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Feel your feet on the floor beneath you. Freeze like a statue. Take a deep breath and look around you. Take note of the situation, your feelings, your surroundings. Then, go forward — with purpose.
It’s an example of a technique that a juvenile in the state’s detention facilities might learn as part of a program of Dialectical Behavioral Therapy, or DBT — a psychotherapy program centered around developing skills that allow people to manage their emotions and function in social settings.
“For some of these kids … that’s, like, life-changing for them, because they’ve never stopped themselves from acting on impulse in their whole life,” said Michele Galietta, a consultant who has trained Connecticut employees in juvenile detention facilities in DBT for just over three years.
The state is investing millions in mental health programs like DBT for teenagers and young adults in juvenile detention with the hope that those skills will keep these young people out of the criminal justice system long-term.
Of the $6.1 million the state spent on education and training for public employees in 2023, the four biggest contracts, totaling approximately $3.2 million, went to four organizations contracted by the state judicial branch to provide mental health services for juveniles.
Many of these programs are based on a type of treatment called Dialectical Behavioral Therapy, or DBT, which in recent years has become a popular technique for treating young people in juvenile detention.
Galietta, who is an expert in the use of DBT in the criminal justice system, said the state is an outlier in its whole-hearted embrace of DBT, and its insistence on putting in checks to make sure that what was actually happening in the detention centers matched the standards of the program.
“They did their research very carefully,” said Galietta.
She said the technique was first used with juveniles in Washington State, and they found that the approach reduced violence among inmates.
“That’s why a lot of people were initially interested in it, is that it does a great job of stabilizing the environment so that you don’t have kids beating each other up or hurting staff,” she said.
The evidence of its success in reducing recidivism is limited, but Galietta said it has the best success rate of any program she’s seen.
Cathy Foley Geib, director of juvenile residential, clinical, and educational services for the Connecticut Judicial Branch, confirmed the branch’s desire to use programs that demonstrated clear evidence of keeping young people from repeatedly returning to the juvenile justice system.
“Ultimately for kids who end up in the deeper end of the system, we don’t want to see them going into the adult system,” said Foley Geib “So we really want to invest in programs that have a strong evidence base showing that they do make an impact on that behavior.”
The state of Connecticut launched the effort in 2018, when the responsibility for juvenile detention was transferred from the Department of Children and Families to the Judicial Branch.
“We had to research and design a program that would essentially meet the needs of both the kids but also the community, right? So really sort of starting from scratch,” she said.
The goal behind the use of these therapies is to keep young people out of the court system. That’s why, Foley Geib said, for the lowest-risk offenders, the judicial branch tries to divert them into services provided in the community. DBT is aimed at the highest-risk young people — those who need to be in facilities. And for those somewhere in-between, the branch invests resources in a therapy called Multisystemic Therapy, or MST, which works with young people and their families in the home.
“Really the goal is that we have a system in place that would prevent kids and youth from ever getting involved in the court,” said Kim Nelson, chief program officer for Wheeler Clinic, which also contracts with the judicial branch to provide therapeutic services for juveniles.
The number of yearly juvenile cases added to the docket dropped steadily for about eight years prior to the pandemic – from about 12,300 cases in 2012-13 to about 4,200 cases in 2020-21. Cases rose to about 5,400 in 2021-22. Data from the judicial branch shows that the number of teens on probation admitted to juvenile detention facilities – in Bridgeport, Hartford and Hamden — hovered around 50 in the years 2019, 2020, and 2021.
Yet recidivism rates are rising. The percentage of juveniles who have previously appeared in court five or more times increased from a low of 11.1 percent in 2019 to 15.6 percent in 2021.
In 2019, juvenile court received referrals for 5,248 young people, a number that dropped to 3,197 in 2020. In that same time period, the number of juvenile referrals for young defendants brought to court five or more times rose from 413 to 585.
Foley Geib said that they used DBT for young people who were considered a risk to public safety — they’ve stolen cars, been arrested with weapons, been arrested for manslaughter or for physical or sexual assault. She said these young people often have multiple problems — they came from poverty or difficult family relationships, or had substance abuse or mental health issues.
The state is also paying the organization Community Solutions $3.5 million to open a new residential treatment facility for adolescent girls in the juvenile justice system. The facility, which will open later this month, will house between six and eight girls between the ages of 13 and 17 who are currently on probation and at high risk of re-offending.
Fernando Muñiz, CEO of Community Solutions, said the facility will also be relying on the DBT model. The facility includes programs like art therapy, equine therapy and has a school on the premises.
“Outside of juvenile detention, which is locked, this is going to be the most intensive program in Connecticut,” said Muñiz.
Galietta said that DBT takes a very different approach than traditional talk therapy — it’s about building specific skills the young people can take with them into the outside world.
“A lot of times what counts for therapy is counseling somewhere just like supportive counseling,” said Galietta. “It’s problematic, because these kids have super high needs …when we look at risk factors for juvenile incarceration. They have tremendous trauma histories.”
