The juvenile justice system is experiencing significant legislative changes to support youth rehabilitation and improve public safety outcomes. Key reforms include: 

• The expansion of Medicaid coverage for justice-involved youth. 

• An increased emphasis on community-based alternatives to incarceration. 

• A stronger focus on mental health services. 

These shifts reflect a growing consensus among policymakers and advocates that effective juvenile justice relies on addressing immediate legal concerns while meeting the health and social needs of young people involved in the juvenile justice system. 

New Medicaid requirements, for example, mandate broader access to mental health services, which may reduce recidivism through early intervention. Community-based alternatives, such as non-police crisis response teams, aim to reduce youth detention rates by providing support to individuals in crisis without involving law enforcement. Updated standards in mental health care stress trauma-informed approaches and individualized treatment, underscoring the importance of proactive, preventive care. 

As these reforms take effect, professionals in the juvenile justice system will need to adapt their practices to align with these evidence-based, youth-centered approaches. 

The Impact of New Medicaid Requirements on Youth Justice 

Beginning in January 2025, new Medicaid provisions will partially lift the inmate exclusion policy for youth in correctional facilities, thanks to changes under the Consolidated Appropriations Act of 2023. With expanded eligibility, more justice-involved youth will qualify for Medicaid coverage before and after release, ensuring that vital healthcare services are available during a critical transition period. Now, youth under 21, youth under 19 on CHIP, and young adults up to 26 who were formerly in foster care can access Medicaid or CHIP coverage, supporting continuity of care that is essential for successful reentry. 

This expanded Medicaid access also reflects a broader shift from punitive measures to preventive, rehabilitative care. Coverage will include crucial services like behavioral health screenings, case management, prescription medication, and medication-assisted treatment, which youth can now access pre-and post-release. By covering these services, Medicaid alleviates strain on local juvenile justice systems and promotes a model that prioritizes youth well-being and resilience over detention. 

Juvenile justice system professionals are encouraged to integrate these Medicaid-funded resources into case management practices, creating a continuum of support that extends from detention into the community. This holistic approach underscores the role of healthcare access in reducing recidivism and aligns juvenile justice system practices with research-backed strategies for long-term rehabilitation and public safety. 

Shift Towards a Focus on Community-Based Alternatives 

Other legislative changes demonstrate a solid commitment to reducing detention in favor of community-based alternatives throughout the juvenile justice system. Research consistently shows that arrests and formal justice involvement can often worsen issues rather than resolve them, negatively impacting public safety and young people's well-being. Individuals with disabilities and mental health conditions remain disproportionately affected by arrests and incarceration. Yet, police officers and jail staff generally lack the specialized training and mandates to manage these needs. 

As a result, around 25% of those killed by police have serious mental health issues, and suicide is one of the leading causes of death in local jails. Recognizing these alarming statistics, the juvenile justice system is increasingly emphasizing mental health interventions and adopting approaches that replace punitive measures with proper mental health care. Specialized crisis intervention training for law enforcement, for instance, has been instrumental in equipping officers to handle mental health crises more effectively, helping to de-escalate situations and create safer outcomes for all involved. 

However, this training and traditional policing alone has proven insufficient for addressing the needs of those experiencing mental health crises. In response, programs like Eugene, Oregon's CAHOOTS (Crisis Assistance Helping Out on the Streets) offer an alternative model by dispatching trained medical and crisis professionals instead of police for crisis calls. This approach, which focuses on de-escalation and connection to necessary care, has inspired similar programs nationwide. Initiatives like Atlanta's PAD (Policing Alternatives & Diversion Initiative), Chicago's CARE (Crisis Assistance Response and Engagement), Denver's STAR (Support Team Assisted Response), and Durham's HEART (Holistic Empathetic Assistance Response Team) all aim to divert people with mental health needs away from the juvenile justice system and toward appropriate services. 

Research shows that youth directed to community programs often experience better mental health outcomes and are less likely to re-offend. As demand grows for humane, community-centered responses to mental health crises, maintaining high standards of care will be critical to sustaining these impactful reforms and achieving meaningful reductions in recidivism. 

Increased Focus on Mental Health in Youth Justice 

Other recent reforms mandate comprehensive mental health screenings and assessments to identify issues early and intervene before they escalate. Recognizing that approximately 70% of detained youth have a diagnosable mental health disorder, with 25% having severe conditions, these mandates aim to address a pervasive need in the juvenile justice system. By implementing regular assessments, youth justice professionals can tailor interventions to the specific needs of each individual, promoting better outcomes and reducing the likelihood of re-offense​. 

