its approach to determining the amount of treatment that youth in DJS treatment programs receive. Youth are required to complete a minimum number of hours of treatment based upon their assessed risk level and identified needs. For example, youth identified as low risk may receive a range of 123-201 treatment hours depending on their needs.
DJS is also enhancing its treatment programs to include DBT, which will be the overarching treatment model, and staff coaching of youth. Treatment programming is intended to target risk factors that increase youth’s likelihood of engaging in delinquent behavior and create new positive behaviors through a skills-based approach. Youth with particular case characteristics may require additional services/hours that focus on needs such as substance use, anger management or appreciation of victim impact. Length of Stay guidelines reflect the ranges of treatment hours.
Treatment Program Components:
- Treatment Interventions to include DBT
- Structured Activities & Recreation
- Education/Vocational Services
- DBT Skills incorporated into the educational setting
- Behavior Motivation System
- Somatic Health & Psychiatry Services
- Treatment Planning Meetings and Interventions
- Youth Voice Practices
DJS leadership established a core team to translate CTM into practice. The team created several topic-specific subcommittees and workgroups, involving staff from various disciplines and at all levels throughout the agency to make this plan a reality.
The groups addressed the following areas:
- Data analysis – research supporting the initiative
- Research-based tool utilization – assessing level of risk
- Report development – tracking individual youth progress
- Policy writing – developing guidelines and procedures
- Procurement – obtaining treatment programming
- Training – improving staff competency
- Communication – messaging internally and externally
- Outcomes – refining tools to monitor and measure progress
The core team develop an action plan and implementation is underway with guidance from DJS executive leadership. The plan includes implementing DBT by training all staff in this treatment approach. In addition, the Youth Voice practices that began in 2020, have become official policy. The practices, such as youth roundtables, admission video conferences, and youth workgroups to review proposed changes, is the first in a series of new policies to be implemented. The Department also engages youth through advisory boards, focus groups, leadership roles with the Behavior Motivation System, and families via support sessions and workgroups.
In preparation for implementing CTM, DJS conducted beta testing with youth, families, and staff. The core team solicited feedback from these individuals about the practical use and effectiveness of newly developed policies and tools.
This feedback is currently being used to modify policies and procedures. New handbooks are also in the process of being developed, to include the Department’s first handbook specifically designed for families of youth who are in the department’s treatment programs.
Treatment teams will monitor a youth’s progress towards achieving their treatment goals by meeting monthly. Youth will co-lead these meetings with staff and be able to see their progress visually depicted with a special graphic created by the treatment program.
Education services will play a significant role in this comprehensive treatment model. All education staff will receive basic training on DBT so that DBT can be integrated into the classroom environment. DJS is also exploring the potential to deliver DBT skills training during school hours for course credit.
Once these policies and procedures are developed, staff will be formally trained, and this reimagined treatment model will become standard practice throughout the department’s treatment programs. Throughout this effort, DJS will continue to monitor progress and examine lengths of stay to ensure they are equitable, fair, and appropriate for DJS youth and achieve the best possible outcomes.