Clinical approach; Juvenile court program tackles social, mental and medical issues.

Byline: Gary V. Murray

WORCESTER - Disturbing trends have emerged in the state's juvenile justice system in recent years.

Experts in the field report that younger and younger children, some between the ages of 7 and 10, are being brought before juvenile court judges on delinquency matters. More and more female adolescents are being arrested and many of them, court clinicians say, have been the victims of sexual exploitation by criminal adults.

The numbers of youths using hard drugs or at risk for suicide are reportedly on the rise, as well, and the system is said to have seen an increase in juveniles with multiple, complex problems who, for whatever reasons, have fallen through the cracks of various state agencies.

The Massachusetts Alliance of Juvenile Court Clinics estimates that more than 70 percent of the children and families who wind up in juvenile court face a combination of problems ranging from mental health and substance abuse issues to learning disabilities and histories of abuse and neglect.

Identifying those problems and making recommendations to judges that are designed to foster rehabilitation and reduce the need for future court involvement is the job of people such as Julie Ann Lamacchia.

Ms. Lamacchia is a certified juvenile court clinician, a licensed social worker and program director of Community Healthlink's Worcester Juvenile Court Clinic. A member of UMass Memorial Health Care, Community Healthlink is the contracted vendor for the Worcester clinic.

Located on the ground floor of the Worcester Trial Court at 225 Main St., in the same building as the Worcester Juvenile Court, the clinic has a staff of two part-time psychologists, a part-time social worker and four master's level clinicians who cover juvenile court sessions in Worcester and several other area communities.

Funded through the state Department of Mental Health with oversight by the Juvenile Court Department of the Massachusetts Trial Court, the clinic is part of a statewide system of juvenile court clinics. The clinics undertake a variety of court-ordered evaluations and identify referral options to assist judges in determining how to best resolve the cases before them.

One such assessment would be a comprehensive psychosocial evaluation a judge might request, for example, for a 12-year-old boy arrested as a result of a fight. The evaluation could help the judge decide whether the child is mentally ill and in need of psychiatric treatment or was simply acting out of "adolescent impulsivity," according to Ms. Lamacchia.

The question becomes, "What are the reasons behind their problematic behavior? There are so many dynamics we have to look at," she said.

The clinic also conducts emergency mental health screenings and specialized evaluations for substance abuse, sexual offending, violence risk and, on rare occasions, fire-setting. As in adult court, evaluations are sometimes requested to determine whether a youth is mentally competent to stand trial or criminally responsible for his or her alleged unlawful conduct.

The Worcester clinic, with an annual budget of about $480,000, conducts an average of 250 to 300 court-ordered evaluations a year and sees about 10 percent of the youths involved with the juvenile court, according to Ms. Lamacchia. The vast majority of evaluations are requested in delinquency matters or CHINS (Child in Need of Services) cases, which involve truants, runaways, stubborn children and habitual school offenders, she said.

"I can say that in delinquency and CHINS cases that have required an in-depth assessment of the needs of a particular child that the evaluations are extremely thorough and provide a road map for treatment and, hopefully, rehabilitation of the delinquent or CHINS behavior," said Worcester Juvenile Court Judge George F. Leary.

In addition to formal evaluations, clinic staff are often called upon to consult informally with judges and probation officers, Ms. Lamacchia said.

"The court is balancing rehabilitation and provision of services with public safety. What the juvenile court clinic is trying to do is fill in the question marks for the judge," said Deborah Ekstrom, Community Healthlink's chief executive officer.

"I find it to be a very useful and beneficial tool for a variety of reasons," lawyer Steven J. Bolivar, who specializes in juvenile and probate law, said of the clinic.

"Having them right there, it really gives the court the immediate insight into the mental health makeup of the juvenile that the court might not otherwise have," he said.

Mr. Bolivar described the clinic's efforts as "one way to start digging and getting to the source of what has caused these kids to be in the juvenile system and to identify the problem and, hopefully, the solution."

Contact Gary Murray by e-mail at [e-mail].

ART: PHOTO; CHART

CUTLINE: (PHOTO) The Worcester Juvenile Court Clinic, part of a statewide system, helps judges determine the best solutions for matters involving troubled youth; shown are court clinicians Doreen Bell, center, Delia Galloni, left, and Laura Bailey. (CHART) Worcester County Juvenile Court Clinic

PHOTOG: (PHOTO) T&G Staff/CHRISTINE PETERSON (CHART) T&G Staff