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Can you help my child? Adolescent Consultation Services 2014 Year-End Report

To Our Donors and Colleagues From the desk of Fran Miller Fran Miller is ACS’s Board President. An active So often the children ACS serves have survived repeated, held professorships in law, To our donors – member of the board for over 20 years, Fran has complex trauma. Their homes have not always been places of safety. Their relationships with the vital adults health care management in their lives have been badly damaged. ACS’s mission is and public health at nothing less than to begin the process of healing broken Boston University. She is relationships, provide reasons to trust again, and restore and comparative healthcare hope to these kids and their families. systems and is passionate There is great power in having just one person really an authority on health law listen and care. ACS’s highly trained clinicians listen. about all families having The stories that they hear often begin as ones of struggle access to care. – with mental illness, with the effects of trauma, with circumstances no one would choose. But with time and care, treatment, services, education, and advocacy, these stories become ones of restoration and resilience. And that, as Dr. Shonkoff says, is what it’s all about. Your generosity and support make it possible. Thank you, “ The active ingredient … that's having an influence on development is the quality of the relationships that children have with the important people in their lives. That's what it's all about.” - Jack P. Shonkoff, M.D.

Thank you! In this report: You helped ACS serve hundreds of court-involved children and families in 2014. You helped us become their champions. Without you, we could never have 2 What Do We Do? reached so many vulnerable kids suffering from— - trauma, 4 What are the Results? - depression, - anxiety, 5 Karim: Caught Between - substance abuse, Cultures - learning disabilities, 6 “We know Caleb is in - immigration struggles. good hands.” How did we help kids and families manage in these tough times? We offered evaluation services to get to the root of their problems; we followed up with 7 Section 35s recommendations and treatment services that were specifically tailored for what the child and family needed; we advocated for them, stressing the urgency 8 Adverse Childhood of their needs. We maximized strengths and went the extra mile in accessing Experiences services. With your help, we became their champions. 10 The Community Gathers: In 2014 you helped us serve more children of immigrant families than ever An interview with Amy before. These are kids whose families immigrated from so many different Nechtem, Chief Justice of countries—Algeria, Nepal, Brazil, Cameroon, Guatemala, Pakistan to name the Juvenile Court just a few. About 25% of the families we served in 2014 had at least one person who was a recent immigrant. We helped them access culturally sensitive services 12 ACS honors Dr. Jack and services in their first language. Karim’s story on page 5 demonstrates the Shonkoff challenges these kids face. 14 Client Demographics There is never enough time. These kids and families have urgent needs that require our attention and care. And the systems of care are far from perfect. 15 Treatment Groups Often, the role we play is to take a step back and ask why multiple services and systems have not really helped ourthis particular client and their family. You 16 ACS Public Education help us uncover the underlying issues, find the right services, bridge the gaps 17 What is CYV to ACS? and encourage the various parts of the system to work together better. You help us do all this and more. So you can share in the satisfaction of progress—kids 17 MAJCC! improving at school, engaging in services, having their parents more involved. 18 Financials Thank you for your steadfast support. We couldn’t have done it without you! 19 2014 Donor List Rebecca Pries Executive Director 1

What Do We Do? ACS provides a range of therapeutic clinician evaluated Christina and risk assessments and evaluations services for vulnerable, court-involved arranged for immediate in-patient of substance abuse, fire setting, youth and families who need help in psychiatric care. sexual offending and violence risk achieving their child's healthy growth typically related to a range of complex and development. ACS intervenes in a Specialized Testing and underlying problems. All evaluations variety of ways at critical points when Remedial Solutions include recommendations for positive outcomes are still possible. ACS conducts specialized testing when appropriate treatment. ACS provides: there are questions of psychological processes, neuropsychological Competency to Stand Trial Evaluations—the foundation of functioning or cognitive capabilities. Evaluations to assess Competency ACS services. While evaluating Sam, a 12-year-old to Stand Trial are conducted Comprehensive Biopsychosocial boy from Malden who had stopped when a child's attorney or a judge Evaluations attending school, the ACS clinician questions whether a child is capable Evaluations of children and teens uncovered that he was suffering from of understanding and participating are ordered by the Judge. Most often anxiety and an undiagnosed learning in Court proceedings. For example, children and families have already disability. The clinician worked with ACS’s clinician was asked whether received services that fall short of the family, school and community 13-year-old Christopher who was meeting their needs. Clinicians agencies to match Sam with the arrested for stealing could assist his interview the child and family, gather services needed to address behavioral lawyer in participating in his defense. school and behavioral health records issues at school while supporting The need for competency evaluations to review past and existing services, him with an appropriate educational is rising as more youth come before and submit a confidential report to the plan and finding a mentor in the the Juvenile Court with mental health Court explaining the child’s behavior community. issues, cognitive limitations and/or to the Judge with specific, realistic Specialized Risk Assessments striking immaturity. recommendations. For example, Funded by: 14-year-old Sara was referred following ACS has expertise in highly specialized an extensive history of truancy areas where careful evaluations are - Massachusetts Trial Court and out-of-control behavior in her necessary to protect the child and - Department of Mental Health home and at school. The evaluation community. ACS conducts specialized - You (our private donors) discovered untreated depression due to previously unknown trauma and recommended special trauma- specific services. Emergency Evaluations at times of crisis Many children appear before the Court with critical, emergency needs. These include evaluations of children who may require hospital-level care because of a risk of suicide or harm to others. For example, 14-year-old Christina returned to Court after having run away from home for six weeks. She told her court-appointed attorney that she wanted to kill herself “because nobody cares.” The ACS 2