Key to these efforts is the Massachusetts Youth Screening Instrument (MAYSI-2), one of the most widely adopted mental health assessment tools in juvenile justice system settings. Designed to identify behavioral health needs in youth aged 12-17, MAYSI-2 provides a quick and effective means of determining which individuals may require further mental health evaluation or immediate intervention. This tool, available in both paper format and an audio-assisted, cloud-based version- Web MAYSI-2, allows professionals to efficiently screen for issues such as depression, anxiety, and trauma, ensuring that those at higher risk receive appropriate referrals for necessary care. 

However, the expanded focus on mental health screening also presents challenges, particularly in resource-limited settings where funding and trained personnel may be scarce. Implementing these screenings and subsequent interventions requires ongoing training for staff and a framework for integrating mental health care within broader case management practices. Despite these challenges, the emphasis on early mental health identification represents a promising advancement in youth justice. 

Decriminalize Youth and Stop Prosecuting and Sentencing Them as Adults 

Other recent legislation across the U.S. reflects an effort to keep youth out of the adult criminal justice system. Despite the Supreme Court's ruling that minors should not be held fully accountable in the same way as adults, all states still allow youth under 18 to be tried and sentenced in adult courts. As of 2023, at least 23 states and Washington, D.C., have no minimum age for prosecution, meaning that even very young children can face severe penalties. However, reforms are beginning to shift this approach, recognizing the developmental differences of young people and the long-term benefits of rehabilitation over punishment. 

Vermont's "Raise the Age Law," passed in 2018, set a precedent by extending juvenile court jurisdiction to individuals under 19, with eventual plans to include 19-year-olds. While the full implementation has been delayed due to resource challenges, early findings suggest that including 18-year-olds in the juvenile justice system has helped reduce delinquency caseloads, with many cases diverted from formal processing. This law highlights the potential of juvenile justice systems to manage young offenders more effectively than adult courts. According to a Columbia Justice Lab report, 85% of cases involving 18- and 19-year-olds were for misdemeanors, with over 40% resulting in fines rather than harsher punishments. This data underscores the opportunity for states to offer rehabilitative responses tailored to youths' needs and maturity levels. 

Youth prosecuted as adults face higher rates of re-offense and experience worse mental health and social outcomes than those in juvenile facilities, where interventions such as education, therapy, and life skills training can better address their needs. Legislators and advocates argue that adolescents, still developing emotionally and cognitively, are more prone to impulsive decisions. The Sentencing Project reports that in 2020, over 8,600 individuals were incarcerated for crimes committed as minors, many serving lengthy sentences that ignore their potential for change. This data supports the view that juveniles are better served by systems designed to rehabilitate rather than punish. 

However, implementing this legislative shift is not without challenges. Transitioning youth cases away from adult court requires comprehensive policy updates, increased resources for juvenile facilities, and dedicated training for staff to handle more complex cases traditionally managed in adult courts. Some states, like Vermont, have faced delays due to staffing and facility limitations. 

Despite these obstacles, these reforms present a crucial opportunity for positive change. By expanding the juvenile justice system's capacity and ensuring age-appropriate interventions, states can support better long-term outcomes, helping young people rebuild their lives with the guidance needed to succeed beyond their justice involvement. 

Implications for Professionals Working in the Juvenile Justice System 

As more youth justice programs prioritize community-based care and mental health interventions, justice professionals are tasked with implementing strategies that align with these new mandates. These changes require enhanced skills in mental health assessment, case management, and evidence-based intervention, underscoring the need for professional development that supports a data-driven, individualized approach to rehabilitation. 

Tools like the Youth Assessment and Screening Instrument (YASI) and the Web MAYSI-2 are becoming essential in the juvenile justice system toolkit to support these demands. YASI, an advanced risk and needs assessment tool, enables professionals to evaluate risk factors and the protective strengths that can be used to address a youth's vulnerabilities. By providing comprehensive data on each individual, YASI facilitates tailored case planning that addresses youth's risk factors and strengths, allowing for more effective service delivery. Similarly, MAYSI-2 provides an efficient, accessible mental health screening option that identifies pressing behavioral health needs, such as trauma or substance use, ensuring that youth receive timely and appropriate interventions. 

Integrating these tools into daily practice allows youth justice professionals to meet new legislative standards while advancing a therapeutic, rather than punitive, model of care. However, adapting to these shifts may require restructuring workflows and investing in training for staff to fully utilize these assessment instruments and incorporate trauma-informed approaches. 

As the system aligns with evidence-based practices, it is poised to offer young people the resources they need to rebuild their lives and create a positive future. Through these reforms, youth justice professionals are empowered to lead the way toward a safer, more compassionate system that prioritizes lasting rehabilitation over punishment. 

Orbis Partners provides solutions for criminal justice and human services systems, specializing in designing and implementing services for at-risk client groups. Orbis’ risk, needs, and strengths assessment tools are designed to guide the casework process by incorporating an individual’s unique set of needs. For more information about our assessments, visit our Assessments page.