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The House Select Committee on Mental Health met on March 22 to hear invited testimony related to children’s mental health/behavioral health, including, but not limited to clinical medicine, treatment, public education, and juvenile justice.
 
Opening Remarks

  • Chair Four Price – Select Mental Health will release a comprehensive report on all recommendations at the conclusion of a series of interim hearings
  • Price – Today’s testimony focuses on hearing from professionals involved in the major aspects of juvenile mental health (clinical, educational, and correctional)

 
Clinical Medicine
Dr. Anu Partap, UT Southwestern

  • More children in Texas suffer from mental illness “than we would otherwise expect”
  • Untreated mental illness can negatively impact childhood success and have long-lasting detrimental effects well into adulthood
  • Many opportunities exist to offer evidence-based services, but the state must be “prepared” to offer care
  • Private care practitioners are not typically prepared to care for a child with mental or developmental issues, even when they are able to care for a wide variety of other issues; “for every condition other than mental illness” patients will receive the care they need
  • Asthma is a good example of effectiveness of evidence-based care, introduction of evidence-based care revolutionized and expanded asthma treatment dramatically
  • Price – Comments that follow up is critical for care, however for mental health follow up is not “predictable” as with other conditions, can integration help with this?
    • With fractures, seizures, asthma, etc. there are tailored follow up scenarios, family is also usually distressed enough to spur follow up or care providers know exactly who to contact for follow up
    • Integration can help solve these issues, can provide familiar setting to provide care for patients with vastly differing requirements
  • Price – Do you have integrated care at UT Southwestern?
    • Yes, hard to imagine operating without it, UT Southwestern has incorporated psychiatrists and other specialists
  • Rep. Sarah Davis – Is there a higher incidence of mental health issues in children in state conservatorship?
    • Children in foster care are 2-5x more likely to have mental health indicators
  • Davis – Can you talk about “toxic stress” and trauma?
    • Household functions and experiences can adversely affect biological systems
    • Untreated parental mental issues or substance abuse can adversely affect the health of their children, the longer children live with high stress family conditions the more children are affected by mental health issues into adulthood
  • Davis – So incidents of “toxic stress” in foster care would be quite large
    • None of the studies on toxic stress have been done on children in foster care, children in foster care are already dealing with trauma in the family before they enter the system and these problems magnify in foster care
  • Rep. Senfronia Thompson – Have you been able to do research on military families with PTSD issues
    • No personal research done, military has done an excellent job on research this issues
    • Military has found that separated families and military parents who return do have an impact on children’s mental health
  • Thompson – Particularly interested in the impact of the return of military veterans on families
    • Impact is “strong”
  • Thompson – Obesity is often prevalent in these situations, wonders if this could contribute to stress
    • Certainly presents in these situations
    • Integrated clinics can address childhood obesity issues in tandem with mental health roots
  • Dr. Partap presents six basic and achievable healthcare goals:
    • Regular mental health screening
    • Development of referral networks between primary care and specialists
    • Establish specialized service networks for children with serious or co-morbid conditions, i.e. mental health and developmental issues
    • Link crisis mental health networks to first responders, emergency departments, and hospitals
    • Families should receive support services when encountered in high-risk settings, link family support programs with frontline providers
    • Promote integrated care practices
  • Price – So you’re suggesting an annual mental health screening during required annual pediatric health screening
    • Correct, already 15 to 18 visits from birth to maturity, regular mental health screening could help greatly
    • Currently mental health screening is only offered once between age 12 and 18
  • Rep. Chris Turner – Right now under Health Steps program, what is required before age 12?
    • A developmental screen that does not include mental health and only looks at general development
    • No required mental health screening
  • Turner – American Academy of Pediatrics also recommends annual screening, what are you recommending
    • Annual after 3 years, 3 to 4 times before 3 years of age
  • Turner – What is the cost of including this screening?
    • Mental health screening is necessarily more involved, no cost information ready to be presented, however great tools exist that are free and available in English and Spanish
    • Dr. William Streusand, A&M Health Science Center – Primarily the cost will be time rather than monetary
  • Turner – What about children on private insurance?
    • Not familiar, but private practices exist in Texas have already developed robust screening, several tools are available for purchase
  • Price – Trying to understand how legislature can encourage these suggestions, how could state link crisis networks with other healthcare providers?
    • Crisis response teams exist in certain communities, have not seen hospitals implementing crisis response team practices
    • Solution would be to plan and develop teams that have delegated responsibilities from or close association with hospitals
  • Thompson – Is there an increase in suicide rates amongst this population due to lack of service?
    • Dr. Streusand – No specific answer, but certainly an increase in attempts
  • Thompson – What type of services are provided to families with children who need mental health services
    • Dr. Streusand – Will discuss this a bit later, but focus is on integrated care
  • Thompson – Do you try to integrate family services with community-based services?
    • Yes
  • Mental health care expansion should focus on building effective treatments for common issues such as anxiety or depression
  • Early and consistent care is very important in developing healthy adults
  • Rep. Kenneth Sheets – His family members have been patients of UT Southwestern, appreciates the effort shown here