life skills to turn their lives Community Consultations— around. A recent graduate of broad-based connections the Young Women’s Group ACS has ties with hundreds of schools said: “It makes you realize and community providers, who often other people care about you turn to ACS for help in understanding because there are two people everything from basic court procedures here who were strangers and to how to access specific mental health they care about you.” See services. Consultation to families, more about our groups on schools, community providers and page 15 of this report. state agencies regarding the complex and rapidly changing service delivery Individual and Family Therapy systems may prevent a child’s further court involvement or the need ACS provides both short- for more intrusive and extensive and long-term counseling, frequently Treatment Services—specially focusing on a specific problem such as interventions. For example, a school tailored for court-involved conflict with a parent. ACS works with guidance counselor sought advice for children and families Maria, a 15-year-old girl who was family members to facilitate productive Through our unique partnership with changes within a family that make hesitant to report violence at home for the Juvenile Court, Juvenile Probation, the future success of the child and fear of being deported. and the District Attorney's Diversion family possible. 15-year-old Julie, for Program, ACS engages adolescents example, was initially reluctant to meet and families who would not otherwise with her ACS clinician; but later she receive treatment services. agreed she benefitted by learning how to understand her feelings that led to Group Treatment overeating and how to avoid escalating Group counseling is one of the most arguments with her mother. effective ways to engage teens in treatment. Groups focus on problem Funded by: solving and training in life skills such - You (our private donors) as self care and managing conflict. Education and Advocacy— ACS offers the following groups based linkages that sustain growth on referrals from the Court and the District Attorney's Diversion Program: Education and Advocacy is an ACS- developed service model that includes - Young Men’s Group follow-up services that strengthen the - Young Women’s Group resiliency of children and families. - Anger Management Group See more about our Education and - Motherhood Group Advocacy service model and its success on the next page of this report. The groups are typically made a requirement of Probation and Funded by: have increasingly been made part - You (our private donors) of Middlesex County’s Diversion Program. The groups provide a unique opportunity for the teens to express their concerns about the Court process, as well as learn valuable 3

What are the Results? Education and Advocacy (E&A) helps comprehensive needs of the child and • Advocate for the clients and link children and their families sustain family, are what lead to their success. them with community services – positive life changes. ACS clinicians In the course of E&A, ACS clinicians: medical care, mental health treat- leverage public and private resources ment, in-home support for to find services for vulnerable youth • Educate children and families about a family. issues identified in the evaluation within their home communities. • Follow up with clients and providers Individually tailored responses, which process – special learning needs, to help ensure that clients are actually mental illness, substance abuse. take into account the urgent and getting the recommended services. Year after year, E&A has been a catalyst Outcomes for positive changes for thousands of kids and families. These note-worthy Compliance with Treatment 89% results only exist because of the School Attendance 86% generosity of everyday people like you. ACS thanks its loyal donors for “giving Increased Family Involvement 91% legs” to these great outcomes! Serving Immigrant Families About 25% of the families of ACS clients had at least one parent who was a recent immigrant. Language barriers, cultural adjustment issues, and a lack a familiarity with the juvenile justice, child welfare, and educational systems increase the vulnerability of these families. ACS client families come from many countries of origin. 4

Karim: Caught Between Cultures Karim, age 14, was struggling at Nour also distrusted the American school. His persistent truancy and mental health system. Instead, she aggressive outbursts led the school wanted Karim to attend a local Islamic to file a Child Requiring Assistance afterschool program. Katherine (CRA) application with the Juvenile supported Nour’s decision to enroll Court. Karim had immigrated with his him in the program, but Karim rarely mother, Nour, from Algeria when he attended and his behavior and school was four. He was now fully bilingual attendance didn’t improve. but his mother still spoke mainly Arabic. The Court referred Karim to In fact, Karim’s behavior worsened. ACS for an evaluation, knowing that He sent sexually suggestive text it needed to understand him better messages to girls in his class and before recommending services. was repeatedly sent to the office for disrupting class with foul language Katherine Hughes, the ACS clinical and aggressive behavior. Nour and social worker, met with Karim and Karim both viewed these incidents his mother to piece together the as misunderstandings or innocent threads of Karim’s story. In reviewing situations blown out of proportion. school and medical records, she learned that his current behavior Katherine felt certain that at least some was part of a longstanding pattern. of Karim’s behavior was due to his She learned that his father had been early trauma. She also saw that Nour abusive to both Karim and Nour, was distracted by her own trauma and continued even after the divorce. and struggle to earn a living. She was Katherine also learned that Nour unable to provide consistent rules had very limited education in Algeria, and discipline for Karim and was lost which complicated communication in cultural misunderstandings with with everyone. service providers and the school. Having grown up in America, Karim Katherine suggested testing to see if learning difficulties were at the root thinks of himself as American. He her. In a very real sense, they are from of Karim’s behavior problems and isn’t interested in his mother’s culture different cultures.” whether he might qualify for special and the Islamic after-school program; So progress has been slow. A break- education services. Nour objected instead he connects with other through came when Nour accepted vehemently, expressing deep distrust alienated American peers. Karim and educational testing for Karim and of the school. She believed the school his mom needed home-based services the Court appointed an educational already singled Karim out unfairly to address the cultural divide that had advocate. Nour also engaged in her and felt that special education services developed between mother and son own counseling and started reaching would result in further discrimination. and had led to a serious deterioration out to Katherine for support. The in their relationship. good news is Karim’s behavior at “This may be the one of the most school has improved—and that’s the difficult cases of my career,” explained beginning of real progress! Katherine. “We always try to work within the wishes and understanding of the family. But the solutions Nour wanted weren’t working, and what her son wanted wasn’t acceptable to 5

