By Doug Vance, PhD, Advisory Council Chair
AUSTIN, Texas – Many readers may recall when the TJJD Mental Health Grant (Grant N) was first made available during the FY 2014-2015 Biennium. The purpose was to provide funding to juvenile probation departments in order to increase mental health services and to supplement existing mental health services to juveniles. What readers may not be aware of however, is the vitally important role the Advisory Council played in helping establish the need for this funding, which is – “The Rest of The Story.”
In 2013, in order to help juvenile probation departments justify a need for mental health funding, the Advisory Council was asked to develop a comprehensive description of children with mental illness in the juvenile justice system. The assignment was given to the Advisory Council’s Mental Health Committee chaired by Doug Vance, and consisting of members Carrie Barden, Randy Turner, Mark Williams, and their TJJD Chief Financial Officer Bill Monroe.
The Committee’s first task was to identify an agreed upon list of serious mental health disorders that youth within the juvenile justice system are commonly diagnosed with.
The list was codified as follows:
- Intellectual Disability Disorders
- Persuasive Developmental Disorders
- Elimination Disorders
- Psychotic Disorders
- Mood Disorders
- Anxiety Disorders
- Dissociative Disorders
- Paraphilias
- Eating Disorders.
- ADHD
The inclusion of ADHD in the list is due to the fact that the child’s level of functioning is often significantly delayed relative to chronological age, and as such many times have significant difficulty complying with rules and structural rigor common to a correctional setting without more intensive supports. The impulsivity associated with an ADHD diagnosis and the other related cognitive deficits often lead to aggressive acting out and even impulsive suicide attempts.
It was also understood that given the prevalence of trauma exposure within the juvenile justice population and growing interest in the relationship between trauma and delinquency, there is a more far-reaching impact of trauma in children that extend beyond official PTSD symptom criteria to include neurological impacts, self-regulation deficits, and severe attachment/relationship problems.
The Committee suggested that these trauma-related symptoms combined with the often maladaptive attempts at coping, often times lead to a high percentage of the mental health crises in juvenile justice facilities.
The Committee also acknowledged the reality that justice-involved youth rarely meet criteria for only one disorder. They typically have multiple co-existing diagnoses, including those listed here, as well as substance abuse, which result in added complexity of the case.
In our analysis, it was also critical that we acknowledged the importance of family in the treatment process suggesting that the biggest predictor of treatment effectiveness relates to family engagement in the intervention. Justice involved families face many challenges that impact the mental health status of the child. In order to effectively treat the child it may be necessary to assist the family in developing the necessary support system so that they are more able to devote the time and energy required to properly help their child. The severity of the symptomology and maladaptive behavior as described above result in a need for more intensive treatment than is commonly available, without added funding, within many juvenile probation departments.
Concerning complexities of treatment, the Committee suggested the following to be essentials of effective treatment:
- Increased collaboration among different treatment providers and child-serving systems involved in the case;
- Heightened attention to continuity of care efforts to ensure that all treatment needs continue to be met as the child moves through the juvenile justice system or between systems;
- Recruitment and retention of highly qualified treatment providers capable of providing comprehensive treatment for the broad range of diagnoses.
Additionally, the Committee recognized that Justice involved youth often times have a history of intermittent treatment or insufficient treatment in the community and efforts to obtain appropriate services are often complicated by:
- The presence of multiple co-existing diagnoses (i.e. mental health, substance abuse, and intellectual). Because these various diagnoses interact with each other, the child needs comprehensive, integrated treatment services capable of addressing all of the issues. Unfortunately, this kind of treatment is rarely available in the community. The result is often a sequential approach to treatment which is far less effective and increases the risk for the child falling through the cracks at transition points.
- Lack of recognition and understanding of the complex mental health needs, both in the family and in the various child-serving agencies working with the child.
- Lack of resources and support systems to facilitate the type of intensive intervention that is needed.
After much review, research, and discussion, the Advisory Council was ultimately successful in its efforts to help juvenile probation departments establish a clearly defined and succinct need for additional mental health funding, and as we all are now aware, significant state appropriations were soon to follow.
And now you know - “The Rest of The Story.”
