Juvenile Justice & Mental Health Initiative 2007 Data Book

1
Juvenile Justice Mental Health Initiative2007
Data Book
2
Examples of Possible Targeted Areas for
Improvement

• Texas Special Needs Diversionary Program
• Statewide funded initiative involving mental
  health juvenile justice agencies
• Co-located probation/licensed practitioner of
  healing arts
• Referrals allowed at every point in the process
• Teams provide case management, service provision,
  and supervision
• New York PINS Diversion Program
• Collaboration between nine state agencies
• Divert status offenders from further penetrating
  system via community-based services
• Alternatives to formal processing and secure
  confinement
• Connecticut CSCI Teams
• System-wide implementation of the MAYSI-2
• County-based assessment model for providing
  expedited mental health evaluations
• Creation of multi-disciplinary case review teams
  to review assessments and make recommendations
  for services
• Significant expansion of evidenced-based
  treatment services
• Minnesota Targeted Areas of Improvement
• Follow-up after the screen

3
Data Book Organization

• Key National Reports related to Juvenile Justice
  and/or Childrens Mental Health to inform our
  work
• Key Minnesota reports/work related to Juvenile
  Justice and/or Childrens Mental Health to inform
  our work
• Available Minnesota data that informs our work
• Summaries of the national and Minnesota issues
  using the four cornerstones Collaboration
  Identification Diversion Treatment plus Funding
• A final summary of what Minnesota has in place
  and what needs improvement

4
The National Perspective

• Surgeon Generals Report 2001
• Presidents New Freedom Commission 2003
• Roadmap to Transforming Mental Health 2005
• NCMHJJ Issues and Emerging Trends 2000
• NCMHJJ Blue Print for Change 2006

5
National PerspectiveSurgeon Generals Mental
Health Commission 2001

• Children at greatest risk for mental health
  disorders
• Physical problems
• Intellectual disabilities
• Low birth weight
• Family history
• Multigenerational poverty
• Caregiver separation
• Abuse, neglect

6
National PerspectiveSurgeon Generals Mental
Health Commission 2001

• Nationally, 1 in 5 youth experience symptoms of
  DSM-IV disorder
• Challenges and Solutions
• Organization and financing of mental health
  services
• Data privacy and information sharing
• Efficacy of treatment options
• Stigma of mental disorders
• Supply of providers and services
• Family involvement as partners
• Trained staff in schools, justice system
• Treatments that are tailored to age, gender,
  culture
• Systems of care approach
• Residential treatment and re-entry

7
National PerspectivePresidents New Freedom
Commission 2003

• There are limited mental services in correctional
  facilities
• People who come in contact with JJ system are
• Poor
• Uninsured
• Disproportionately members of minority groups
• Homeless
• Living with co-occurring disorders
• As youth progress through the JJ system, rates of
  mental disorder increase (Baerger et al, 2000)

8
National PerspectivePresidents New Freedom
Commission 2003

• Goals with accompanying recommendations
• MH is essential to overall health
• Services must be consumer and family-driven
• Disparities are eliminated
• Need for early mental health screening,
  assessment, and referral
• Services are quality and research-based

9
Presidents New Freedom Commission Consumer and
Family-Driven

• Address mental health problems in the juvenile
  justice
• System with
• Appropriate diversion and re-entry strategies
• Individualized care plans
• Align funding streams to improve access and
  accountability
• Collaborative, coordinated system of care
  (federal, state, local government, families and
  consumers)

10
Presidents New Freedom Commission Eliminate
Disparities

• Improve access to culturally competent care
• Improve access in rural and remote areas

11
Presidents New Freedom Commission Screening,
Assessment, and Referral

• Routine and periodic early screening
• Screen for co-occurring and link with integrated
  treatment
• Clear agency or system responsibility for SED
  children (partnership with schools)
• Payment for core services of evidenced-based,
  collaborative care including case management,

12
Presidents New Freedom Commission Quality and
Research

• Advance evidenced-based practices
• Develop knowledge in understudied areas including
  mental health disparities, medications, trauma,
  acute care
• Reimbursement polices that foster converting
  research to practice

13
National PerspectiveRoadmap for Federal Action
on Americas Mental Health Crisis 2005

• Concrete implementation steps for Presidents
• New Freedom Commission
• Maximize effectiveness of scarce resources by
  coordinating programs
• Stop making criminals of those whose MH results
  in inappropriate behavior
• Get the right services to the right people at the
  right time
• Invest in children include family in decision
  making
• Promote self-sufficiency

