Improving Outcomes for Youth in the Juvenile Justice System
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Shairi Turner MD, MPH Chief Medical Director September 25-26, 2007 Walter A. McNeil, Secretary - PowerPoint PPT Presentation

Improving Outcomes for Youth in the Juvenile Justice System Shairi Turner MD, MPH Chief Medical Director September 25-26, 2007 Walter A. McNeil, Secretary The Office of Health Services First established in 2005

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Shairi Turner MD, MPH Chief Medical Director September 25-26, 2007 Walter A. McNeil, Secretary

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Improving Outcomes for Youth in the Juvenile Justice System

Shairi Turner MD, MPH

Chief Medical Director

September 25-26, 2007

Walter A. McNeil, Secretary


The Office of Health Services

  • First established in 2005

  • Role: To provide oversight for the delivery of medical, mental health, substance abuse and developmental disability services to the youth adjudicated delinquent.

  • Majority of services delivered by contracted providers.


The Office of Health Services

Serves

  • Over 150,000 youth

  • 4 Major Program Areas

  • All of Headquarters

  • 55 State Clinical Staff


The Office of Health Services


Office of Health Services Responsibilities

  • Data Collection

  • Staff Training

  • Surveillance

  • Quality Assurance

  • Interagency Collaborations

  • Clinical Assistance

  • Policy and Rule Development

  • Contract Enhancement and Standardization

  • Legislative Support


A Profile: Who Are Our Youth?

  • Impoverished

  • Minorities

  • Males

  • Mentally Ill

  • Substance Abusers (Co-Occurring Disorders)

  • Medically complex and neglected

  • High Risk behaviors (STDs, Teen Pregnancies)

  • Developmentally Disabled

  • Disenfranchised families in crisis

  • Delinquent and Dependent


Primarily……

Non-violent minority males referred for misdemeanor offenses


Our Girls

  • One of three youth referred to the Department for delinquency is a girl.

    • 45% of those referred are African-American Girls

  • 21% of Detention admissions

  • Extensive trauma histories

    • 50-75% suffer from PTSD

  • Unique health needs


3 Primary Issues:Medical Mental Health / Substance Abuse (Co-Occurring Disorders)Developmental Disabilities


Medical


I have 2 external pacemakers for my heart, one works and the other does not, I pull on them to get the staff worked up

* * *

I give myself extra insulin so I can eat more food

Their words…


Overlying Concerns:

  • Complex conditions

  • Limited resources

  • Ensuring accountability with privatization

  • Systemic Barriers


Services Provided to Youth

  • Obstetrical Services (pre and post-natal)

  • Gynecological Services

  • Infant care

  • Emergency Services

  • Health Education

  • Intake Screenings

  • Physical Assessments

  • Sick Call Encounters

  • Immunizations

  • Medication Management

  • Acute and Chronic Disease Management


The Health Status of Incarcerated Youth

Baseline Health

  • Asthma

  • Diabetes

  • Dermatologic Problems

  • Dental Caries

  • Hypertension

  • Obesity

  • Seizure Disorders

  • Traumatic Injuries

  • Orthopedic Injuries

Greater Risk for

  • Sexually transmitted diseases

  • Hepatitis B and C

  • HIV/AIDs

  • Teen Pregnancy

  • TB exposure

  • Mental Illness

  • Substance Abuse


Complex Conditions

  • Cardiac Disorders

  • Cystic Fibrosis

  • Inflammatory Bowel Disease

  • Existing and New Cancers/Tumors

  • Sickle Cell Disease

  • Kidney Failure

    *A Medically Underserved Population*


Limited Resources

  • Insufficient physician and nursing services

  • Over-reliance on direct care staff

  • Diversion to State-operated programs

  • No specific funding for dental services

    *Inadequate treatment *


Ensuring Accountability

  • Medical Services Privatized

  • Monitoring through contracts

  • Laypeople overseeing medical providers

  • Limited technical assistance

    *Insufficient Oversight*


Systemic Barriers

  • Youth in any State-Operated Detention or Residential facilities OR any High/Maximum risk programs lose Medicaid Eligibility*

  • Youth who become ineligible are disenrolled not suspended from Medicaid**

    *Federal Regulations

    ** State Regulations

    *Continuity of care jeopardized*


Addressing: Complex Conditions

Proposed Recommendations

  • Small programs with 24 hour nursing services and expanded physician coverage for medically complex youth.

  • Diversion of medically complex youth into community based treatment programs.


Addressing: Limited Resources

Proposed Recommendations

  • Increased funding for medical and dental services.

  • State employed medical staff


Addressing: Accountability

Proposed Recommendation

State-employed Clinical staff to provide assistance, oversight and improved accountability.


Addressing: Systemic Barriers

Proposed Recommendations:

  • Suspension of Medicaid instead of dis-enrollment.

  • Improved collaboration with the Department of Children and Families upon discharge.