“We know Caleb is in good hands.” Angela Foley was tense and anxious as she entered the Cambridge Juvenile Court. She didn't want to be there but honestly believed that what happened that day might determine if her 15 year-old son, Caleb, would live to be 16. Accompanied by a very reluctant Caleb, she was seeking to file a petition with the court (under Chapter 123, Section 35 of the Massachusetts General Laws) to have her son involuntarily committed to a program for treatment of his very serious and increasingly dangerous substance abuse problem. She knew that once she filed the application, the Court would order an evaluation by a Certified Juvenile Court Clinician. ACS’s Dr. Dan Sanford was called to evaluate Caleb. He began by asking Ms. Foley her concerns. She said Caleb had been struggling with depression since he was 13 and had been taking anti-depressants intermittently since that time. She thought he had started using drugs about two years ago. Most recently Caleb had been at a residential substance abuse program on a voluntary basis but had checked himself out against the advice of the program. He returned home briefly, but ran away after his parents discovered that he was trying to buy drugs online. When picked up by In order to protect confidentiality, ACS the police, he was wildly changes identifying features of clients. intoxicated and admitted that he had been drinking heavily, taking pills, and smoking marijuana. Dr. Dan Sanford, ACS's Clinical Director 6

Caleb’s impulsivity, use of heroin, and Section 35s increasing use of multiple drugs at the same time placed him at great risk of Massachusetts law* requested in Middlesex voluntarily—frequently overdosing as by his own admission he allows the court to County and the number a preferred outcome. already had, at least once. civilly commit a child to of children involuntarily However, in cases where a treatment program sent to treatment previous voluntary Caleb's mother testified that Caleb for substance abuse increased significantly. treatment efforts have had repeatedly promised to stop following a court- In part, this was due to failed or the risk of harm drinking and using drugs but that ordered evaluation by the alarming statewide is particularly high, the such promises, however sincere in the a qualified psychiatrist, increase in heroin/ court may determine moment, had proven impossible for psychologist or social opiate abuse, which by that an involuntary him to keep. worker. The court must its nature is exceedingly commitment is determine that the high-risk. warranted for the child’s The judge weighed all these statements child’s substance abuse ACS clinicians conduct safety. and then decided to commit Caleb to presents a likelihood these evaluations, Children who abuse a facility approved by the Department of serious harm and rule out the need for substances often have of Public Health for the treatment warrants commitment to in-patient psychiatric other mental health of juveniles with substance abuse a treatment program for care, and testify before issues or particularly disorders. With a resigned expression, up to 90 days. Typically, the court. In the end, difficult personal and Caleb left the court in the custody the child’s parent the decision to commit family circumstances petitions the court based a child belongs to which require further of the Sheriff’s department to be on a fear that the child’s the court. The child, attention upon transported to the program. life is at stake. represented by an their stabilization or A few days later, Dr. Sanford received In 2014, the number of attorney, may offer discharge. an email from Caleb's mother: Section 35 evaluations to go to treatment * MGL Chapter 123, Section 35 “In our fight to get Caleb well, I “ In our fight to get Caleb well, I find myself navigating system after find myself navigating system after system often in ‘real time.’ It is When asked about Caleb’s previous I really party. But usually I only drink system often in ‘real time.’ It is challenging and frightening, to say history of substance abuse, his mother and smoke weed.” challenging and frightening, to say said that Caleb had admitted to the very least. I am very grateful the very least. I am very grateful her that at least one time when he’d In the court hearing, Caleb's court- for your methodical, detailed runaway, he had overdosed on heroin. appointed attorney said that his for your methodical, detailed gathering of information. While client was willing to enter voluntary gathering of information. While Dr. Sanford then spoke with Caleb. treatment. Dr. Sanford's testimony the facts behind the Section 35 the facts behind the Section 35 Initially he admitted only to \"some\" urged a higher level of care. He are heartbreaking for our family, I drinking and smoking marijuana testified that Caleb’s history of briefly are heartbreaking for our family, cannot thank you enough for helping with “friends.” Then he admitted engaging in treatment and then I cannot thank you enough for us to achieve this necessary goal. that on several occasions he had been leaving, running away from home, helping us to achieve this necessary in a car driven by a friend who was and while away from home engaging goal. intoxicated. Other drugs? Dr. Sanford in some of his most dangerous drug We know Caleb is in good hands.” asked. Ecstasy? Yes. Cocaine? Yes. use, suggested that Caleb was not We know Caleb is in good hands.” Heroin? Yes. Finally, Dr. Sanford likely to be successful in voluntary stopped and Caleb said, “When I run, treatment. Dr. Sanford testified that 7

