Juvenile Court Clinic Evaluations
A palette of forensic psychology assessments.
Posted Nov 06, 2020
Juvenile court clinics are a forensic psychology niche, and they present 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.
In juvenile court clinics, practitioners are usually an even mix of psychologists and master's level specialists. The former mostly provide competency and criminal responsibility evaluations. The latter primarily 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 malleable and therefore more easily corrected before bad habits crystallize.
Juvenile Court Clinic Evaluations
That said, plenty of delinquent youth enter the juvenile court and need competency or responsibility evaluations. However, a majority of assessments are specialized diagnostic evaluations that allow the court to better understand the dynamics of the youth's life. The evaluations provide guidance for working effectively to ebb the tide of their problematic behaviors.
Psychological assessments 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, or CHINS) occur when a guardian or school official petitions the court for assistance in supervising a troubled youth. It is usually considered a step in preventing their escalating problematic behaviors from evolving into delinquent behaviors.
In Massachusetts, there are five CRA categories, the most common being the Stubborn. This is for children exhibiting an escalating pattern of disrespectful, oppositional, defiant, or aggressive behaviors. Others are more self-explanatory and include the Truancy, Runaway, School Offender, and Sexual Exploitation categories.
Each of these concerns is not uncommonly correlated with mental health concerns. For example, truancy is frequently related to Social Anxiety Disorder, Separation Anxiety, or the frustrations of ADHD and 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 may even have worsened. 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 them forward. While we're not treating people in the Court Clinics, evaluation is an intervention. Consider the following example:
Jaime, an 11-year-old boy, developed an increasing penchant for unruly behavior in a short time. He didn't sleep much, often snuck out and be gone all night unless his parents were awake with him. His pediatrician and psychiatric nurse specialist diagnosed him with ADHD and Conduct Disorder.
Looking through his records, the court clinician, Sarah, noticed the first complaints of Jaime's unruly behavior coincided with the initiation of ADHD stimulant medication. Sarah also thought it was odd that a child with no earlier history of troubles would spontaneously develop Conduct Disorder over a couple of months. In the records, Sarah noticed that as weeks progressed, Jaime's increased restlessness was simply viewed by his prescriber as escalating hyperactivity of ADHD, and his stimulant dose would be increased.
Sarah was skeptical of Jaime's diagnoses, and she concluded that he was most likely experiencing medication-induced manic symptoms. Sarah presented this to the court in her assessment, with the recommendation that Jaime receives a second opinion about medications by a child psychiatrist.
Jaime's probation officer followed up several weeks later to inform Sarah that he was done with probation. The stimulant medication was discontinued and his troublesome behavior subsided. Once examined off the stimulant, the child psychiatrist opined Jaime's restlessness was due to anxiety, and suggested the family engage in therapy before he prescribed medication. Jaime's family was back to a normal life and the problem was caught before it led to real trouble.
Juvenile court clinic assessments are not only rewarding in the challenging clinical work it affords, but it is very satisfying to know many will 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 Jaime are simply looked at as bad seeds. More often than not, it is something they don't understand or the result of the misguidance of people "who know better for them."