Joint Committee Studying Treatment Options for Offenders with Mental Illness and Substance Abuse Disorders
June 28 , 2001, Richmond
The third meeting of the SJR 440 Joint Committee focused on the delivery of services to juvenile offenders in state facilities, local detention homes and communities.
Department of Juvenile Justice
The Department of Juvenile Justice (DJJ) operates seven residential correctional centers, a Reception and Diagnostic Center, and 32 court service units. Three additional court service units are operated locally in Fairfax County, Arlington, and Falls Church with substantial funding from the department. In addition, the department operates Culpeper Detention Center, which is attached to the Culpeper Juvenile Correctional Center, and oversees through policies and standards 22 locally operated detention homes.
The Virginia Juvenile Community Crime Control Act (VJCCCA) served more than 20,000 young people in fiscal year 2000 in programs designed to be alternatives to juvenile detention. Nevertheless, detention home admissions grew from 16,000 in fiscal year 1996 to more than 22,000 in fiscal year 2000. The average daily detention home population currently exceeds capacity, but additional expansions are planned for the next several years. The average length of stay in a detention home is approximately 18 days. Concurrently, the number of commitments to state juvenile correctional centers has decreased from 1,735 in fiscal year 1996 to 1,456 in fiscal year 2000. The trend continues in fiscal year 2001 with an expected decrease to 1,250 commitments.
Initial screening for substance abuse takes place within the court service units, followed by a more detailed assessment, if indicated, by qualified personnel using standard, validated instruments. The screening and assessment instruments are designed to be used specifically with adolescents: the Substance Abuse Subtle Screening Inventory (SASSI); the Child and Adolescent Functional Assessment Scale (CAFAS); and the Adolescent Problem Severity Index (APSI). Qualified and certified staff and screening and assessment instruments in each court service unit are funded through a combination of state general funds ($950,000), federal grants ($1.1 million), and the Drug Offender Assessment Fund ($300,000).
During the period from June 2000 through May 2001, 8,888 SASSI screenings and 2,549 assessments, using APSI or CAFAS, were completed for juveniles under the supervision of court service units. Thirty-four percent of the juveniles were identified as moderate to high risk for substance abuse. Alcohol and marijuana were the drugs used most frequently, and the age of first use for a large majority was below age 14. Significant numbers use alcohol or marijuana on a daily basis and about 30 percent use the drugs up to eight times per month. In addition, 72 percent of the juveniles who were assessed on the CAFAS test have a severe or moderate impairment from abuse of substances.
Treatment is accessed through a combination of private insurance, community services boards, local grant programs, VJCCCA, and the Substance Abuse Reduction Effort (SABRE). The SABRE appropriation for fiscal year 2002 is $2.34 million. A critical issue is the lack of funding and availability of residential services to remove the juvenile from the home and the community to allow for stabilization and intervention. Such care is expensive and only one dedicated adolescent residential treatment facility (30 beds) exists.
DJJ does not have a system to collect information about the mental health needs of juveniles who come before the court. Section 16.1-275 provides for the court to order mental examinations of juveniles. If the family cannot pay for the cost of the examinations, DJJ is required to pay. DJJ expenditures for court-ordered mental health evaluations have increased from $218,486 in fiscal year 1998 to $364,213 in fiscal year 2001. Estimates from detention and juvenile correctional facilities suggest a significant level of need. A consistent message from court service units is that, in many localities, mental health services are often insufficient or difficult to access. There are limited numbers of public inpatient psychiatric beds and many children who are in the non-mandated category for the Comprehensive Services Act are often not served by the localities' Comprehensive Services Act Programs because of insufficient funds.
Juvenile Drug Treatment Courts
Juvenile Drug Treatment Courts combine intensive substance abuse treatment and probation supervision, relying on the court's authority to mandate the juvenile's compliance. There are currently two juvenile drug treatment court programs: (i) the City of Richmond and (ii) the City of Fredericksburg, in conjunction with the counties of Stafford, Spotsylvania, and King George. Federal funding has expired and funding depends on the DJJ and the localities. The projected capacity is 25 to 50 juveniles each. Two additional programs are in the planning stages in the City of Newport News and the City of Charlottesville. Charlottesville has an innovative program that involves the family in the process.
