Among the Juvenile Code provisions that distinguish juvenile delinquency cases from criminal cases are the statutes that explicitly tie mental health assessments and access to mental health treatment to the procedure required to construct and enter a dispositional order. After an adjudication of delinquency occurs (meaning that the juvenile was found beyond a reasonable doubt to be responsible for the offense(s) charged), the case moves to the dispositional phase. Under some circumstances the court must obtain and review mental health assessment information and other times the court has the discretion to obtain mental health assessment information. This post explains this legal structure and the options the court has at disposition to order juveniles to comply with mental health treatment.
Addressing the Needs of the Juvenile as a Dispositional Purpose
There is a dual purpose to a juvenile disposition in a delinquency action – to “design an appropriate plan to meet the needs of the juvenile and to achieve the objectives of the State in exercising jurisdiction, including the protection of the public.”G.S. 7B-2500. Dispositions should include, among other things, treatment to assist the juvenile toward becoming a nonoffending, responsible, and productive member of the community. G.S. 7B-2500(3). In choosing among the allowable dispositional alternatives under the statute, the court must consider five factors. G.S. 7B-2501(c). Several of those factors relate to public safety and accountability, but the final factor is “the rehabilitative and treatment needs of the juvenile indicated by a risk and needs assessment.” G.S. 7B-2501(c)(5). The court is therefore required to order a disposition that is designed to address both public safety and the juvenile’s needs, including treatment needs. There is no statutory definition of “treatment” in the Juvenile Code. However, the required and discretionary processes for obtaining mental health assessment information described below suggests that addressing the mental health needs of the juvenile is a primary consideration in shaping delinquency dispositions.
Mental Health Assessments
Required Assessments
The Juvenile Code requires a mental health assessment before the court can order a disposition for any juvenile who has been identified with (i) a suspected mental illness through the use of a validated screening instrument or other evidence or (ii) a suspected developmental or intellectual disability.G.S. 7B-2502(a2). This assessment must be a comprehensive clinical assessment (CCA), or an equivalent assessment, and must evaluate the developmental, emotional, behavioral, and mental health needs of the juvenile. Id. It must be conducted within 90 days before the disposition hearing. Id. If a CCA or its equivalent has not been conducted within that timeframe the court must order the Division of Juvenile Justice and Delinquency Prevention (DJJDP) to make a referral for the assessment. Id.
The court must review the required assessment before entering disposition. G.S. 7B-2502(a3). If during that review the court finds sufficient evidence that the following three criteria are met, the court must order the DJJDP to convene a care review team before the court can order disposition:
- the juvenile has a severe emotional disturbance, developmental disability, or intellectual disability;
- that disturbance or disability substantially contributed to the delinquent behavior; and
- the juvenile is eligible for a Level 3 disposition (commitment to the DJJDP for placement in a Youth Development Center (YDC)) or is recommended for placement at a Psychiatric Residential Treatment Facility. Id.
Care Review Teams
According to G.S. 7B-2502(a4), the care review team must include at least: the juvenile; their parent, guardian, or custodian; representatives from the DJJDP; a representative from the LME/MCO or prepaid health plan in which the juvenile is enrolled; and representatives from any state agency or local department of social services that is currently providing services to the juvenile or their family.
The care review team must develop a recommendation plan for appropriate services and resources that address the identified needs of the juvenile. G.S. 7B-2502(a4). The team has 30 calendar days from the date the court ordered the DJJDP to convene the team to submit its recommendation plan to the court. Id. The court must review the recommendation plan when determining the disposition. Id. The statutory factors of G.S. 7B-2501(c) that the court must consider in every delinquency disposition still govern the court’s dispositional determination.
Optional Mental Health Assessments
The court also has the authority to order examinations of the juvenile by psychiatrists, psychologists, or other qualified experts as may be needed for the court to determine the the juvenile’s needs in any delinquency matter after adjudication occurs. G.S. 7B-2502(a). These assessments may be different than a CCA or its equivalent. For example, courts sometimes need a trauma assessment, an assessment specific to problematic sexual behavior, or an assessment that dives deeper than a CCA into complex mental health conditions. The Juvenile Code does not limit the scope of assessments that can be ordered under this provision except that they must be needed for the court to determine the needs of the juvenile.
Substance Use Testing
Substance use testing is sometimes required following an adjudication of delinquency and in other circumstances, it is allowed but not required. The court must require testing for use of controlled substances or alcohol within 30 days of an adjudication of delinquency for committing an offense that involved the possession, use, sale, or delivery of alcohol or a controlled substance. G.S. 7B-2502(a1). The court is also authorized to order testing for use of controlled substances or alcohol for any juvenile who has been adjudicated delinquent when the court deems the testing necessary. Id. Whether the testing is mandated or ordered at the court’s discretion, the results are only allowed to be used for evaluation and treatment purposes. Id.
The statute also suggests that a juvenile could be placed out of their home under this subsection (G.S. 7B-2502(a1)) or under other subsections of G.S. 7B-2502. The language of the subsection includes a requirement that the court consider whether it is in the juvenile’s best interest to remain in their community of residence in placing a juvenile in out-of-home care under this section of law. Id.
Mental Health Treatment
Ordering Treatment Following a Court-Ordered Assessment
The statute that authorizes the court to order optional mental health assessments, G.S. 7B-2502(a), also allows the court to conduct a hearing to determine whether the juvenile needs psychiatric, psychological, or other evaluation or treatment on completion of the assessment. The court has the authority to order that the juvenile comply with any evaluation or treatment recommended by the assessment. Id. While most dispositional alternatives in delinquency cases are tied to one of three statutorily prescribed dispositional levels, the option to order mental health evaluation and treatment under G.S. 7B-2502(a) is available in any delinquency case after adjudication, regardless of the statutorily prescribed dispositional level.