14
National PerspectiveRoadmap for Federal Action
on Americas Mental Health Crisis 2005

• Stop making criminals to those whose
• mental illness results in inappropriate
• behavior
• Fund diversion programs for nonviolent offenders
  treatment instead of detention
• Eliminate warehousing of youth in juvenile
  facilities
• Promote successful community re-entry

15
National perspectiveNCMHJJ Trends and Emerging
Issues 2000

• Clarity needed-which agency is lead agency for
  providing mental health services
• Inadequate screening and assessment
• Lack of training, staffing and programs
• Lack of funding and clear funding streams to
  support services
• Lack of balance between community-based services
  and mental health beds

16
National PerspectiveBlueprint for Change 2006
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National PerspectiveBlueprint for Change
Cornerstones

• Collaboration The JJ and MH systems must work
  jointly to address the issue
• Identification Systematically identify needs at
  all critical stages
• Diversion Whenever possible divert youth to
  community-based services
• Treatment Provide youth with effective treatment
  to meet their needs

18
National PerspectiveBlueprint for Change
Critical Intervention Points

• Places within the juvenile justice system where
  opportunities exist to improve collaboration,
  identification, diversion and treatment for these
  youth.

Detention
Secure Placement
Initial Contact and Referral
Judicial Processing
Intake
Re-Entry
Probation Supervision
19
Blueprint for Change Practical Application at
Critical Intervention Points

• Initial Contact
• Specialized training for law enforcement
  officials
• Co-responding teams
• Probation Intake
• Standardized mental health screening for all
  youth
• Creation of diversion mechanisms

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Blueprint for Change Practical Application at
Critical Intervention Points

• Detention
• Standardized mental health screening
• Establishment of linkages with community-based
  mental health providers
• Judicial Processing
• Ensure that Judges have access to the information
  they need to make informed dispositional
  decisions

21
Blueprint for Change Practical Application at
Critical Intervention Points

• Dispositional Alternatives
• Community-based alternatives with a strong
  probation supervision component whenever possible
• Access to evidence-based mental health treatments
  for youth committed to juvenile corrections
• Re-Entry
• Discharge planning that begins shortly after
  placement
• Linkages with community providers to ensure
  access to mental health services
• Planning to ensure that a youth is enrolled in
  Medicaid or some other type of insurance

22
Past and Current Mn Initiatives

• Childrens Comprehensive Mental Health Act 1989
• DHS Integrated Fund 1992
• Supreme Court JJ Task Force 2001
• DHS Blueprint for a MN MH System of Care 2002
• Juvenile Justice Mental Health Screening 2003
• PACER Survey 2004
• Umbrella Rules 2005
• Mn Mental Health Action Group 2005
• State Advisory Council on Mental Health 2006
• JDAI and DMC 2006
• Doing Juveniles Justice 2007
• Evidenced-based projects and grants

23
MinnesotaComprehensive Childrens Mental Health
Act 1989

• Governs the states county-based, publicly funded
  childrens mental health service system
• Based on system of care model with 3 entities
  state authority, local authority, providers
• Childrens Mental Health Collaborative can assume
  duties of local authority

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Minnesota Comprehensive Childrens Mental Health
Act 1989

• Services
• Education and prevention
• Mental health identification and intervention
• Emergency services
• Additional services for children with ED and SED

25
MinnesotaDHS Childrens Integrated Fund 1992

• A legislatively mandated study of the feasibility
  of a
• childrens mental health integrated fund.
• Identified barriers
• Many seriously emotionally disturbed children are
  not classified as SED.
• Many children accused of breaking the law are
  emotionally disturbed.
• Emotionally disturbed and delinquent populations
  are the same children. Maintaining the
  distinction hinders treatment allowing one agency
  to pass the child off to another agency.