Virginia Juvenile Community Crime Control Act
Funding for the Virginia Juvenile Community Crime Control Act (VJCCCA) has grown from $11.1 million in fiscal year 1996 to almost $30 million in fiscal year 2002. Each locality prepares a plan based on court data and an assessment of the need for services and programs. Most of VJCCCA placements are non-residential. In fiscal year 2000, VJCCCA served 20,742 youths. Of the 7,203 youths released from a VJCCCA program or service, nearly 57 percent had no new juvenile intakes or adult arrests after release. In fiscal year 2000, only 5.2 percent (1,938) of placements were for substance abuse assessment and treatment and 2.8 percent (1,054) of placements were for mental health assessments. Two percent ($928,092) of VJCCA funding was used for substance abuse assessment and treatment and 0.2 percent ($73,538) was used for mental health assessments. The largest categories of expenditures are for residential placements, outreach detention and electronic monitoring.
Juvenile Correctional Centers
Juvenile correctional centers serve approximately 1200 to 1300 youths per year. The percentage of committed youths who need mental health treatment increased from 33.6 percent in 1993 to 61.7 percent in 2000. All youths committed to the DJJ are assessed at the Reception and Diagnostic Center. Psychological assessments may include intelligence testing, mental status, personality assessment, alcohol and drug questionnaire/interview, and referrals for psychiatric consultation. Approximately 50 percent have a history of taking psychotropic medication prior to admission to the juvenile system; more than 20 percent of males and females have had a prior psychiatric hospitalization. More than 60 percent of males and more than 71 percent of females leave the Reception and Diagnostic Center with a designated mental health treatment need. Almost four percent of the males (three per month) meet the criteria for a psychotic disorder. Substance abuse assessments indicate that more than 35 percent of females and almost 40 percent of males exhibit a high probability for alcohol and drug dependence.
The DJJ Behavioral Services Unit provides mental health, sex offender, and substance abuse treatment services in the juvenile correctional centers. Mental health services are adequately staffed, according to a DJJ representative. The total mental health budget is $3.5 million for the eight juvenile correctional centers.
However, substance abuse services are not adequately staffed. Intensive residential services are available at only two facilities, Barrett and Bon Air, with a combined capacity of 124. There are significant waiting lists for prescriptive and substance abuse education services at the other facilities. There is a shortage of substance abuse counselors at Beaumont, Hanover, Culpeper, and Bon Air, although approximately 50 percent of the juveniles in these facilities have a diagnosed substance abuse treatment need. DJJ lacks an adequate number of certified substance abuse counselors. One hundred and forty-two youths are on a waiting list for services system-wide.
Localities or multi-jurisdictional commissions operate 22 local detention homes. DJJ provides support in the form of capital construction and 50 percent of operating costs. A 1994 study by the Policy Design Team indicated that almost 50 percent of the juveniles in detention homes needed mental health services. A Department of Mental Health, Mental Retardation and Substance Abuse Services study of juvenile detainees in two detention homes, Norfolk and Rappahannock, indicated that more than 82 percent reported using both alcohol and drugs during their lifetimes. More than one-half of the juveniles met criteria for needing substance abuse treatment, but most were not receiving treatment at the time of arrest.
Detention homes are required by § 16.1-248.2 to screen juveniles upon admission and to complete an assessment (if indicated) of mental health needs within 24 hours. A survey of detention homes found that community services boards, detention home staff, or private providers in all 22 detention homes provide at least limited mental health services. In contrast, only 17 provide substance abuse treatment services. The mental health and substance abuse treatment services are funded through a combination of detention home budgets, community services boards and grant funds. Eighteen homes provide mental health assessment, eight provide medication management, seven provide medication assessment and individual counseling and six provide group counseling. Similarly, eight provide substance abuse assessment and six provide group or individual counseling or education. Fifty percent (11) indicated discharge planning regarding mental health and only 38 percent (8) indicated discharge planning related to substance abuse treatment.
Representatives of the Fairfax County Juvenile Detention Center, a 121-bed facility, reported that 65 percent of juveniles in their center need mental health services. Mental health screening includes interviews with the juvenile and the parents or guardians. Fairfax is hiring new staff to deal with the mental health needs of their detainees. Postdispositional cases get more mental health services than the general population. The community services board provides the postdispositional program with two mental health professionals, two alcohol and drug service professionals and a consulting psychiatrist (4.5 hours per week). If parents cannot afford the services of the psychiatrist, the center absorbs the cost. Postdispositional cases are provided in-house services, psychiatric evaluations, medication consultations, and discharge planning. An aftercare counselor does intensive follow-up for 60 days after the juvenile is released from the detention center.