Adverse Childhood Experiences (ACEs) of Court-Involved Children What are ACEs? A Center for Disease than 17,000 participants, by formally gathering Control (CDC) study from had remarkable results: information regarding the late ‘90s examined as the number of ACEs ACEs within our unique the connection between increased, so too did the population. ACS childhood exposure to risk for several physical and systematically notes ten types of trauma and mental health problems. clients’ ACEs using the dysfunction and both short- questionnaire developed and long-term health and In October 2012, ACS for the CDC study. social outcomes. The ACEs joined with other court ACS continues to collect study, which totaled more clinics across the state ACEs data. to apply the CDC study What is the link between these ACEs and adverse health and social outcomes? ACEs, such as: Mental health Maladaptive coping Long-term outcomes: issues, such as: mechanisms such as: • emotional abuse • heart disease • physical abuse • anxiety • smoking • COPD • sexual abuse • anger • drug use • liver disease • family dysfunction • depression • overeating • early death If untreated… • sexual promiscuity ACS interventions engage clients in services to help them develop healthy ways to manage difficult past experiences and move their lives in a positive direction. Associated Health Outcomes • Alcoholism and • Liver disease alcohol abuse • Sexually transmitted • Chronic obstructive diseases (STDs) pulmonary disease • Suicide attempts (COPD) • Early initiation of • Depression smoking • Fetal death • Unintended or • Illicit drug use adolescent pregnancy 8

Trey’s Story Trey is a 14-year-old Trey’s traumatic home life Plan and engage in trauma- court-involved boy. His led to many behavioral specific individual therapy story shows the negative issues both at home and to develop better coping effects Adverse Childhood at school; he used drugs, skills. His ACS clinician Experiences (ACEs) can set fires, and physically also recommended that have on the life of a child. assaulted family members Trey’s mother get treatment After his father’s suicide, and kids at school. Trey’s for her depression and Trey grew up in a single- aggressive behavior towards that Trey and his mother parent family. He saw his others finally brought him participate in Intensive mother treated violently to the attention of the court Family Stabilization by her subsequent partners and to ACS. Services to work on setting and was also the subject and accepting boundaries of physical and emotional Realizing that his troubled and maintaining a safe abuse and neglect. His history was driving his household. mother used alcohol to behavior, Trey’s ACS safely living at home, cope with her depression clinician recommended that Thanks to his clinician’s doing better at school, and and had a hard time caring he and his mother complete understanding of Trey’s engaging in positive after for her children. a Fire and Home Safety trauma history, he is now school activities. Number of ACEs in National vs. Prevalence of Adverse Childhood Court-Involved Youth Populations Experiences 0 50% 100% 2014 court-involved youth* Emotional abuse Number of ACEs in National vs. Court-Involved Youth Populations National average** Physical abuse Sexual abuse Percentage of clients Emotional neglect National Percentage of ACEs 100 2014 ACS Percentage of ACEs Physical neglect 80 Mother treated violently percentage of people 40 Household substance abuse 60 Household mental illness 20 Parental separation/divorce Incarcerated household member 0 0 1 2 3 4+ scale Number of adverse childhood experiences * 166 Total ACEs Questionnaires number of adverse childhood experiences ** Based on Centers for Disease Control ACEs Study 9

The Community Gathers An interview with The Honorable Amy Nechtem, Chief Justice of the Juvenile Court for the Commonwealth Rebecca Pries: Congratulations! We’re so fortunate to have you as our new Chief Justice. Chief Justice Nechtem: It’s such an extraordinary opportunity to serve. My entire professional career has been in Juvenile Justice and Child Welfare. I started out as an Assistant District Attorney specializing in child abuse prosecution, I worked for the Attorney General’s office, I was in private practice, and I sat on the Juvenile Bench in Essex County for 13 years. RP: And you were President of the National Association of Women Judges! So you have a national reputation and overview as well. CJN: I’m fortunate to still be chair of the Juvenile Justice and Child Welfare national committee. It all makes me see the Juvenile Court Department as uniquely positioned—not as “the first line of defense” but as “the first line of opportunity” to intervene with our children and families and affect the wellbeing of society. If we’re successful, we can curtail the penetration of juveniles into the juvenile justice system and strengthen families. But we don’t do it alone. We have a great staff of dedicated professionals and we have extraordinary court clinics, which are unique to Massachusetts. “A child really needs somebody who believes in them.” RP: Looking at the big picture, what are the responsibilities of the Chief Justice of the Juvenile Court? CJN: There’s an overarching responsibility to protect children from abuse and neglect and promote a stable, secure and permanent living situation for them—and at the same 10