There are some limits on what the court can order. The court is prohibited from committing the juvenile directly to a State hospital or developmental center, except when ordering an evaluation to determine capacity to proceed. G.S. 7B-2502(d). The Supreme Court of North Carolina also held that the juvenile court cannot order counties to create expensive programs to address the needs of juveniles through dispositional orders. In re Wharton, 305 N.C. 565 (1982).
Payment for evaluation and treatment ordered under this statute is addressed in G.S. 7B-2502(b). If the juvenile does not have health insurance coverage for the recommended treatment the court is required to conduct a hearing to determine who should pay the cost of the assessment, evaluation, or treatment. The court must allow the parent, guardian, custodian, or other responsible person to arrange for evaluation or treatment. If that person declines or is unable to make necessary arrangements, the court may order the needed evaluation or treatment, and the court may order the parent (but not the guardian, custodian, or other responsible person) to pay the cost of care if the parent has the ability to pay.
The statute suggests that if the parent does not have the ability to pay, funding may be available from DJJDP. See G.S. 7B-2502(b). DJJDP funds a limited number of community programs. DJJDP-funded programs explicitly focused on mental health include Juvenile Crisis and Assessment Centers and Functional Family Therapy (provided by AMIkids and available in all 100 counties). If DJJDP funding is not available and the parent is unable to pay, the court must order the county to arrange and pay for the juvenile’s evaluation or treatment. The county manager or any other person designated by the chair of the board of county commissioners of the county of the juvenile’s residence must be notified of the hearing and allowed to be heard before any such order is entered.
Treatment as a Dispositional Alternative
The court has the authority to order compliance with community-based treatment when ordering a Level 1 or Level 2 disposition. This includes an order that the juvenile cooperate with a community‑based program, an intensive substance abuse treatment program, or a residential or nonresidential treatment program for up to 12 months. G.S. 7B-2506(3), -2508(c), (d). The court also has specific authority to order that the juvenile cooperates with placement in a residential treatment facility, an intensive nonresidential treatment program, or an intensive substance abuse program as part of any Level 2 disposition. G.S. 7B-2506(14), -2508(d).
Treatment and Monitoring as Part of Probation
The court has significant discretion in determining probation conditions when placing the juvenile on probation. Probation supervision can be ordered for any Level 1 or Level 2 disposition. G.S. 7B-2506(8), -2508(c), (d). The court can order conditions that are related to the needs of the juvenile and are reasonably necessary to ensure that the juvenile will lead a law-abiding life, including any condition the court finds appropriate. G.S. 7B-2510(a)(14). This catch-all condition could include compliance with mental health treatment.
Unlike mental health treatment, the Juvenile Code explicitly includes allowable probation conditions related to substance use and monitoring of substance use. A condition of probation may be that the juvenile refrains from use or possession of any controlled substance or alcohol. G.S. 7B-2510(a)(7)a., b.. The court can also order that the juvenile submit to random drug testing as a condition of probation. G.S. 7B-2510(a)(7)c. While most probation conditions cannot be delegated to the juvenile court counselor (who supervises juveniles on probation) for imposition, the court is allowed to delegate the requirement to submit to substance abuse monitoring and treatment to the juvenile court counselor to impose as they see fit. G.S. 7B-2510(b)(2).
Treatment as Part of a Youth Development Center Commitment
Treatment is required as part of any commitment to the DJJDP for placement at a YDC, which can only occur for a Level 3 disposition. The statutes do not specifically address whether treatment includes treatment for mental health and substance use disorders, or treatment to address some other need, nor do they address which treatment modalities must be available at a YDC.
The discretion to identify and address treatment needs is given to the DJJDP, which serves as the physical custodian of the juvenile while they are committed to the YDC. The juvenile’s parent, guardian, or custodian remains the legal custodian of the juvenile while they are committed to the YDC. G.S. 7B-2513(g). The DJJDP must prepare a plan for care or treatment of a juvenile within 30 days after assuming physical custody of them. G.S. 7B-2513(f). Each juvenile committed to the YDC must also be tested for use of controlled substances or alcohol and the results of this initial test must be incorporated into the plan of care for the juvenile to be used for evaluation and treatment purposes only. G.S. 7B-2513(i).
Nearly all commitments to the physical custody of the DJJDP for placement at a YDC must be indefinite commitments that last for a minimum of six months. G.S. 7B-2513(a), -2513(b). The DJJDP must evaluate the progress of each juvenile in its physical custody at least once every six months. G.S. 7B-2514(a). The DJJDP has the discretion to determine when the juvenile is ready for release. Id. Any determination that the juvenile should remain at the YDC must be based on the DJJDP’s determination that the juvenile requires additional treatment or rehabilitation. Id. If the DJJDP determines that the juvenile’s commitment should be extended beyond the maximum time period initially allowed by law (See G.S. 7B-2513(a4) and a prior blog on determining this maximum commitment period), the DJJDP must modify the plan of care or treatment for the juvenile to specify the goals and outcomes that require additional time for care or treatment; the specific course of treatment or care that will be implemented to achieve the established goals and outcomes; and the efforts that will be taken to assist the juvenile’s family in creating an environment that will increase the likelihood that the efforts to treat and rehabilitate the juvenile will be successful upon release. G.S. 7B-2514(b).
Research Survey on Practice
This blog describes the statutory intersection of the delinquency system and mental health needs for juveniles who are adjudicated delinquent. I am fortunate to be conducting research to address how the delinquency and mental health systems intersect in practice. One piece of that research is a survey for district court judges, personnel from DJJDP, community-based and residential mental health providers who serve justice-involved youth, and Local Management Entities. If you are among these stakeholders and want a link for the survey, please email me at greene@sog.unc.edu.