Identifying and providing services to Texas' juvenile offenders with mental health needs.

Amother calls 911 to report her child to the police in response to a behavioral tantrum that is caused by the child's mental health condition. When asked why she did not seek mental health services, the mother states that she has been told by law enforcement, school officials, other parents and mental health practitioners that the only way her child will receive help is if he or she is referred to the juvenile probation system because the mental health system does not have enough resources.

This situation is not unusual. Across the nation, the question of how to effectively address the mental health needs of youths entering the juvenile justice system is being asked and people are struggling to find a responsible way to answer it.

During the 77th legislative session (January to May 2001) in Texas, there was a great deal of discussion about this issue. At a time when the state's leadership was beginning to recognize a shortfall in the state's budget, lawmakers began to explore ways to impact the apparently increasing number of juvenile offenders entering the system with mental health issues.

An exploration of the issue included, but was not limited to, the following discussion points:

* There was no way to accurately determine the number of juveniles in the probation system with mental, health issues since each of the state's 168 autonomous juvenile probation departments used different screening instruments.

* The mental health system acknowledged it was underfunded to service all clients needing its services.

* The mental health system requires the client to want the mental health services it provides.

* Juvenile offenders with mental health issues in the probation system were often referred for domestic violence and/or assault of their teacher in their special education class or alternative education setting. Their mental health need(s) were often the deciding factor in determining how to proceed with the case.

* The cost to the state for failing to identify and serve these juveniles early on became more expensive the older they were.

* Placement options for these juveniles in the state were limited and expensive. Since the money necessary to access these placements is not readily available, many of these youths were committed to the Texas Youth Commission, the state school system for juvenile offenders. Alternatively, the parents would relinquish their parental rights and the youths would be committed to a state-run mental health facility.

* Many juveniles with substance abuse issues also had mental health needs (often undiagnosed) and were using drugs to self-medicate.

* Without specialized supervision and treatment services, many of these juvenile offenders would be underserved and unsuccessful in the community.

Improving Mental Health Services

In an effort to impact this issue, Texas lawmakers passed legislation that allowed the Texas' Juvenile Probation Commission (1) to designate a mental health screening instrument to be used by all departments. The instrument selected was the Massachusetts Youth Screening Instrument. TJPC staff trained juvenile probation department personnel across the state on the use of the instrument as part of the formal intake process, which began Sept. 1, 2001.

The Legislature also passed HB 1901, requiring that the Texas Council on Offenders With Mental Impairments (TCOMI) provide the Legislature with a comprehensive plan detailing how the state could improve mental health and substance abuse service delivery to juveniles who are involved with or at risk of becoming involved with the juvenile justice system. As detailed in the legislation, the TCOMI plan is required to provide a "process to define and identify juveniles with mental health and substance abuse disorders ... including recommendations on uniform screenings, assessment procedures, sharing of information between entities, and data collecting and reporting."

The legislation also requires that the council develop a process to improve coordination and communication among state and local entities, review mental health and substance abuse interventions that have proved effective for juveniles, analyze the array of service interventions available for both populations and determine what, if any, state, federal or local regulations might create programmatic, financial or other types of barriers that would impact the development of such programs.

The Special Needs Diversionary Project

While no new dollars were appropriated to the mental health system, TCOMI was appropriated funds and charged to work with TJPC to develop a program designed to provide a comprehensive array of mental health services to this population. The project was named the Special Needs Diversionary Project. Funds appropriated to the project were to be used to expand the existing program available for adult probationers and parolees and provide services to juvenile probationers and parolees. This article focuses only on the juvenile probation aspect of the program.

The project's concept was to create a caseload of juveniles with mental health issues to be supervised by juvenile probation officers trained to work with this population. The specialized probation officers work very closely with mental health practitioners, guaranteeing the delivery of the necessary mental health services.

The goals of the council's project are to keep the offenders at home within the community, reduce recidivism of those in the project, and have juvenile probation closely collaborate with the local mental health providers to ensure proper identification and service delivery of those on the caseload.

Of the total $35 million TCOMI was appropriated to address its adult and juvenile responsibilities in this pro gram, $10 million was designated for juvenile services. The council's role in the project is to fund the local mental health provider's staff and the necessary resources for each of the sites and each segment of the program (adult/juvenile, probation/parole). TJPC received $4 million to provide project departments with the funding to hire and train the juvenile probation officers working with the specialized caseload and to purchase necessary equipment.