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MinnesotaDHS Childrens Integrated Fund 1992

• Identified barriers
• Efforts at coordination are often informal,
  taking the form of interpersonal relationships
• Inadequate funding levels
• Eligibility criteria limit matching youth to
  services
• Least restrictive setting can limit tx options
• State agencies missions are narrowly defined,
  the result is fragmented delivery

27
Minnesota DHS Childrens Integrated Fund 1992

• Identified Barriers cont
• Family preservation policy when children
  shouldnt return home
• Resources go to most seriously ill leaving little
  for prevention and early intervention
• The conduct disorder label can exclude children
  from mental health tx and EBD services instead
  placing them in correctional settings
• No one agency has overall responsibility

28
MinnesotaSupreme Court Juvenile Justice Services
Task Force 2001

• Gaps in services include
• Assessment Mental health services CD services
• Fetal alcohol screening assessment
  Culturally and gender specific services a
  family-centered approach
• Unified, systematic approach to assessments
  throughout the state
• Use of evidenced-based services

29
Minnesota DHSBlueprint for a Childrens Mental
Health System of Care 2002

• A blueprint for repairing and re-building the
  Minnesota childrens mental health system of
  care.
• The report identified service gaps and made
  recommendations for change.
• One significant outcome from this report was the
  2003 Juvenile Mental Health Screening legislation
  for youth in the corrections and child protection
  systems

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Minnesota DHS Blueprint for a Childrens Mental
Health System of Care 2002

• Funding
• Mn childrens mental health system of care is
  fragmented because of federal and state funding
  streams
• Funding has not been adequate to meet the
  mandates of Mn Comprehensive Childrens Mental
  Health Act
• Enhance multiagency coordination and develop
  reimbursement schemes that encourage coordination
• Educate POs that children in juvenile justice
  system are eligible for services under Childrens
  Mental Health Act

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Minnesota DHS Blueprint for a Childrens Mental
Health System of Care 2002

• Coordination
• Coordinate screening, referral, and assessment
  activities across agencies
• Integrate appropriate transition services into
  service systems and case planning at all levels
  (juvenile justice to community)

32
Minnesota DHS Blueprint for a Childrens Mental
Health System of Care 2002

• Early Identification
• Both locally and nationally, correctional systems
  in
• particular are becoming default mental health
  providers a
• direct consequence of a lack of early
  intervention
• Create/expand targeted venues for mental health
  screening i.e. juvenile corrections
• Create incentive for agencies to invest in front
  end services
• .

33
MinnesotaJuvenile Justice Mental Health
Screening 2003

• Who? Juvenile Justice Population
• Children ages 10 to 18
• Judicial finding of delinquency
• Allegedly committed a delinquent act and who have
  had an initial detention hearing, with court
  ordering the child in detention (parent consent
  required)
• Committed a juvenile petty offense for the third
  or subsequent time

34
Minnesota Juvenile Justice Mental Health
Screening 2003

• Funding and Data
• Counties receive an allocation based on the
  number of completed screens
• Counties report data through the Court Services
  Tracking System and submit to DHS

35
MinnesotaJuvenile Justice Mental Health
Screening 2003

• Next Steps
• Continue to promote the benefits of early
  identification and intervention
• Training mental health disorders
  evidenced-based mental health treatment
• Work with Counties to increase screenings
• Develop better data analysis strategies

36
MinnesotaPACER Family Needs Research Project 2004

• The goal was to better understand what
• parents families need from mental health
• system
• Public Policy Recommendations include
• Access and information
• Training
• Funding

37
MinnesotaPACER Family Needs Research Project 2004

• Access and Information
• Easier access to service
• Access to information regarding the right to
  services
• Need for an effective oversight mechanism
• Well defined roles and responsibilities
• Include parents in planning implementation
• Appropriate use of medication

38
MinnesotaPACER Family Needs Research Project 2004

• Training
• Service providers are competent with cultures
  they serve
• Professionals are adequately trained
• Professionals deliver quality services

39
MinnesotaPACER Family Needs Research Project 2004

• Funding
• Simplify
• Clarify financial responsibility of insurers and
  providers
• More prevention and early intervention for
  adolescents
• Funding so schools have adequate resources to
  provide mandated services for children with
  mental health concerns

40
MinnesotaUmbrella Rule 2005

• Joint DHS and DOC rules promulgated to
• provide consistent secure and non-secure
• "licensing" and "program" standards
• Enables juvenile facilities to provide
  appropriate
• services to juveniles with single or multiple
• problems who are in out-of-home placement
• programs. 