 
Dr. William Streusand, A&M Health Science Center

  • Barrier exists in child psychology, no patient wants to be a patient, parents are afraid they will be blamed for children’s issues
  • Huge shortage exists in the field
  • Child psychiatry has unique challenges, psychiatric issues are complex and involve emotional, biological, developmental, and environmental factors
  • Linear protocols are thus not a good fit for mental health issues, e.g. a diagnosis for autism will never have just one path of treatment
  • Price – Do you believe the shortage of practitioners is due to complexity of issues combined with coverage and compensation?
    • Payer issues are a problems, personally does not take insurance
    • Integrated care and broadening providers can address shortage issues
  • Rep. Greg Bonnen – Why don’t you take private insurance?
    • Does not have to, trying to wrestle with an  insurance company to get approvals is wasted time that could be spent on care
    • Insurance companies also complicate formulary issues, companies tend to dictate what to prescribe and why, Dr. Streusand does not want to deal with this with visits as well
  • Bonnen – It seems very difficult to find a psychologist or psychiatrist that does take insurance, would like to know why and how to address it
    • Not enough providers compared to the need, care could be expanded through physician assistants and nurse practitioners
  • Bonnen – Are there barriers to being paid?
    • All of the above, has dealt with multiple insurance plans and always had issues
  • Bonnen – Has a general concern that, even with insurance, patients will not have access to care
    • Private sector has withdrawn due to market factors
    • Does not see movement into medicine by students, limiting qualified graduates
  • Bonnen – Seems easier to jettison mental healthcare over apparent injuries, problems facing mental healthcare seem to be a portent of problems that will face healthcare in general
    • Salaried positions are an option, can happen
    • Many doctors do not want to open private practices and will take a competitive salaried positions
  • Bonnen – Does not understand who will hire physicians if they cannot be paid by private insurance
    • Would hope hires would happen through integrated health clinics supported by the state
  • Price – Some of these funding issues should be saved for the appropriations committee
  • Creating a system of care for mental health is easier than the legislature might imagine, legislature should focus on personal treatment and needs, practices do not need a lot of administrative oversight
  • Integrated clinic models are the best route, nation is trending towards this and MHMRs are falling away
  • Thompson – How many integrated care models are in place currently?
    • No clue, however integrated care models are creative and can be tailor-made for specific services
  • Davis – State has historically grappled with shortage issues, movement is needed within medical schools and medical community to identify appropriate future psychology specialists
    • Completely agrees
  • Vice Chair Joe Moody – Appreciates the testimony focusing on crisis prevention and care, focus on at-risk populations is important and highlights legislative movement that can require offenders to pay for child psychological care
    • Juvenile justice system and criminal responsibility is a huge area, promoting this is very important

 
Christine Bryan, Clarity Child Guidance Center

  • Price – Is the Clarity Center an option for law enforcement or crisis response personnel looking for assistance with crisis intervention
    • Yes, Clarity is part of the team that does crisis intervention training for law enforcement
  • Clarity accepts children regardless of acuity, illness, ability to pay, etc. as each child deserves treatment
  • Family support is very important to child success, Clarity considers many factors such as socio-economic ability and desire to continue care
  • Clarity tries to bring providers, families, and children together for therapy and increase effectiveness of a session
  • Issues exist with prior authorizations and separate pharmacies, Clarity is planning on implementing an on-site pharmacy to address this
  • Day programs focusing on stress coping has been very effective is improving child mental health, however this is not a required benefit for Medicaid and legislature might want to consider this
  • Crisis Management Assessment Center is Clarity’s 1115 waiver project, includes observation beds and other crisis management services with a focus on preventing children from being admitted and cutting readmission rates, however funding has been a struggle
  • Children’s inpatient care is very expensive as children must be constantly watched
  • Clarity has seen great outcomes, 9 out of 10 parents report improvement in children after treatment at Clarity
  • Clarity responds to every budgetary decision made by the legislature, budgeting and marketing teams are very active
  • Clarity is asking the legislature for help, is more flexible than payer-providers seem to be
  • Clarity spends a lot of time defending its care model to MCOs
  • Price – Clarity is doing amazing things, do you have any recommendations for Clarity practices that can be replicated across the state?
    • Clarity has been approached by other programs across the state, currently putting an information package together
    • Key is to ensure every professional is on the same page, that way training is easy and care is coordinated
  • Bonnen – Has Clarity explored CPS and justice organizations for funding
    • If there is an organization that has a dollar, Clarity has explored the option
    • Collaboration is always cost effective