time to be mindful of strengthening RP: We see so many youth in the families. The Juvenile Court also has Juvenile Court with such difficult, to look at protecting public safety challenging lives. Do people ever ask and at rehabilitating youth so they you, “How do you do that work?” can adjust to society, put whatever issues they have behind them, and CJN: They certainly do and I move forward as an adult. Another always say, “I wouldn’t do any other overarching part is to ensure access work”—and I think I can safely say to justice which is fair and impartial. the other judges and staff would say Our kids have attorneys, they have the same. It’s the most rewarding jury trials, they have an independent work—challenging and rewarding judiciary. Massachusetts is one of the and uplifting. We get to change few states without elected judges. the trajectory of a child’s life. What could be better? I think you know— I couldn’t do any of this work without nothing’s better than that. the 41 judges sitting in 11 counties supports these youth. We’re keeping across the Commonwealth—they are RP: That desire—to help make a more and more kids out of detention exceptional at what they do and so child’s life better and to strengthen which is great and getting them into dedicated. the life of their family—is at the heart programs and helping the whole of what motivates the Juvenile Court family as well as the child. RP: What do you see as a common Clinics as well. misperception of the Juvenile Court? I've seen the impact we as judges CJN: I’ve always seen the clinicians and clinicians can have on a child. CJN: I don’t think people understand and clinics as valued partners in child It is remarkable what some love and how many different kinds of cases we welfare and justice. I cannot thank attention can do. A child really needs hear. The Juvenile Court is not open the clinicians enough for the work somebody who believes in them. to the public so it is important that we they do and their ability to access reach out to inform our community. community programs. We benefit RP: In the end, what would you say We address abuse and neglect cases, from their expertise. Often they’re the you like most about working in the delinquency cases, adoptions. We conveners to help people get to the Juvenile Court? handle not only District Court-type table to provide for the safety and well- cases but Superior Court cases. Very, being of the child. We want to move CJN: It’s the kids. These youth are like very serious cases. these youth into programs right at the heroes. They have so many challenges outset before they penetrate further to deal with and then you realize what strengths they have. They are into our system. I’ve found that when courageous, absolutely courageous. it comes to kids, the community And like anyone else, they want to feel gathers so we’ve been able to start appreciated and recognized. They want some incredible initiatives—like respect and kindness—both go a long diversion initiatives—and outreach in way. It’s terrifying coming into court— our communities. so terrifying. So to have a judge say, I credit our first justices and judges for “I understand” and to explain what’s participating in these and getting out going on and recognize that what into the community. It is very exciting! they’re going through is a really hard We’re learning more about the brain thing. And then to try to accentuate science—children are children—and the positive and keep positive youth how best we can safeguard public development in mind. As I said earlier, safety and do our jobs in a way that’s we can change the trajectory of consistent with the law, but also a child’s life. 11

ACS Honors Dr. Jack Shonkoff On November 19, ACS’s friends, donors, and supporters gathered to honor Dr. Jack Shonkoff, Director of the Center on the Developing Child at Harvard University. ACS honored Dr. Shonkoff for his contribution to the understanding of the impact of trauma on brain development in children. Dr. Jack Shonkoff engages the crowd. Dr. Jack Shonkoff and Marylou Sudders, LICSW, now Secretary of Health and Human Services for the Commonwealth, compare notes about trauma in children. Three pediatricians convene: Dr. Michael Yogman, Dr. Ben Siegel, and Dr. Jack Shonkoff. Gail Garinger, Esq., the Child Advocate for the Commonwealth, with members of her staff. ACS Clinical Director, Dan Sanford, Psy.D., and the Hon. Jay Blitzman, First Justice of ACS clinicians, the Middlesex County Juvenile Chelsea White, Court, catch up. LICSW, and Elizabeth Shepherd, Psy.D., chat before the event. 12

Manleen Singh and Courtney McClellen talk with ACS clinicians Bethany Hadley, LICSW, and Colleen Clinkscale, LMHC “ The relationships that children have with the important people in their lives actually influence the emerging architecture of the brain. They sculpt the wiring of the brain.\" – Dr. Jack Shonkoff ACS Executive Director, Rebecca Pries, chats with ACS board member Jane Seigel, LICSW, Dr. Shonkoff, and ACS Board Chair William H. Paine, Esq. Citizens for Juvenile Justice Deputy Director Gale Munson, Esq. and Executive Director Naoka Carey, Esq., supporters of positive youth development. Rebecca Pries thanks Marylou Sudders, LICSW, for introducing Dr. Shonkoff and for her long- standing support of the juvenile court clinics ACS supporters, Pete Caron and Bill Poorvu, and ACS board member Lia Poorvu listen to Dr. Shonkoff’s research. 13

Client Demographics The 562 clients ACS served in 2014 represented the following: Race Mental Health Disorders Out of all the comprehensive evaluations performed in 2014, Mood Disorder, ADD/ Hispanic ADHD, Anxiety, and Suicidality are the most 23% prevalent mental health conditions found among ACS clients, leading to a high incidence White 50% of hospitalization. Overall, 77% of ACS Black clients have at least one mental health disorder. 14% Nationally, 70% of youth in the juvenile Asian justice system have at least one mental health 7% condition and at least 20% live with a severe Other 6% mental illness.* Gender Mood 76% 50+23+14+7+6A ADD/ADHD 65% Anxiety 64% Substance abuse 56% d+21+39+44+56+64+65+76 Male Female Hospitalization 44% 62% 38% Suicide 39% Self-mutilating 21% 300 number of clients Age 250 200 150 * Skowyra, K.R. & Cocozza, J.J. (2007) Blueprint for Change: A Comprehensive Model for the Identification and Treatment of Youth with Mental Health Needs in 100 Contact with the Juvenile Justice System. The National Center for Mental Health and Jevenile Justice; Policy 50 Research Associates, Inc. The Office of Juvenile Justice and Delinquency Prevention. Delmar, N.Y.: The National Center for Mental Health and Juvenile Justice; Policy 0 under 7 7 to 12 13 to 15 16 to 17 18 and over Research Associates, Inc. 14