41
MinnesotaUmbrella Rule 2005

• The Rules promulgate
• Program outcomes that promote healthy development
  including mental health
• Mental health screening
• Chemical abuse/dependency screening
• Case plans that provide needed services
  identified by screening
• Timely access to services
• Coordinated delivery of social services
• Trained staff

42
Minnesota Mental Health Action Group 2005

• MMHAG is a coalition of agencies and
  organizations including
• Depts. of Human Services and Health and created
  to transform
• the mental health system to better serve children
  and families.
• Public/private partnerships that are responsive
  to consumers
• Fiscal framework that delivers right services at
  right time in right setting
• Quality of care that is measurable
• Adequate supply of trained qualified
  professionals
• Earlier identification and intervention
• Coordination of care and services so system is
  easy to navigate

43
MinnesotaState Advisory Council on Mental Health
and Subcommittee on Childrens Mental Health 2006

• Develop and fund an adequate infrastructure
  within the correctional system to identify and
  treat mental health
• Increase public awareness of service gaps
  addressing MN issues as a priority in JJ system
• Develop database to monitor the long terms
  outcomes of youth in the corrections system with
  MH or co-occurring disorders
• Establish a task force to develop and implement a
  comprehensive system to prevent youth with MH
  issues from entering JJ system

44
MinnesotaJuvenile Detention Alternative
Initiative 2006

• JDAI Mission To make systemic changes to
• juvenile detention practices by
• Addressing issues of detention utilization
• Reducing reliance on secure detention
• Addressing minority over-representation
• Establishing process for improvement
• Pilots in Hennepin, Ramsey, Dakota counties

45
MinnesotaDoing Juveniles Justice March 2007

• A blueprint for reform from the Juvenile Justice
  Committee
• of the Childrens Mental Health Collaborative in
  Henn Co.
• Reduce Institutionalization
• Reduce Racial Disparity
• Ensure Access to Quality Counsel
• Create a Range of Community-based Programs
• Recognize and Serve Youth with Specialized Needs
• Improve Aftercare and Reentry
• Maximize Youth, Family, and Community
  Participation
• Keep Youth Out of Adult Prisons

46
MinnesotaDoing Juveniles JusticeReducing Racial
Disparities

• Uniform statewide structure for documenting a
  youths racial/ethnic identity
• Data collection by race and/or ethnicity at in
  comparison to proportionality at each point of
  contact in the JJ system

47
MinnesotaDoing Juveniles JusticeEnsure Access
to Quality Counsel

• Specialized training for attorneys on topics such
  as adolescent development, mental health and
  special education
• Cross-system representation when adolescents are
  involved in multiple systems
• Evidenced-based practices that meet
  individualized youth needs

48
MinnesotaDoing Juveniles JusticeCommunity-Based
Programs

• Conduct an audit in each county to assess the
  availability of local treatment for mental
  health, chemical health, family/cultural issues.
• Shift funding priorities from out-of-home
  placement to increasing community-based
  programming

49
MinnesotaDoing Juveniles JusticeYouth with
Special Needs

• Silos are replaced by holistic care, wrap-around
  models
• Screening tool for mental health and chemical
  dependency issues
• Expansion of services for mental health and
  chemical dependency issues
• County-funded, community-based mental health
  services

50
MinnesotaDoing Juveniles JusticeImprove
Aftercare and Reentry

• Statewide use of risk to re-offend tool
• Uniform standards for aftercare
• Require all juvenile treatment programs to report
  recidivism data and risk adjusting factors

51
MinnesotaDoing Juveniles JusticeMaximize
Participation

• Assessments of family system/support
• Use of family-strengthening communitybased
  interventions including MST, FFT, and ART

52
Minnesota Challenges in Childrens Mental Health
(from DHS 2007)

• Decrease in state and county spending since 2003
• Reductions in funding to Childrens and Family
  Collaboratives
• Overcoming fragmentation as different public
  systems who serve same children struggle to
  integrate resources
• More meaningful partnerships between public and
  private systems

53
MinnesotaNew 2007 Childrens Mental Health
Legislation

• Approximately 50 of the proposed infrastructure
  investments for
• childrens mental health in the Governors Mental
  Health Initiative was
• approved by the legislature.
• Increase in funds available for school-based
  mental health services
• Increase to providers awarded a childrens mental
  health grant including CTSS
• Funds for early intervention services
• Funds for respite care for youth at risk of
  out-of-home placement
• Funds for lost funding to Collaboratives
• Funds for adolescent integrated dual diagnosis
  treatment services
• Funds for culturally competent mental health
  professionals and services
• Targeted dollars for victims of trauma and
  refugees
• Expanded case management
• Funding for ACE
• Funding for voluntary opt-in suicide prevention
  efforts in schools

