The report also noted concerns of state administrators on how ill-prepared juvenile detention center employees are to provide proper care for young people who are severely depressed, suffering from separation anxiety or suicidal.

Taking a Holistic Approach

In its report entitled Mental Health Treatment for Youth in the Juvenile Justice System, the National Mental Health Association recognized two Texas initiatives that “incorporate promising practices to address the mental health, substance abuse and co-occurring needs of youth involved in the juvenile justice system.” Both programs address the needs of the family, rather than just the individual.

The Texas First Time Offender program, available in 43 of the 254 counties in the state, provides services that range from screening and assessment, substance abuse counseling, case management and connecting the family to community support systems. This program works to keep young people from criminal behavior by addressing their mental health needs and by working to increase the stability of the family.

Tarrant County’s Family Matters works with youth deemed at risk for delinquency by the county’s Juvenile Probation Department. This program arranges and coordinates such treatment services as individual and family counseling and family stabilization.

Special Needs Diversionary Program

Erin Espinosa is a program specialist in the federal programs division of the Texas Juvenile Probation Commission. She says that mental health issues were not addressed by the juvenile justice system in Texas until 2000. “We realized that we had no data on mental illness among young people in our system,” she said. “Thanks to a small surplus in the state budget, we were able to address this.”

The Texas state legislature provided funding for the Special Needs Diversionary Program (SNDP) in 2001. It’s an alternative to incarceration for juveniles with mental health needs, seeking to prevent their removal from their homes and to keep them from further involvement with the juvenile justice system. At the same time legislation was enacted that requires that every juvenile formally referred to juvenile probation departments be given a standard mental health screening.

These screenings can result in the juvenile being referred for further mental health assessment. In 2004, 18 percent of juveniles screened were referred for further mental health assessment. However, fewer than half of those referred actually received a subsequent assessment, due to limited access, especially in smaller localities.

SNDP applies a team approach, in which a juvenile probation officer who receives special training is paired with a licensed mental health practitioner. Each team manages a caseload of 12 to 15 youth and their families. Bexar, Dallas, El Paso, Tarrant, Travis, Hidalgo and Cameron counties, representing half of the state’s juvenile justice population, were selected for SNDP’s first round of funding (2002). In its first year, 764 youth were enrolled in 19 sites, served by 38 teams. More than fifty-two percent of these juveniles finished the program.

Dr. Jeannie von Stultz is the director of Mental Health Services for the Bexar County Juvenile Probation Department. She says that SNDP brought a welcome change in that treatment is now geared toward addressing a diagnosis based on screening and assessment, rather than controlling behavior. “We use MAYSI [the Massachusetts Youth Screening Instrument] which allows us to prescribe more specific treatment,” von Stultz said.

The diversionary program is designed for juveniles who meet certain criteria: They must be at risk of removal from their families because of their psychiatric symptoms, or they must have been identified by their school system as needing special education due to their emotional difficulties. And it is mandatory that a family member or other adult in the young person’s life agree to participate in the program. Otherwise the juvenile is not eligible.

Juveniles and their families who qualify can receive a wide range of support services. Von Stultz says that system of care is especially critical for the success of the program. “We provide skills training and therapy for the child and the family. Many of our families have had bad experiences with various parts of the system and get overwhelmed,” she said. “Our program includes a family advocate, and that aspect works very well.”

The SNDP approach provides intensive intervention and is family-based. The team works with the juvenile and the family to create an individualized case plan, incorporating such services as individual and family therapy, rehabilitation services, skills training and chemical dependency education. SNDP guidelines require that the team meet with the family three to five times a week. Two of these visits must occur in the home. The family is encouraged to play an active role so that, over time, they become less dependent upon the SNDP team and more reliant on supports available to them in the community.

One of the positive outcomes reported by the Bexar County program in its first year was that the majority of family and youth who participated in the program were successful in identifying resources within themselves that helped them manage stressful situations.

Mental Health 101

The best treatment programs, according to the National Mental Health Association, use well-qualified and well-trained staff. Erin Espinosa handles the special training that juvenile probation officers undergo in order to participate on the SNDP teams. “I call it Mental Health 101,” says Espinosa. “It’s structured on the definition of normal versus abnormal behavior, and how adolescents develop.”

This training is critical, given the mental health diagnoses of the juveniles enrolled in the program’s first year. Major depression was the single most reported mental disorder. According to a 2002 study conducted by Columbia University’s Center for the Promotion of Mental Health in Juvenile Justice in collaboration with the Texas Juvenile Probation Commission, separation anxiety also ranked high among the reported disorders. Fourteen percent of the sample (drawn from youth referred to juvenile probation departments in the eight largest counties in Texas) reported that they had made a suicide attempt during their lifetimes.

Next Steps

Erin Espinosa is concerned about continuity of care for youth who come through the state’s SNDP, which provides services to enrolled juveniles and their families for four to six months. “What we’ve seen so far is a gap in the availability of services after young people leave our programs,” she said. “Of the 75 percent of kids who are tied back into follow-up care, less than 25 percent actually receive it.” This is especially true in the rural areas. “Urban areas have more opportunities to provide continuity of care and community for these kids,” Espinosa said. “In the rural areas, there’s not much available for them after the programs.”

While the major goal of the SNDP program is to provide an alternative to incarceration for juveniles in need of mental health services, ultimately its success depends upon the local availability of these services once the youth completes the program. The Texas Juvenile Probation Commission is working on a plan to address this gap through the use of telemedicine. The Telemental Health Pilot Initiative would utilize the latest advances in telecommunications to connect communities in need with the mental health expertise of a major regional medical center specializing in psychiatric services.

The plan is in the conceptual stages. We’ll track of its progress and keep you posted.

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