 
HHS Agencies’ Children’s Programs and Services
Lauren Lacefield-Lewis, DSHS and Gary Jessee, HHSC

  • Price – Asks for an update from Jessee about the 6 recommendations from Dr. Partap and is HHSC has incorporated some of these into HHSC contracts
    • Changes could be made to frequency of screenings
    • Later this year, HHSC will be debuting the STAR Kids program, divided amongst 10 MCOs across the state, development of STAR Kids replicated the STAR+PLUS care program
    • HHSC is mandating 4 face-to-face visits in order to coordinate care and monthly calls to care supporters
    • Other mandates include implementing evidence-based practices and medical homes
    • Many of the recommendations the committee have already been heard by HHSC and are already in contracting standards
  • Thompson – Was STAR Kids development contracted out
    • STAR Kids is driven by feedback from communities and providers
    • HHSC managed the STAR Kids development
  • Davis – References complaints filed against HHSC commissioner alleging that care is lacking for children aging out of foster care, what has HHSC done to address this?
    • HHSC has been working to address the complaint, children aging out need close care and support
    • Will continue to work with TJJD
  • Davis – Hopes that HHSC will continue to work to resolve issues and address things like toxic stress
  • 37 local mental health authorities cover every area in Texas, currently serve 61,000 families and DSHS attempts to ensure access to evidence-based care
  • DSHS focuses on child and family based service system
  • 1115 funding has expanded the availability of integrated care
  • DSHS highlights two successful programs
    • Youth Empowerment Services, 915(c) waiver, seeks to provide flexible, gap-filling care
    • Residential Treatment Center project, partnership with DFPS that has helped to expand care and currently has 30 beds, designed to prevent need for long-term surrender for care to DFPS
  • DSHS is also focusing on safety-oriented culture, looking to identify and inform about dangerous environment for self harm in children and also looking to expand suicide screening
  • Thompson – What is the suicide rate now
    • Can provide this
  • Also highlights Mental Health First Aid Initiative, designed to spot mental health issues quickly and respond, has been very successful and reached thousands of educators and 5,000 non-educators
  • Price – Would like better tracking of who is being trained would this information, currently more detailed tracking is not required and demographics over problem districts is not available, can anything be done to address this?
    • DSHS has the ability to compile this information, has not previously because of worries of burdening providers
    • Can survey LMHAs and collect information to provide it to the legislature
  • Price – Would like it broken down by district or county and would like to be informed on what is possible
  • Price – Currently non-educators may be charged a fee of $80 to $120, and the state is required to pay $100, would like more information on why the state is being charged for this
    • Can investigate and provide this information
  • Rep. Garnet Coleman – Recently there has been a high amount of flooding, what protocols exist for the state to go into disaster-affected communities and address mental health issues
    • DSHS has a particular group that focuses on behavioral health disaster-related issues, works to get federal grant money to get boots on the ground
    • LMHAs tend to be involved from the beginning and are frequently the contractors working with DSHS after federal funding is obtained
  • Coleman – How can I explain this to the local communities and how can communication issues be addressed?
    • Because situations are individualized, cannot necessarily speak to certain communities, but DSHS can look into communication issues and get back to the legislature
  • Coleman – Would like someone to contact the local authorities to begin to address this and make changes on the ground