54
MinnesotaEvidence and Community-Based Practices

• The Hawaii Model Evidenced-based practices for
  Childrens Mental Health (3 year systems change
  grant)
• Northwest Council of Collaboratives (systems of
  care grant) involving 6 counties including
  Kittson, Marshall, Mahnomen, Norman, Polk, and
  Red Lake
• STARS for Childrens Mental Health is a six year
  cooperative agreement created by Central
  Minnesota Mental Health Center and Benton,
  Stearns, Sherburne and Wright counties to design
  a system of care that improves the coordination
  of access to and effectiveness of services for
  youth with social, emotional, and behavioral
  concerns
• FFT, MST, and ART in several counties
• Early intervention programs like ACE, Ramsey
  County
• Truancy Diversion Programs in various counties
• Treatment foster homes and group homes (MITH)

55
Minnesota Interviews

• Legislators including Reps. Walker, Loeffler,
  Paymer, Greiling, Johnson, Sens. Berglin, Huntley
• Director, Ramsey County Childrens Mental Health
• Ombudsman,State Mental Health
• Director, Wilder Childrens Mental Health
• Director, Tri County Community Corrections (Polk,
  Norman, Red Lake)
• Deputy Director and Mental Health Liaison, Dakota
  County
• Juvenile Probation Supervisor, Olmsted County
• Pacer Family Advocates
• Washington County team including probation,
  mental health, detention, residential placement
• MCCCA Residential Treatment Providers

56
Interview Themes from County CorrectionsFunding

• Funding for mental health services is inadequate
• Payment for mental health services for
  corrections youth is an issue
• The size of agency placement budgets drives the
  degree to which agencies collaborate
• Mental Health Collaboratives are increasingly
  reliant on grants for funding
• Funding is not available for probation to consult
  with mental health professionals
• Mental health professionals are needed in
  education and justice system but funding is in
  mental health and social service divisions

57
Interview Themes from County CorrectionsCollabora
tion

• Mental health system is very fragmented
• There are no incentives for collaboration among
  agencies
• Agency leadership drives the degree to which
  county agencies collaborate
• Relationships drive the degree to which county
  agencies collaborate
• Dont know how many corrections kids are open for
  case management because SS has the data
• If youth arent labeled SED they dont have
  access to a case manager
• Large case manager caseloads dampens
  collaboration
• Youth go from one system to the other so things
  get dropped and cases get closed
• Collaboratives are designed for deep end kids
• Probation agents are not trained in mental health
• Probation has little contact with social service
  agencies
• Lack of resources and services to meet mental
  health needs
• The case management model does not work well

58
Interview Themes from County CorrectionsIdentific
ation

• The differences in the language and assumptions
  of the two systems influences access to services
• Debate about whats driving the behavior
  influences subsequent decisions
• Follow-up to screenings are expensive and not
  timely
• Monitoring of mental health screen follow-up is
  not centralized and is inconsistent from county
  to county
• Not enough resources are put into the
  identification of co-occurring disorders
• Data is not available i.e., How many corrections
  kids in social service system? How many screens
  are positive? What happens to positive screens?
  What happens to SED kids?

59
Interview Themes from County CorrectionsDiversion

• When case management caseload size gets high,
  kids have a lower chance of getting case
  management services
• Kids with mental health issues get mixed with
  hard-core corrections kids in detention when they
  should be diverted
• Lack of treatment beds and hospital beds keep
  youth in juvenile justice system when they could
  be diverted to mental health system
• State hospitals wont work with kids with
  aggressive behavior
• Expectations for family involvement are low
• Schools zero tolerance policies send students to
  juvenile justice system
• Not enough resources are put into diverting youth
  with co-occurring disorders into appropriate
  treatment options

60
Interview Themes from County CorrectionsTreatment

• Not enough community-based services available
• Evidenced-based services like FFT, MST, and ART
  are not MA reimbursable. When a family is
  finished with corrections, these services are no
  longer available
• The debate about whats driving the behavior
  (mental health vs corrections) drives subsequent
  decisions
• Not clear what system should be paying for
  residential services when the family is not
  insured
• Not clear what system should oversee the length
  and type of mental health services/treatment
• Hospital and residential beds are shrinking and
  not available
• Aftercare and transition plans are inconsistent
  and lacking
• Parents are often not involved in the treatment
  process or aftercare process
• Inadequate treatment resources that integrate
  mental health services along with security
• Lack of resources that deal for DD and JJ youth

