While there are similarities to adult courts, juvenile court clinicians have additional tasks. Here, court clinicians are even more specially-trained to perform evaluations regarding child welfare and guiding the court in its supervision of troubled youth.
Juvenile court clinicians are usually an even mix of psychologists and master’s level practitioners. The former mostly provide competency and criminal responsibility evaluations. The latter mostly perform in-depth/specialized diagnostic assessments and care and protection/child welfare evaluations.
Since their inception in the late 19th century, juvenile courts have been less punitive and more rehabilitative, making the need for diagnostic assessments a central component. This makes sense, as children are viewed as rather malleable; therefore being more easily-corrected before bad habits become crystallized.
Types of Evaluations in Juvenile Court Clinics
That said, there are plenty of delinquent youth coming through the juvenile court that need competency or responsibility evaluations. However, a majority of evaluations are in the form of specialized diagnostic assessments that allow the court to better understand the dynamics of the youth’s life and provide guidance for stabilization. These are performed not only for children with garden variety charges, but there are also specialized assessments for children with fire setting and problematic sexual behaviors. A bulk of referrals regard civil-related matters in what in Massachusetts are called child requiring assistance (CRA) petitions.
CRA’s (formerly called Child in Need of Service [CHINS]) occur when a guardian or school official petitions the court for assistance in supervising a troubled youth. It is often considered a step in preventing their escalating problematic behaviors from evolving into delinquent behaviors. In Massachusetts there are five CRA categories:
- Stubborn: children with an escalating pattern of disrespectful, oppositional, defiant, or aggressive behaviors
- Truancy: children who are habitually truant
- School Offender: children who habitually encounter significant behavioral problems in school
- Runaway: children whose modus operandi involves lack of whereabouts accountability
- Sexually-exploited child: children whose guardians fear the child is being sexually taken-advantage of
Each of these concerns are not uncommonly correlated with mental health concerns. As explored in the 7/23/2020 post, for example, children are often oppositional and defiant because of depression. Another example is that truancy is frequently related to Social Anxiety Disorder, Separation Anxiety, or the frustrations of ADHD or learning disabilities. In order to get the children back on track, court officials look to the court clinic to explain the dynamics and offer guidance for remedying the matter.
An Inside Look at Juvenile Court Clinic Diagnostic Assessments
Despite some children having years of mental health care, many have not improved or even gotten worse. Court clinicians have a luxury not often afforded to therapists: hours of exploring the child’s history and current functioning. Acting as clinical detectives, we very carefully piece together histories to understand present behavior. We often formulate second opinions about diagnosis and treatment for children who have been unsuccessfully treated for months or years. Our reports are frequently empathic stories and highlight resiliency factors and strengths that can be cultivated to move forward. While we’re not treating people in the Court Clinics, evaluation is an intervention. Consider the following example:
Jack, a 12-year-old boy, over the course of several months, developed an increasing penchant for unruly behavior. He rarely slept, and would sneak out and be gone all night unless his parents were awake with him. His pediatrician and psychiatric nurse practitioner diagnosed him with ADHD and Conduct Disorder. Looking through his records, Dr. H noticed the first complaints of Jack’s unruly behavior coincided with the initiation of ADHD stimulant medication. Dr. H also thought it was strange that a child with no otherwise troubled history would spontaneously develop Conduct Disorder. He didn’t like that Jack was written off as “gone astray” by his family. In the records, Dr. H noticed that as weeks progressed, Jack’s increased restlessness was impulsively viewed by his prescriber as escalating ADHD hyperactivity and his stimulant dose increased. Dr. H was skeptical of Jack’s diagnoses, as discussed in the 06/24/2020 post. His conclusion was that Jack child was experiencing medication-induced mania. Dr. H presented this to the court, with the recommendation Jack receives a second opinion on his medication by a child psychiatrist. Jack’s probation officer followed up to tell Dr. H that Jack was done with probation. He was taken off the stimulant and troublesome behavior subsided. Once examined off the stimulant, the psychiatrist opined Jack’s restlessness was due to anxiety, and he suggested the family tries therapy before anxiety medication. Jack’s family was back to a normal life and the problem was caught before it led to real trouble.
This work is not only rewarding in the challenging clinical work it affords, but more than anyone, kids need to be given the benefit of the doubt and its really satisfying watching them march into adulthood in a better space. True, we can’t save them all, but the work performed in juvenile courts leads many to brighter futures. Untold numbers of children with poor behaviors like Jack are simply looked at as bad seeds or “gone astray.” More often than not, it is something they don’t understand or the result of misguidance of people “who know better for them.” If you’re interested in social justice at its roots, and making misunderstood kids understood and unstuck, juvenile court clinic work may be the ultimate.