Treatment Groups ACS’s Young Men’s, Young Women’s, Young Men’s Group Young Women’s Group Anger Management and Motherhood The Young Men’s Group is an open “I feel better about myself.” Groups received referrals from the and safe space where court-involved Court and Diversion Programs. Over boys find validation as they share – 15-year-old girl in the half of the kids in group treatment their experiences and struggles. Young Women’s Group had been diverted from formal court Using a variety of exercises, the group The Young Women’s Group provides proceedings; this kept them from helps the boys increase awareness a positive peer setting for teenage girls getting a court record. and understanding of their emotions. to talk about healthy relationships and They learn to reframe their emotions to improve their decision making. The Motherhood Enrichment Group addresses the specialized needs Program and develop healthy coping mechanisms, leading to improved of court-involved girls and helps them The Motherhood Enrichment behavior. The group covers topics discover their untapped strengths. Program is offered to court-involved such as drug use, peer and family mothers from all walks of life. relationships and anger management. Young women learn new strategies The small-group setting allows for dealing with difficult emotions and each mother to share her individual “It makes you realize other people care stress. Strengthened by mutual support, struggles. Women reflect on their the girls tackle serious and often roles as mothers and develop skills about you because there are two people sensitive issues such as “sexting” and in mindfulness and parenting. The here who are strangers and they care other risky sexual behaviors, conflict group covers topics such as domestic about you.” with their parents, self-care, healthy violence and stress management and – 14-year-old boy in the eating and ways to reduce stress. uses art to explore therapeutic issues. Young Men’s Group Anger Management Group The Anger Management Group helps kids understand the basis and triggers for their anger and the roles played by substance abuse and family and peer relationships. Many of the youth have assault and battery charges or are referred as a diversion from court involvement. The Group focuses on helping the kids learn better ways of managing and coping with their strong feelings. Art from women in the Motherhood Enrichment Program 15

ACS Educates Dr. Elizabeth Shepherd shared her expertise on autism spectrum disorder as a guest lecturer at the Massachusetts School of Professional Psychology. Liza Berkowitz, LICSW, shared her expertise on identifying signs of domestic violence in court-involved youth and their parents with Juvenile Probation Officers at the Cambridge Juvenile Court. Executive Director Rebecca Pries, LMHC, discussed School Avoidance at the Middlesex Partnership for Youth School Attendance Conference in October. Also presenting were (L-R) Richard Melillo (Somerville Schools), Tim Carey (Juvenile Probation), Tom Malone, Esq (DCF), and Margie Daniels, ED of Middlesex Partnerships for Youth. Janice Hrabovszky, LICSW, helped train new clinicians for the Commonwealth’s Juvenile Court Clinics in a training session on Dr. Susan Flood (R) discussed conducting biopsychosocial competence to stand trial evaluations in November. evaluations that she conducts for youth referred to ACS at a Wheelock College class on Juvenile Justice taught by Marlies Spangaard, Esq. (L) 16

Youth Voices Cultivating Youth Voices (CYV) is a coalition of agencies committed to serving court-involved youth. CYV sponsors a blog featuring powerful stories about kids’ struggles within the juvenile justice system as well as their battles with mental illness, discrimination and trauma. These stories come from kids involved with the Coalition partners: Children’s Law Center of Massachusetts (CLCM), Citizens for Juvenile Justice (CfJJ), Health Law Advocates (HLA), Salvation Army / Bridging the Gap (BTG), and Adolescent Consultation Services (ACS). CYV also sponsors Kids and Judy Evers, Assistant Chief Court Officer, Judge Tan, and Ralph* from Bridging the Gap. Judges Day (see picture), a unique * Release on file. experience for court-involved youth where they are given a closer look Court House. The kids sat arm’s at the court house including holding length from Judge Tan and asked cells and the court room and meet their questions: “How do you with a juvenile judge. The kids separate your emotions from your come prepared with questions to judgment?”, “What are my rights as ask the Judge in hopes of better a juvenile when I come to court?”, understanding how the system they “How do you feel when you commit are involved in works. a young person?”, “As a judge do you ever feel threatened?”. After In August 2014 Judge Gloria Tan the Q&A, the kids felt comfortable graciously hosted Kids and Judges enough to see how it feels to sit in Day at the Cambridge Juvenile the clerk, jury and judge’s chairs. MAJCC! the Juvenile Court—trauma, substance abuse, special education needs, abuse Success! The Massachusetts Alliance and neglect, difficulties due to recent of Juvenile Court Clinics (MAJCC) immigration. After nine years of finally reached the funding goal of concerted advocacy, the statewide $2 million in 2014. alliance reached the $2 million goal set in 2005 for statewide increases. Since 2006 MAJCC has been educating ACS Executive Director serves as Co- public-sector decision makers about chair of MAJCC along with Dr. Gary the vulnerabilities of court-involved Dube of JRI. kids and families and the need for increased funding to serve them better. ACS receives separate funding for MAJCC briefed legislators on key MAJCC from the Gardiner Howland issues facing kids and families before Shaw Foundation. 17

