e-Connect quickly links arrested teens at risk for suicide with the services they need

The Enterprise — Michael Koff

“We’ve already diverted one youth from going to the hospital … At this very moment, our licensed professional is interviewing a young person at Level 2,” says Audrey LaFrenier, president of Northern Rivers, during Tuesday’s press conference while Bill Connors, director of Albany County’s department of probation, listens.

ALBANY COUNTY — A quarter-century of research by Dr. Gail Wasserman and the Center for the Promotion of Mental Health in Juvenile Justice at Columbia University has led to tablets being placed in the hands of youth who are arrested in Albany County.

On Tuesday, Daniel McCoy, the county executive, announced the e-Connect program, which is designed to quickly get help for youth at risk of killing themselves.

McCoy sounded both somber and passionate at Tuesday morning’s press conference as he noted he had served 30 years in the military and recalled that, on his first day at boot camp, he got a phone call from his father, saying that one of his friends had killed himself. 

“It’s one of the hardest things,” McCoy said of suicide. He went on to name initiatives he’s led as county executive, saying, “You can fight BP, you can fight oil, you can fight pharmaceuticals, opiates. This is something you don’t talk about. You kind of get lost in the heat of the moment …We’re not forgetting anyone. It may sound corny, but in the military, no one gets left behind.”

McCoy went on, addressing the press, “Even if you save one life, it’s important. If you take anything away from this: Sometimes you’ve just got to listen to someone in your life … even the people that seem the strongest … they have troubles.”

Bill Connors, director for the county’s department of probation, described the questionnaire that arrested youth would fill out on a tablet and how, based on their answers, at-risk youth would be characterized in real time at one of three levels. Albany County started using the e-Connect system last week, Connors said. 

“Because of the use of this screening program, we no longer have to wait … ,” said Audrey LaFrenier, president and chief operating officer of Northern Rivers, which provides services to 16,000 children, adults, and families in 35 counties in upstate New York.

“We’ve already diverted one youth from going to the hospital … At this very moment, our licensed professional is interviewing a young person at Level 2,” said LaFrenier.

She also said that Northern Rivers applauds Albany County for “initiating a program that will reduce juvenile recidivism and save lives.” And she noted that Northern Rivers works closely with the department of mental health.

“We respond to phone calls, make a decision to go out and intervene,” LaFrenier said, stating that the organization’s hospital diversion rate is over 85 percent at this point. “This program provides an opportunity to make it even better,” she said of e-Connect.

Connors noted that suicide is the second leading cause of death for youth in the United States, and it is much more common in the juvenile justice system.

He noted that New York State’s recent Raise the Age legislation requires counties to screen youth in the juvenile justice system for mental-health problems. Raise the Age went into effect last Oct. 1. 

Formerly, New York was one of just two states that treated 16-year-olds as adults under the law. As of last October, most 16-year-olds — other than those charged with violent felonies involving a weapon or causing serious injury — were to have their charges heard in Family Court and not be sent to prison with adults; the law will phase in 17-year-olds this October.

Connors projects that, when both 16- and 17-year-olds are being serviced under Raise the Age, as well as younger offenders, his department will handle 500 Albany County youth per year. Each will be part of the e-Connect program.

Other counties, besides the 10 in the Columbia University e-Connect program, are using alternate assessment through the state’s Division of Criminal Justice Services.

“We’re hoping this is successful and we can roll it out past probation,” said McCoy.

Mary Rozak, spokeswoman for the county executive’s office, told The Enterprise after the press conference that she was unable to find the cost of the e-Connect program but said that it is not being paid for by Albany County. Rather, it is being funded through a state agency, the Office of Probation and Correctional Alternatives, part of the Division of Criminal Justice Services. Currently, eight tablets are in use, Rozak said.


“Grease the pathway”

“My group and I have been studying mental health and substance use at various venues in the juvenile justice system,” Dr. Gail Wasserman told The Enterprise on Tuesday evening.

Research it has amassed shows that youth in the juvenile justice system have a higher prevalence of mood and substance-use disorders; of trauma exposure; of access to killing themselves such as through guns or illegal substances; and of decreased family supervision.

In 2014, the Office of Juvenile Justice and Delinquency Prevention released a bulletin stating that 11 percent of juvenile justice youth had attempted suicide. Wasserman has found that repeat offenders are almost three times as likely to report a recent suicide attempt.

Wasserman’s group, in the 1990s, uncovered a high level of suicide attempts and, by the end of the decade, started a pilot study in four county probation offices in New York State, including Albany County.

“It’s a no-brainer to me,” said Wasserman. “You want to identify risk systematically … That’s not the end game. The point is to get the needed services.”

Wasserman noted it’s hard for “people who aren’t clinicians” in a probation office to identify youth at risk for suicide.

“They’re probation officers and they freak out,” she said. “We worked out what to do so it was planned in advance. And, lo and behold, kids increased service access three-fold.”

The professor summarized the approach this way: “You make a path and grease the pathway.”

She went on, “Fast forward to 2019 … Here we are with all sorts of apps.”

