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

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slide1

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
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 services3
The Office of Health Services

Serves

  • Over 150,000 youth
  • 4 Major Program Areas
  • All of Headquarters
  • 55 State Clinical Staff
slide5

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
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
Primarily……

Non-violent minority males referred for misdemeanor offenses

our girls
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
slide9

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

their words

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
Overlying Concerns:
  • Complex conditions
  • Limited resources
  • Ensuring accountability with privatization
  • Systemic Barriers
slide13

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
slide14

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
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
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
Ensuring Accountability
  • Medical Services Privatized
  • Monitoring through contracts
  • Laypeople overseeing medical providers
  • Limited technical assistance

*Insufficient Oversight*

systemic barriers
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
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
Addressing: Limited Resources

Proposed Recommendations

  • Increased funding for medical and dental services.
  • State employed medical staff
addressing accountability
Addressing: Accountability

Proposed Recommendation

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

addressing systemic barriers
Addressing: Systemic Barriers

Proposed Recommendations:

  • Suspension of Medicaid instead of dis-enrollment.
  • Improved collaboration with the Department of Children and Families upon discharge.
their words24

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…

slide25

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 concerns26
Overlying Concerns:
  • Complex conditions
  • Limited resources
  • Ensuring accountability with privatization
  • Systemic Barriers
complex conditions27
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.
slide28

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 resources29
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 accountability30
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 barriers31
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 barriers32
Systemic Barriers
  • Lack of diversion (or less restrictive) alternatives in the community.
  • Limited Aftercare Services
    • Inadequate discharge planning
    • Medicaid Reform and Access
addressing complex conditions33
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 resources34
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 accountability35
Addressing:Accountability

Proposed Recommendation

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

addressing systemic barriers36
Addressing:Systemic Barriers

Proposed Recommendations

  • Inter-agency and community collaboration to ensure appropriate:
    • Placement
    • Aftercare
    • Case management
their words38

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
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 conditions40
Complex Conditions
  • Youth have developmental disabilities AND Mental health/substance abuse issues.
limited resources41
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 barriers42
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
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
For these are all our children.We will all profit by, or pay for, whatever they become.- James Baldwin