ACS Thanks James A. Champy James Champy served ACS as a long-term member of the Board of Directors for over “ Jim’s devotion to ACS 30 years—1983 through 2014. We can’t thank him enough for his dedication and loyal has sustained us and years of service! As the former Chairman of Consulting at Dell Perot Systems, Jim is helped us thrive through- recognized throughout the world for his work on leadership and organizational change. out his years on the board. Jim brought his business management and fundraising skills to benefit ACS. Author of His compassion and Re-engineering the Corporation: A Manifesto for Business Revolution, a life member of the generosity have touched MIT Corporation, which serves as the board of trustees the lives of countless for MIT, Jim has also served as a member of the Board of the Commonwealth’s of Overseers of Boston College Law School. His most vulnerable kids dedication to ACS’s clients and mission will continue and families.” beyond his board tenure. The ACS Board of Directors - Lia Poorvu, ACS wishes to take this opportunity to express their sincere President Emeritus appreciation for his service. “ It has been a privilege to work with ACS. I have never seen an organization manage its resources so well and do so much good. Its families and staff are inspiring.” -Jim Champy Financials From the most recent audited fiscal year: FY 2014 (July 1, 2013 - June 30, 2014) FY14 Funding Sources Income FY 2014 FY15 Budget Public Sector Contracts Public Sector Contracts $881,554 $881,550 55% Other Investments Grants and Contributions $445,894 $405,450 11% Other Income $166,278 $53,000 Contributed Facilities 6+11+55+28t and Services 6% MAJCC $20,800 $19,000 Grants and Contributions In-kind $94,000 $94,000 28% Total Income $1,608,526 $1,453,000 Expenses FY14 Program Efficiency Salaries, Benefits, Taxes $1,120,255 $1,152,000 Occupancy (In-kind & Rent) $140,178 $121,450 Program Services 82% Professional Fees and Insurance $124,197 $107,500 MAJCC $21,937 $28,000 Fundraising 6% 6+82+12t Other Expenses $20,173 $44,050 Administration Total Expenses $1,426,740 $1,453,000 12% 18

Calendar Year 2014 Donor List Through a longstanding public/private partnership, we create can make a real difference. We have transitioned to a new successes for vulnerable kids and families. ACS has state donor management system and have made every effort to contracts for a portion of our work. But it’s only with you – record names and levels accurately. Thank you for contacting our individual, foundation and corporate donors – that we us if you see an error or omission. LEADERS Public Sector Katharine and Tony Pell Charles and Sara Goldberg (Gifts of $5,000 and above) Department of Mental Health Gary and Mary Pforzheimer Charitable Trust Private Sector Massachusetts Juvenile Court Deborah Z. Porter Terrie Graham Anonymous (2) Mary and David Shahian Virginia L. Kahn C.F. Adams Charitable Trust CHAMPIONS Wendy Shattuck and Mark Kritzman and Elizabeth Gorman Ronald Ansin (Gifts from $2,500 to $4,999) Sam Plimpton Fran and Hugh Miller Stevenson Family Frederick A. Bailey Trust Anonymous (2) Charitable Trust Tim and Joanne Oyer Bennett Family Foundation Trustees of the Ayer Home Robert and Molly Tarr Jonathan and Amy Poorvu Marion F. Boynton Trust Charitable Foundation Ann and Marvin Collier Ellen M. Poss Ann W. and Donald A. Brown David K. Wilcox and Cosette Charitable Fund Rebecca and Weldon Pries Cambridge Community Thomas E. and Charlotte R. Pierce Abby Rockefeller and Foundation Barbara B. Leggat Fund Lee Halprin Bushrod H. Campbell and John J. Petrowsky ALLIES Jane and Ben Siegel Adah F. Hall Charity Fund (Gifts from $500 to $999) Beth K. Pfeiffer Richard Wenger James and Lois Champy Richard Barnum Marilyn and Irvin Yalom Cogan Family Foundation ADVOCATES Lynn Cetrulo Mary W.B. Curtis Trust (Gifts from $1,000 to $2,499) Barbara H. Clark SUPPORTERS Devonshire Foundation Nancy and Richard Donahue Aquidneck Foundation Thomas and Andrea Dupree (Gifts up to $500) Forest Foundation Judith Aronstein Joseph Figueiredo and AmazonSmile Foundation Linda Stewart Roy A. Hunt Foundation Rhoda Baruch (continued on next page) 6+11+55+28t Klarman Family Foundation Fay Chandler Pete Caron Janey Fund Charitable Trust Anne Covert Jonathan Kutchins Peter B. Culman Lodge of St. Andrew Memorial Fund Ludcke Foundation Doran Family Foundation “ Whenever I talk about ACS, William and Margaret Paine Draper Laboratory I find myself speaking in James W. and Patricia T. Poitras Fund Joseph E. and Frances E. superlatives. I’m impressed Heney Charitable Trust by the efforts to welcome and Lia G. and William Poorvu Family Foundation Daniel Jacobs and help a child and his family, Susan Quinn to find individually tailored Karen F. Richards Barbara F. Lee services, to assist families 6+82+12t TJX Foundation George and Ann Macomber navigating the legal system through the production of Kids Gardiner Howland Shaw Foundation and the Law. Without a doubt, ACS makes inroads that Edward H. Mank Foundation Middlesex Savings Bank -Judith Aronstein, ACS donor Richard P. and Claire W. impact young people at a crucial juncture in their lives.” Morse Foundation 19