The group developed a questionnaire with 15 or so questions that youth can take on a tablet. For example, one question with several parts, asks the youth, “When was the last time you had significant problems with … .”

Among the listed potential problems are “Feeling very trapped, lonely, sad, blue, depressed, or hopeless about the future,” “sleep trouble such as bad dreams, sleeping restlessly, or falling asleep during the day,” and “feeling very anxious, nervous tens, scared, panicked, or like something bad was going to happen.”

Youth can click on the text if they would like any of the questions to be read out loud.

“It goes up to the cloud where it’s scored,” said Wasserman. Instantly, algorithms generate one of three levels of risk for the youth with problems who answered the questionnaire.

The first level is a crisis where the risk is imminent. “We anticipate 1 to 2 percent would be in this class,” said Wasserman. That means, if Albany County has the predicted 500 youth answering the questionnaire each year, five or 10 of them would fall in this category.

The second level is a youth in crisis where, said Wasserman, “You’ve got 72 hours.” About 20 percent are expected to be in this class, she said. That would translate to 100 Albany County youth in the probation system each year.

The third level is for a youth who has mental-health or substance-abuse problems where standard protocol can be used. About 50 percent would be in this class, which would mean about 250 annually in Albany County.

Last year, Wasserman’s group had meetings in 10 different counties, including Albany County, to work out communication and protocol between mental-health departments and probation offices. Pathways for response were mapped out at each county. Albany county, for instance, uses a mobile crisis team, she said.

Further, probation officers in each of the 10 counties get online behavioral health training as well as ongoing technical assistance. “Troubleshooting Tips,” for example, describe what to do if the tablet is not turning on or charging, if the touchscreen is not responsive, or if there is no sound when using the e-Connect app with headphones.

The tablet scores the questionnaire results and also downloads a report for the probation officer in charge of the youth. The officer then knows what steps to take.

“We take the drama out of it,” said Wasserman.

She also said, “Suicides are blessedly rare. Suicide risk is not.”

Wasserman called the e-Connect program announced for Albany County this week a demonstration as opposed to the earlier pilot program. “It’s more of a tweaking,” she said.

The National Institute of Mental Health backed the project before New York State had passed its Raise the Age legislation, she said.

In addition to the complex analysis, coming up with a class category leading to steps to be followed for various services, using an electronic device has another advantage over, for example, filling out a questionnaire on paper.

“People are more likely to answer truthfully to a self-administered test on a screen,” said Wasserman. “It gives you a sense of privacy.”

She concluded with “kudos” for Albany County. “They did not have to do this,” Wasserman said, noting the training and time commitment involved. “We are very effortful. We hold them to what they do,” she said of pulling mental-health and probation departments together.

She noted that Colleen Breslin was a probation officer in Albany County 20 years ago with the original pilot project and is still at it today with the tablet demonstration “perhaps because she found that first experience positive,” said Wasserman.

Wasserman concluded, “It’s not an off-the-shelf kind of thing. Just today, we had to make tweaks.”


“A collaboration”

Breslin, deputy director of the Albany County Probation Department, did, indeed, find the Columbia University pilot project to be valuable.

Having been to school for criminal science, Breslin was looking for a balance between law enforcement and social work. She found it when she started working for probation in 1982.

“I wanted to help people and change their lives,” she said.

She spent the first half of her career in the adult division with clients over the age of 16. But she truly found her niche, she said, when she transitioned to the juvenile division.

“I felt these kids benefited from our guidance … They are more open to the process of change,” she said.

Over the last two decades, though, she has seen an influx of youth with mental-health issues.

“It’s hard for us,” she said of the probation department. “We don’t provide counseling in a clinical sense.”

Further, she said that, over the years, it has become harder to connect to services. “The wait lists are long,” Breslin said.

“Twenty years ago, the first Columbia project gave us a clear path not just to identify kids but to connect them to services.” Back then, though, she said, “The technology was a bit of a challenge.”

Even so, she said, “I remember how seamless it was; the connection of kids to services was immediate. We’ve seen such a rise, we needed some kind of a tool … We needed a written protocol to bring Mental Health in.”

Now the technology is streamlined. “When Columbia approached us, we jumped at the opportunity,” said Breslin.

The e-Connect program, she said, brings in kids and their families. Often, Breslin said, families don’t talk about the problems their children face. “Some don’t know their child is struggling, or how extensive their substance use is,” she said.

Using the e-Connect tablet, she said, is useful because “kids are better at self-disclosing … They tend to be more honest.” If they are answering questions to a third party, she said, “They have fear of getting in trouble.”

“Columbia University trained the probation staff to present to families without alarming them. It puts the family at ease,” Breslin said. “It lets them know what will happen next. They don’t have to worry or fear. We include them every step of the way.”

Although the county probation department has had the tablets for just one week, Bresline said, “We’ve had a handful of kids use it.”

Several who answered the questionnaire didn’t fall into any of the three at-risk levels. Two youths were categorized in Level 2 in just the first week.

“It doesn’t surprise us,” said Breslin. “We know our juveniles are struggling.

She concluded, “This program works because agencies are willing to work together … It’s a collaboration.”


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