Shenandoah Juvenile Detention Home is a 32-bed, multi-jurisdictional facility located in Staunton, Virginia. The spokesperson for Shenandoah reported that the average population is 48 children per day, which is 150 percent of capacity. The average length of stay is 14 days because Shenandoah does not have a postdispositional program. The screening is similar to Fairfax but is intended only to identify the child who might commit suicide. Fifty percent of the juveniles who are admitted have mental health needs. A community services board employee is in the detention home several times a week. A juvenile with mental health needs will be assessed by the community services board employee and perhaps will be sent to the Commonwealth Center for Children and Adolescents. The Commonwealth Center, also located in Staunton, is not equipped to handle aggressive and violent children; Shenandoah is not equipped to handle children with mental health needs but receives children on a regular basis from the Commonwealth Center. The Shenandoah representative could not say what happens to a child who is released from detention.
Community Services Boards
Unlike individuals in the adult services system, many children do not receive their primary mental health, mental retardation and substance abuse services from a community services board (CSB). A representative of the Virginia Association of Community Services Boards reported that other sources of service might be public education, social services, juvenile justice, and private providers. Funding streams include Medicaid, private insurance, the Comprehensive Services Act (CSA) or local funds.
In some areas of the state, the CSB is the only provider of services to children. Many agencies may be involved in the child's treatment, and coordination becomes more difficult with multiple agencies. Programs in localities vary, based on local priorities and identification of need, local planning and coordination, and available resources.
There is not a comprehensive public or private system of case management for children in Virginia. Complex funding streams come with specific requirements and specific services that may not allow the flexibility to meet children's special needs.
In addition, Virginia does not have enough children's psychiatric beds or child psychiatrists to meet current needs for these services. When a juvenile in a correctional setting needs psychiatric care and treatment, there is often no psychiatric bed available in Virginia. There were several days in the last quarter when no public or private child psychiatric beds were available. According to the spokesperson, as children's inpatient beds have closed, there has been no concentration on community alternatives.
Funding from the CSA is complex and does not cover all children. The mandated population is those children for whom the state must provide funding and services based on federal law and regulations; i.e., children in foster care and children with Individual Education Plans. However, not all service needs of mandated populations can be funded with mandated dollars. Some services are considered eligible only for non-mandated funding. No locality is required to fund services to non-mandated populations and many do not because of insufficient funds.
In 2000, the General Assembly appropriated $4.25 million each year of the biennium to DMHMRSAS to be used for services to non-mandated youth. All available funds have been used or encumbered for 523 children; at least 17 percent of those children had a referral from the juvenile justice system.
For juveniles in the criminal justice system, funding streams include court service units, CSA, DMHMRSAS, SABRE, DJJ, local dollars targeted by particular localities, federal and state grants, and sliding fee scales. Juveniles lose their Medicaid eligibility when they enter a correctional facility. Blue Ridge Behavioral Healthcare has collaborated with the court service unit to use SABRE money to provide an array of substance abuse treatment, excluding residential treatment. The Virginia Beach CSB with a federal grant has developed a multisystemic program that is focused on reducing juvenile delinquency and recidivism. Since children lose Medicaid status in a correctional setting, there is no funding stream to support the treatment.
The spokesperson recommended that an array of services be developed for children and their families in each community to serve children whether or not they fall into a particular category. The specialized array of services would include family support services, crisis intervention services, case management, outpatient services, intensive community-based services, vocational training, and community-based residential services. The array of services needs a specific funding stream so that the infrastructure can be put in place.
In addition, the following steps were recommended:
Comprehensive Services Act (CSA)
The director of the Office of Comprehensive Services explained the purpose of CSA, the funding stream and the history of expenditures. There is no way to track with the current information system the amount of CSA funds spent for juveniles involved in the criminal justice system who have a diagnosed need for mental health and substance abuse services. While total CSA expenditures have increased from $105 million in 1994 (first year of CSA) to $205 million in 2000, the amount spent on the non-mandated population, which includes juvenile justice and mental health, has remained about the same, decreasing from $10 million in 1994 to $9.96 million in 2000.
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