She said that many of these young people have come from situations where they didn’t receive what they needed as small children — meaning that their abilities to regulate their emotions and create a stable life have to be built from the ground up.
“Even that word — “rehabilitate” — it assumes that there was some level of normal stability that you fell from and needs to be corrected, which is not true for some of our kids. Many of them are DCF involved, and they have been severely neglected and in multiple homes. So you’re really building stuff that like a normal childhood would have put in place and they just don’t have,” she said.
Rather than focusing detention facilities on what she called “compliance” — having a child remain silent and not hurt anyone – the technique instead focuses on articulating emotions. They are asked to share their thoughts, feelings of remorse and what Galietta calls “anti-social cognitions” — for example, the belief that “weak people deserve to get taken advantage of.”
“Compliance doesn’t mean anything. In fact, the kids who get through those systems the easiest are the more psychopathic kids,” said Galietta. “If they want to hurt someone else, they won’t do it themselves. They’ll get someone else to do it, but they’ll look fine on paper.”
The first level of treatment, she said, is letting a child tell the story of their life, and then repeating it back to them. The clinician will ask him or her to imagine their ideal life – maybe using a vision board or interviewing other people — and commit to working toward the ideal. Then, Galietta said, the teens are asked to accept “coaching” from staff members.
“By ‘coaching’ we mean, when these kids get upset or angry, if an officer steps in and says, ‘Hey, would you try this skill with me?’ That’s what we’re looking for to move you up to the next level, which is kind of fairly independent skill use and taking responsibility for your own life,” said Galietta.
Foley Geib said the staff in the facilities validate what the young people feel and then coach them through what skill they should use and how they can best use it in a given situation. The adolescents are taught how to regulate their emotions, how to control frustration and effectively advocate for themselves.
DBT also takes a different approach to punishment. Rather than being disciplined, juveniles who act out are asked to write a “behavior chain” — recounting the events that led up to the outburst or behavior.
“Many of these kids, because of their histories and socialization, they don’t have any skills to manage anger. That’s like one of the biggest problems for a lot of our kids. They’re kind of impulsively angry. They can’t stay in class. They’ve gotten kicked out of their high schools or their middle schools for behavioral issues,” said Galietta.
The state has invested in MST programs since the turn of the millennium, a therapy that sends clinicians to work with young people and their families in the home.
“It’s not the kind of therapy where you’re going to someone’s office for 50 minutes a week,” said Muniz. “This is an intervention that’s really intensive. They’re seeing their clinician two to three times a week, and they’re working with the whole family unit to kind of change the dynamic and the behaviors.”
Community Solutions provides Multisystemic Therapy to young people in a number of states, but does not offer the therapy in Connecticut.
Muniz said the key to both MST and DBT is that they are based on specific actions and skills rather than on talk.
“There’s not a lot of traditional therapy — the stereotype is, like, you lay down on the couch and it’s like, tell me about your childhood and this kind of thing,” he said. “These are very solution focused, very focused on the future, very focused on change.”
After the teens show progress developing coping skills, Galietta said, they start preparing to return to the outside world, like practicing taking job interviews while still inside the facility. Galietta said that sometimes they try to involve young people in sports teams and bands in whatever high school they are attending. For those who are older and lack a high school degree, they work on vocational training.
“The families can be really challenging, because some of the kids — you’re going to try to talk to a kid about not being involved in a gang if two generations of his family have been in that gang,” said Galietta.
She said the judicial branch was currently looking at creating transitional housing for some of these young people.
“We know if they go back to New Haven that they’re going to be on the street. But if they were to be somewhere else in their new job with a little bit of coaching and support in a group home, maybe they could do much better,” said Galietta.
Galietta said it’s still too early to know recidivism rates from Connecticut’s DBT program. But she said that in one facility, the amount of times that staff had to restrain teens decreased by 70 percent.
Foley Geib said that outcomes are mixed. Some teens leave the program and don’t come back. Others commit another crime – sometimes a less serious one — and end up back in the system. She said one thing they hope to do with the data they collect is determine, based on certain risk factors, the length of time that a teen will need to spend in therapy.
Workforce shortages that have hit nonprofits particularly hard also hamper their ability to reach a large number of young people — particularly in the case of MST. Nelson said the staffing challenges that have caused problems for children’s mental health providers have also affected Wheeler’s ability to provide these programs for juvenile offenders. She noted that despite the cost of living adjustment included in the most recent state budget, the Medicaid reimbursement rates and the state grants were still inadequate to attract qualified professionals to work with the teens.
“There’s a lot of unfunded time that goes into these evidence-based practice models. They’re rigorous,” said Nelson. “The training and the consulting and the driving to and from … activities that are non-billable. So you’re restricted in what you can try and get reimbursement for, and then the contract kind of remains flat with the grant dollar.”
Galietta said one of the most valuable things she believes the state could do is create afterschool programs for middle schoolers, to keep them occupied