Required project elements were:

* Wraparound services;

* Coordinated service delivery and planning between probation and mental health staff;

* Provision and monitoring of medication (if necessary);

* Individual and/or group therapy;

* Skills training;

* In-home services such as multi-systemic of functional family services;

* Family focus support services;

* Substance abuse treatment (if needed);

* Benefits eligibility determinations had to be assessed on all juveniles (many of the juveniles are Medicaid-eligible); and

* Co-location of supervision and treatment services.

Each site had at least one team comprised of a juvenile probation officer and a licensed professional of the healing arts. Each team worked together on a caseload consisting of 12 to 15 youths who remained in the project for an average of four to six months.

Eligibility criteria for program participation was determined first by a "warning" or "caution" indicator on the screening instrument (if the youth had a recent psychological examination, no screening was required) and the availability of a guardian committed to working with the mental health and juvenile probation department personnel. If these elements were met, a referral was made to the mental health authorities. At this point, a clinical assessment was conducted to determine the child's ability to function in society. The performance target of the program was to serve a total of 830 juveniles each year of the program.

The program was funded in three phases. Phase 1 required each of Texas' eight largest urban counties to participate. Juvenile probation and its local mental health provider had to work together to design a project (that included the above required elements) for presentation to a panel that included representatives from the state mental health office, TJPC and TCOMI. While funding was guaranteed for the urban counties, their proposals were not funded until all required elements were present and a comprehensive vision of their program could be articulated.

Phase 2 of the project was open to any juvenile probation department in the state that wished to apply for a grant to operate this program. All the requirements of Phase 1 were in effect. By the end of Phase 2, TJPC had exhausted its funds.

Phase 3 consisted of TCOMI providing funding to selected counties for a mental health team that would work with the youths identified by the juvenile probation department. In Phase 3 counties, the juvenile probation department would not receive the money from TJPC to fund a team but would create a specialized caseload and work with the council-paid mental health team.

The First Year

Many problems were encountered with the creation of this project. While the challenges varied in each county, the general themes were: Local mental health authorities had a difficult time hiring staff to work with probation since they were required to make home visits after normal working hours and be on-call 24 hours a day; minimal relationships existed between the local juvenile probation department and the local mental health authority and many times the relationship that existed was very tense; communication between entities was difficult since words common in each system's vocabulary had different meanings in the different systems; and service delivery models were different--one delivered services in the office, the other delivered services in the community.

By the end of the first year, a total of 19 counties were funded:

* Phase 1: Bexar, Cameron, Dallas, El Paso, Harris, Hidalgo, Tarrant and Travis. (2)

* Phase 2: Angelina, Ellis, Fort Bend, Hale, Jasper, Jefferson, McLennan, Randall, San Patricio, Smith and Williamson.

* Phase 3: Brazos, Grayson, Kerr, Lubbock, Midland, Nueces and Tom Green. (3)

The results for the first year of service are as follows: (4)

* Services were provided to a total of 901 juveniles in the three phases.

* Approximately 14 percent of youths involved in the program did not fully meet the criteria for program enrollment.

Of those with an identified mental health issue, the enrolled juveniles' identified diagnoses were:

* Depression -- 22 percent;

* Oppositional defiant disorder -- 19 percent;

* Conduct disorder -- 18 percent;

* Attention deficit hyperactivity disorder -- 9 percent;

* Mania/hypomania -- 5 percent;

* A social phobia, panic disorder or general anxiety disorder -- 3 percent;

* Schizophrenia, post-traumatic stress disorder and obsessive compulsive disorder -- each accounted for 1 percent; and

* Other diagnoses -- 20 percent.

The project entered its second year on Sept. 1, 2002. It is hoped that most of the problems encountered during the first year will not be repeated, that the foundation for the projects has been established and should lead to an increase in the total number of juveniles served, and that other effective means of intervening with this population will be identified as a result of the work done in response to the requirements of HB 1901.

Texas, like other states addressing the impact of mental health in the juvenile justice community, is attempting to determine an effective way to identify children and adolescents with these needs and address them in a manner that would eliminate the need for a referral to the juvenile probation system as a means of accessing mental health services.

ENDNOTES

(1) The Texas Juvenile Probation Commission is the state agency that disburses appropriated funds to Texas' 168 juvenile probation departments. TJPC's responsibilities include, but are not limited to, the promulgation of standards for probation personnel, pre- and post-adjudication facilities, and abuse and neglect investigations in secure and nonsecure programs operated by juvenile departments.

(2) A modified version of the program existed in Cameron and Hidalgo counties.

(3) Brazos and Grayson counties provide project services to Texas Youth Commission youths only.

(4) The numbers referenced are preliminary data obtained from the TJPC database. No Texas Youth Commission numbers are included.

Vicki Spriggs, M.Ed., is executive director of the Texas Juvenile Probation Commission in Austin.