61
Interview Themes from other interviews Funding

• Corrections doesnt know or have access to mental
  health funding streams and therefore has less
  resources
• Identifying a youth as needing mental health
  services vs a correctional consequence may
  increase costs
• Funding drives system access
• When funding is tight, agencies work in silos
• Need for integrated funding streams between
  corrections, social services, mental health
  (Iowa)
• Placing agencies want integrated mental health
  services but arent willing to pay the price

62
Interview Themes from other interviews
Collaboration

• Corrections, mental health, social services,
  schools do not share data nor do they pass it
  along to providers
• Systems close cases once corrections is involved
• Need one identified lead person to coordinate
  services throughout childs involvement in
  multiple systems
• Quality of relationships among agencies drives
  collaboration
• County oversight of cases is lacking
• Smaller counties seem to have greater success at
  collaborating

63
Interview Themes from other interviews
Identification

• Over-representation in correctional and out of
  state placements vs. residential placements
• Behavioral symptoms not causal factors drive
  system access
• Funding drives identification
• Diagnostic information does not follow the youth
  as they move through systems
• In need of one system that screens, diagnoses,
  and develops a case plan that will follow the
  youth through the systems

64
Interview Themes from other interviews Diversion

• De-linking the responsibility of schools to pay
  for mental health services once kids are
  identified will improve mental health services
  delivered in schools
• When acting out behavior in schools gets referred
  to Police Liaison Officers, special education
  youth are more likely to get referred to court
• Victims of child abuse and young truants are two
  identifiable high risk populations that will
  benefit from diversion and early intervention
• The least restrictive alternative court
  philosophy often means that youth do not get the
  most appropriate services and are not being
  placed until they are too far along
• The expectation that families get involved needs
  to occur at the earliest stages (Indiana)

65
Interview Themes from Residential Providers
Treatment

• Need better transition and re-entry services to
  integrate youth back into community and family
• Need for placements that provide safety,
  security, and integrated mental health services
• Umbrella rules allow programs to think more
  broadly about the integration of mental health
  and corrections services in one program
• Providers need to improve quality assurance and
  fidelity
• Placing agencies want integrated mental health
  services but arent willing to pay the price

66
Current Available Minnesota Data

• A picture of childrens mental health in Mn 2007
• Juvenile Arrest Data 2005
• Juvenile Probation Data 2005
• Red Wing Data 2007
• Mental Health Screening Data 2005
• YLS Data 2005/06
• Department of Human Services SSIS Data 2005
• Department of Education Data 2006
• MCCCA Annual Reports 2006
• Overrepresentation in Minnesota 2004
• Minority Youth Corrections Placements in Dakota
  County 2007
• Residential Facilities for Juvenile Offenders
  OLA, 1995

67
Minnesota Childrens Mental Health (from DHS
website 2007)

• A state-supervised, county-administered human
  services
• system
• An estimated 91,000 children need treatment for
  emotional disturbance
• 9 of school-age children have a serious
  emotional disturbance
• 42,600 children annually receive publicly funded
  mental health service
• MA and Minnesota Care accounted for 56 of
  funding for childrens mental health services and
  has been increasing
• Counties provided 24 of childrens mental health
  funding and this has been decreasing

68
MinnesotaJuvenile Arrest Data 2005

• An overall decrease of 30 in juvenile
• arrests between 1999 and 2005. In 2005,
• 50,592 arrests of youth between the ages of
• 10-17.
• 66 male
• 34 female

69
Minnesota2003 Petitions Adjudicated/Found Guilty
(Courts)
70
Minnesota Red Wing Juvenile Probation
Race/Ethnicity (DOC)
71
MinnesotaRed Wing Mental Health Unit

• 1990s an increase of residents with significant
  mental
• health needs
• Response
• 2001 Mental Health unit that provides temporary
  housing (12) and specialized programming for
  offenders whose mental illness prevented their
  participation in regular programming
• A continuum of mental health services from
  psychological assessment to treatment plan
• 47 of RW population on psychotropic meds
• 54 of RW population with special needs

72

MinnesotaJuvenile Justice Mental Health
Screening Data 2005(DHS)

• In 2005, 14,785 new juvenile probation entries.
  9594 youth in
• detention or found delinquent met screening
  criteria
• 56 (5334/9594) completed screens
• 71 (3772/5334) were referred for assessment
• 1777/9594 completed a screen and were referred
• 1068/9594 were under Care of MH Professional
• 571/9594 already screened within 180 days
• 356/9594 already assessed within 180 days
• 11 (1107/9594) not screened for known reasons
• 12 (1158/9594) not screened, reason unknown

73
MinnesotaYouth Level of Service Inventory Data
2005/06 (DOC)

• Co-occurring Disorders
• Of those youth who scored medium to high on
  Personality
• factors, approximately (60) scored medium to
  high on
• Substance abuse. Lots of caveats associated with
  this data.