Calendar Year 2014 Donor List (continued from previous page) Thomas Kreilkamp HONORARY GIFTS John Petrowsky John and Kristin Macomber Karen F. Richards Alice Andrus In honor of Pete Caron Joseph and Rachel Martin Robert Silberman and Susan Ayers and Prudence L. Steiner Nancy Salonpuro Joseph and Julia McOsker Nancy Netzer Leslie Boden and Judy Yanof Susan and Pieter Mimno Mark and Lynne Wolf In honor of Lynda Schubert Bodman Ellen G. Moot Nancy Donahue John and Jane Bradley Gale Munson Ronald Ansin In honor of Pam Riffin Sara Bursac Linda and Martin Myers Pete Caron Paul and Catherine Mary and Sherif Nada In honor of Bethany Hadley Buttenwieser Andrew Navarette Elizabeth Houston Rebecca and Weldon Pries Tsunming and Esther Chen Martha Ondras Julian Houston David Riley and Michael Collins and Katherine Page and Alan Hein Nathan Darvish Beverly Freeman Shirley F. Partoll In honor of Lia G. Poorvu Anne Ellsworth In honor of Rebecca Pries Mathilde Pelaprat Rhoda Baruch Mary K. Eliot Fran and Hugh Miller Margaret Quinn and Ann W. and Donald A. Brown The Emery Bag Thomas Simons Bill and Kay Hudgins Margaret S. Fearey Laurie and Peter Raymond Ann and Marvin Collier Peter and Kathleen Forbes Pam and Tom Riffin Daniel G. and Alison P. Jaffee In honor of Cathy Schoen Emily Frank David Riley and Barbara F. Lee Christopher Hollander Nancy and Richard Fryberger Nathan Darvish Richard P. and Claire W. Morse Foundation Gail Garinger David and Deirdre Rosenberg In honor of Jane Siegel Edward H. Mank Foundation Jacques and Margaret Gelin Stephen Rosenfeld and Alice Andrus Margot Botsford Mary and Sherif Nada Owen and Miriam Gingerich Eleanor Rubin Carol Rosensweig Katharine and Tony Pell Robert P. Gittens and Donna Latson-Gittens Mimi Ross Jamie and Kara Gruver Eleanor Rubin Bethany Hadley Dan Sanford Suzanne and Easley Hamner John and Rhoda Schwarz Herbert and Ann Hershfang Melvin Scovell Debe and Nick Holland Robert N. Shapiro Christopher Hollander Robert Silberman and Nancy Netzer Julian Houston “My daughter was running Lucretia M. Slaughter Bill and Kay Hudgins away. I went to the juvenile Claude and Elizabeth Smith Katherine and Ralph Hughes court to get help, I wanted Prudence L. Steiner to take that extra step, to Daniel G. and Alison P. Jaffee Edward Stern make sure what I was doing Jill Janows and Joshua Rubenstein Robert Straus was right. But I was naïve Kantrovitz & Kantrovitz, LLP Judith and John Styer about the system. It was Helen and Rudy Kass Peter and Charlotte Temin really comforting when we were referred to ACS. Someone Jacquie Kay Katharine E. Thomas was there to help. The clinicians were amazing and I didn’t Lawrence Kotin Soledad A. Valenciano feel alone anymore. ACS’s people were there for us.” Mark and Lynne Wolf -Kathy Pilarski, ACS Advisory Council Michael Yogman 20



Read Karim's story on page 5. For information about ACS's work and immigration, see page 4. To protect confi dentiality, ACS does not use the names, photos or identifying features of clients. ACS Service Area–Middlesex County ACS Juvenile Court - Cambridge The Massachusetts Trial Court provides Clinics serve the four - Framingham ACS with in-kind offi ce space in Juvenile Court locations - Lowell Cambridge, Lowell, and Framingham. in Middlesex County: - Waltham We serve children and families from all 54 cities and towns in the County. Board of Directors Advisory Council President, Frances Miller Executive Director, Gerald Chertavian Chair, William H. Paine Rebecca E. Pries Roxann C. Cooke Treasurer, Jacquie L. Kay Tracy D. Gee Clerk, Jane R. Siegel Clinical Director, Robert Gittens Dr. Dan Sanford Nancy L. Donahue Joel Goldstein Terrie Graham HR and Finance, Silvia M. Gosnell Daniel H. Jacobs Pamela Riffi n Jill Janows Michael Lafl eur Fatinha R. Kerr Lia G. Poorvu * Thomas E. Leggat Laura M. Prager Charles J. Ogletree, Jr. Rebecca E. Pries * * * Kathy Pilarski Mary M. Shahian Jorge Quiroga David K. Wilcox Katharine E. Thomas Kathan Tracy Adolescent Consultation Services, Inc. 189 Cambridge Street, Fax: 617-494-0136 Cambridge, MA 02141 Email: [email protected] Phone: 617-494-0135 www.acskids.org