Mental HealthandSubstance Abuse


My mother put cigarette butts out on my head when I was 2 years old.

* * *

I cannot tell you how many times my father raped me when I came home from school.

* * *

I started smoking marijuana with my parents at the age of 8.

Their words…


Services Provided to Youth

  • Specialized Treatment Beds

  • Mental Health Overlay

  • Behavioral Health Overlay

  • Substance Abuse Overlay

  • Sex Offender Services

  • Intensive Mental Health

  • Comprehensive Mental Health

  • Re-Engineering underway

  • PACT Risk Needs Assessment

  • MST/FFT

  • Suicide Screenings

  • Psychological Assessments

  • Counseling

  • Crisis Intervention

  • Psychiatric Services

  • Medication Management


Overlying Concerns:

  • Complex conditions

  • Limited resources

  • Ensuring accountability with privatization

  • Systemic Barriers


Complex Conditions

Our survey on DJJ youth in Need of Specialized Services

  • 49% of youth in DJJ programs had a diagnosed DSM-IV mental illness and an additional 14% demonstrated behaviors which suggested a mental health problem (63%)

  • 35% of the youth had a diagnosed DSM-IV substance-related disorder and an additional 30% demonstrated behaviors which suggested a substance abuse problem (65%)

  • 52% of the children reported for all substance-related disorders had a diagnosis of Substance Abuse AND 36% had a diagnosis of Poly-substance Dependence.


50

Boys

40

Girls

30

Percent

20

10

0

MDD

PTSD

ConductD/O

Diagnosis related

to Physical Abuse

Diagnosis relatedto Sexual Abuse

Dual Diagnosis

Mental Illness and GirlsDJJ Diagnosis by Gender


Limited Resources

  • Lack of Specialized Early Intervention Programs

  • Detention funded for crisis intervention not treatment

    • Long waits for specialty MH/SA beds

  • Residential Programs under-funded, not intended for complex mentally ill youth.

  • Comprehensive Mental Health beds in DJJ have a per diem nearly HALF of the state inpatient psychiatric per diems.

    *Inadequate treatment *


Ensuring Accountability

  • Mental Health, Substance Abuse and Psychiatric Services Privatized

  • Monitoring through contracts

  • Laypeople overseeing mental health and substance abuse providers.

  • Limited technical assistance

    *Insufficient Oversight*


Systemic Barriers

  • Lack of Mental Health Infrastructure in Florida.

  • Parents press charges vs. child to access mental health services in DJJ.

  • Limited access into Statewide Inpatient Psychiatric Placements (SIPPs)

  • Mental Health Issues interface with Zero Tolerance Policies.


Systemic Barriers

  • Lack of diversion (or less restrictive) alternatives in the community.

  • Limited Aftercare Services

    • Inadequate discharge planning

    • Medicaid Reform and Access


Addressing: Complex Conditions

Proposed Recommendations

  • Culturally Competent Services

    • Evidence-Based studies utilize white youth

  • Comprehensive Gender Specific Programs

    • Effective girls programming not yet achieved

    • Trauma component critical

  • Equivalent services devoted to MH and SA needs.


Addressing:Limited Resources

Proposed Recommendations

  • Reduction in demand for services by diversion of low risk youth to community based programs

  • Diversion of mentally ill/substance abusing youth to alternative community programs

  • Advancement of Risk-Needs tool to ensure proper placement and progress.


Addressing:Accountability

Proposed Recommendation

State-employed Clinical staff to provide assistance, oversight and improved accountability.


Addressing:Systemic Barriers

Proposed Recommendations

  • Inter-agency and community collaboration to ensure appropriate:

    • Placement

    • Aftercare

    • Case management


Developmental Disabilities


Their Words…

* * *

What is a treatment goal and why is it keeping me from going home?

* * *

I am not stupid, I just cannot learn the way they are teaching me.


National Data

  • 70% of all juvenile delinquents have educational disabilities (LD or ED).

  • Youth are more than twice as likely to commit a delinquent offense as their non-disabled peers.

  • Youth with learning disabilities adjudicated at about twice the rate as non-disabled youth, and LD youth have greater recidivism rates.


Complex Conditions

  • Youth have developmental disabilities AND Mental health/substance abuse issues.


Limited Resources

  • Currently few beds to serve Developmentally Disabled youth.

  • Specialized training required for staff to interact with developmentally disabled AND mentally ill youth.

  • No specific funding for disability overlay services


Systemic Barriers

  • Incompetent to Proceed Process

    • Youth can spend up to 379 days in an ITP program and be found “Non-restorable”.

  • Private APD providers


Addressing:Developmental Disabilities

Proposed Recommendations

  • Additional Resources to serve disabled youth

  • Multi-disciplinary workgroup to review ITP process


For these are all our children.We will all profit by, or pay for, whatever they become.- James Baldwin


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