74
Minnesota DHS SSIS Data Corrections Youth in
Placement 2005

• 14,723 Minnesota youth experienced out of home
• care in 2005
• 12 (1738 but under-reported) corrections youth
  in care
• Of those, 53 (924) had disabilities
• Of the 924 corrections kids in care with
  disabilities
• 42 (386) were chemically dependent
• 58 (534) emotionally disturbed

75
Minnesota DHS SSIS Data Corrections Youth in
Placement 2005
76
Minnesota Department of EducationState
Enrollment Data 10/1/06
77
Minnesota Department of EducationTop
Disciplinary Incident Types 5/06
78
Minnesota Department of EducationDIRS Reported
Law Enforcement Referrals

• General Education 17 C (70) AA (12)
• Special Education 11 C(54) AA (18)
• EBD 6
• Average ages 13-15
• Slow Increase in ages 6-9

79
MinnesotaCouncil Child Caring Agencies 2006
Annual Report

• MCCCA agencies include
• Residential treatment center
• Therapeutic group homes
• Treatment foster care
• Corrections residential treatment programs
• Mesabi Academy
• Mille Lacs Academy
• VOA Bar None residential treatment center
• Woodland Hills
• Short-term shelter and/or Diagnostic Programs

80
MinnesotaCouncil Child Caring Agencies 2006
Annual Report
81
MinnesotaCouncil Child Caring Agencies 2006
Annual Report
82
MinnesotaOverrepresentation (DPS 2005)

• Overrepresentation occurs at each point in
• the system and accumulates as youth are
• processed through.
• 17 of Mn youth between 10-17 are minorities
• 35 were arrested
• 36 cases were petitioned
• 40 cases resulted in delinquent findings
• 45 cases resulted in confinement
• 54 cases transferred to adult court

83
Dakota CountyMinority Youth Corrections
Placements

• 33 of offenses occur in school
• African Americans over-represented in offenses
  reported at school (68)
• Offenses involved theft, assault, disorderly

84
Dakota CountyMinority Youth Corrections
Placements

• Equal likelihood of behavioral issues
• occurring in detention among races
• 21 of corrections population is African American
• 13 of African Americans received tx
• African American least likely to be rated by
  self-report and by detention staff) as having
  mental health or CD concerns

85
Dakota CountyMinority Youth Corrections
Placements

• Treatment Services
• 62 white youth successfully completed tx
• 33 black youth successfully completed tx
• Tx staff felt their programs served all youth
  equally effectively
• 5559 POs did not know the ability of programs
  to serve minority youth

86
MinnesotaRates of Juvenile Re-offense
Legislative Auditor 1995

• The most recent statewide re-offense rates are
• for youth released in 1991 from 7 Mn juvenile
• facilities 3 operated by DOC 2 operated by
• Counties 2 privately operated
• 53-77 of males (889) were arrested or petitioned
  with 2 yrs of release
• 41-53 of females (167) were arrested or
  petitioned with 2 yrs of release

87
MinnesotaWhat Does the Data Tell Us?

• Juvenile crime appears to be decreasing
• A significant number of misdemeanants end up in
  out-patient treatment or placement compared to
  felony and gross misdemeanants
• Most youth are on probation in the community and
  not in placement or at Red Wing
• Youth on probation are disproportionately
  represented, the majority being male, therefore,
  the number of youth with MH and co-occurring
  disorders are likely disproportionately
  represented
• Youth of color tend to be placed in correctional
  facilities vs Caucasian youth placed in
  residential treatment (MCCCA)
• High overlap between youth supervised in
  corrections who have emotional disturbance /or
  chemical abuse (SSIS)
• About 70 of youth on probation in Minnesota have
  mental health needs (Screening Data)
• About 60 of youth on probation with medium to
  high personality factors have medium to high
  substance abuse issues (YLS Corrections Data)
• About half of the children supervised by
  corrections have disabilities (SSIS)

88
Summary IssuesFunding

• Corrections doesnt know or have access to mental
  health funding streams
• Need for joint identification of mental health
  funding mechanisms to support strategies at each
  critical stage for youth in juvenile justice
  system
• Identifying a youth as needing mental health
  services vs correctional consequence may increase
  costs
• Funding drives system access
• When funding is tight, agencies work in silos
• Need for collaborative, integrated funding
  streams
• De-link funding for mental health services in
  schools
• Funding mechanisms are needed that pay for
  evidenced-based community interventions

89
Summary IssuesCollaboration

• Agency missions are too narrowly defined and
  result in fragmented delivery
• Unclear lines of responsibility for MH services
  when several agencies are involved-eliminate
  silos
• A need for greater comprehensive planning for
  mental health services at each critical
  intervention point of the juvenile justice system
• Greater efforts to include family members and
  caregivers
• Better data sharing and joint information systems
  among agencies (law enforcement, corrections,
  mental health, schools, courts)
• More cross-training and cross-staffing so
  professionals better understand each others
  system
• A true systems of care approach across the
  state not based on interpersonal relationships
• Educate probation agents that youth are eligible
  for services under Childrens Mental Health Act

90
Summary IssuesIdentification

• Comprehensive mental health screening in two
  steps emergency and general screen
• Access to immediate emergency MH services
• Work with counties to increase the number of
  screenings for eligible youth
• Further assessment administered when indicated
• Combined mental health and risk to re-offend
  assessments
• MH screens and assessments administered by
  trained staff
• Mental health services that are governed by
  appropriate use and privacy policies
• Screening and assessment performed routinely as
  youth move through juvenile justice system
• Assessments that integrate substance use mental
  health
• Individualized case plans that address mental
  health or co-occurring services and follow the
  individual

91
Summary IssuesDiversion

• More prevention and early intervention for youth
• Procedures put in place to identify youth
  appropriate for diversion
• Funding so schools have adequate resources to
  provide mandated services
• Written criteria that governs role of school
  police liaison officer
• Diversion mechanism instituted at every critical
  intervention point in JJ continuum
• Youth are diverted to community-based treatment
  when possible
• Diversion to mental health services are available
  as an alternative to traditional incarceration
  for serious offenders when appropriate
• Diversion programs are regularly evaluated

92
Summary IssuesTreatment

• Greater access to mental health treatment when
  needed
• Treatment programs that are evidenced-based
• Juvenile justice and mental health systems share
  responsibility with one agency established as the
  lead
• Qualified MH personnel are available to provide
  treatment
• Families are fully involved
• Sensitivity to trauma-related histories
• Availability of gender-specific services
• Availability of culturally sensitive services
• Correctional facilities integrated with mental
  health services
• Consistent, statewide, discharge planning
  services upon release from placement

93
Funding Summary Issues Whats in Place/What We
Might Improve
94
Collaboration Summary Issues Whats in
Place/What We Might Improve
95
Identification Summary Issues Whats in
Place/What We Might Improve
96
Diversion Summary Issues Whats in Place/What we
Might Improve
97
Treatment Summary IssuesWhats in Place/What We
Might Improve
98
Definitions

• Case Management Services activities that
  coordinate the provision of services for
  individual children and their families who
  require
• services from multiple service providers (SG,
  01)
• Disability severe, chronic condition due to
  mental /or physical problems with major life
  activities such as language, mobility,
• learning, self-help, and independent living
  (NCD)
• Emotional Disturbance an organic disorder of the
  brain or a clinically significant disorder of
  thought, mood, perception, orientation,
• memory, or behavior that is listed in ICD-9-CM or
  DSM, Axes I, II, III, and seriously limits
  childs capacity to function in daily living
• (Mn legislation)
• Mental disorders health conditions characterized
  by alterations in thinking, mood, behavior
  associated with distress /or impaired
• functions
• Mental Illness an organic disorder of the brain
  or clinically significant disorder of thought,
  mood, perception, orientation, memory or
• behavior that is listed in the ICD-9-CM or
  DMS-MD, Axes I, II, or III and that seriously
  limits a persons capacity to function(245.462)
• Mental Health Problems signs symptoms of
  insufficient intensity or duration to meet
  criteria for any mental disorders