 
Gary Jessee, HHSC

  • HHSC has a very close relationship with DFPS and works with them to serve people within the state support system
  • Roughly 31,000 individuals are supported by the state through DFPS, highlights portions of the STAR Kids support system:
    • Immediate eligibility and access to statewide provider network, Superior is the MCO that coordinates this network
      • Focus is on coordinated care and use of psychotropic medications
    • Electronic health passport is a comprehensive health record that ensures health information follows any given patient through the system
    • Value-added services are provided by MCOs and not included in capitation, includes access to things like Boys and Girls Clubs
    • Psychiatric diversion programs focus on reducing inpatient stays
  • MCOs are required to do telephonic screening on patient entry into the systems, done with families or caseworkers and can lead to enrollment in service management
  • Service coordination teams match service to needs
  • Psychotropic medication utilization reviews use telephonic screenings and pharmacy coordination to track usage of drugs by patients and is governed by parameters that help guide proper use of psychotropic drugs
  • If utilization falls outside of parameters, MCO partner will engage with users to discuss
  • It utilization falls well outside parameters, DFPS has the ability to reach out and take direct action
  • Psychiatric Hospital Diversion Service is a brace of programs that assist in avoiding inpatient psychiatric stays, program has been successful with only 10% ending up in inpatient placements and 15% requiring changes of care placement, shows gains over patients not within the program and leads to savings
  • HHSC has worked very hard to get comprehensive and useful electronics records
  • 1115 Waiver and DSRIP initiatives:
    • 1115 waiver has supported managed care statewide, 1,400 projects spread amongst roughly 290 providers
    • Helps to identify what local communities need for healthcare
    • 46 of these programs focus specifically on juveniles and children and include avoiding justice intervention and increasing access to care
    • Supports telemedicine and tele-health projects, which can help to expand care given the shortage of physicians in Texas
    • HHSC is very concerned with improving access to care and believes that the waiver and DSRIP are a major help
  • Turner – Can you speak to the annual health screening by pediatricians
    • If the American Academy of Pediatrics has made changes HHSC tries to adopt those
    • Jessee’s understanding is that HHSC has implemented all of the American Academy of Pediatrics standards
  • Turner – Is HHSC not aware of the recent recommendations?
    • Personally not aware of any other recent recommendations
    • HHSC  uses those standards to help develop Texas Health Steps, but this area is not necessarily within Jessee’s purview
  • Turner – Would like a follow up for screening guidelines
  • Turner – Can you speak to reports of psychotropic abuse reports by providers and lack of placements for patients?
    • Level of need has certainly increased within the system, placements have been a challenge to meet these needs
    • Behavioral health issues complicate placement issues, placement families are not always prepared to handle behavioral health issues
    • HHSC focuses on supporting placement families and diversion programs to tackle behavioral health placement issues
    • Education is needed over what support is available however, without education patients will not understand the scope of access, coordinating MCO should be front and center in these discussions
  • Turner – Who needs education?
    • Local providers, case workers, pretty much everyone involved needs education
    • Should focus on what support exists and how to access this
  • Turner – What does HHSC need from the legislature to address this?
    • Primary focus should be on preventing children from enduring what they do before they enter the system
    • Rate should be increased, families should be supported, and support options need to be explored
  • Price – Calls Judge Specia forward to discuss this from a DFPS perspective
  • Davis – What is the situation with the 1115 waiver and what happens if it is not extended
    • HHSC is continuing to work with federal partners, trying to produce what they would like to see
    • Both parties agree on content of the study and HHSC is pursuing an extension
    • HHSC believes that an agreement can be reached to stabilize and move forward

 
Judge John Specia, DFPS

  • Level of care system is very imprecise and state is unable to deal with the needs of the highest level of care
  • STAR Health has been a very good partner, but there are limits on DFPS’s ability
  • Wraparound services are needed to progress the system to family and community based care, but these services are not in place
  • Price – Do you have any specific suggestions?
    • Wants to look at this, wants to work on this as part of the LAR process
  • Price – Would like to be kept informed of any suggestions
  • Turner – Is the key to improving mental health a stable environment with regularity and predictability?
    • Absolutely, stable home life is essential
  • Turner – Are RTCs not a good option then?
    • RTCs are appropriate for some children and never for a long time period
    • Appropriate wrap around services would help immensely, system has been reformed to be trauma sensitive
  • Turner – What is the root of the problem? Is it turnover?
    • There is no silver bullet, turnover and staffing is a component, but not the only issue

 
Education K-12
Dr. Pam Wells, Dr. Ginger Gates, and Dr. Clynita Grafenreed, Region 4 Education Service Center Initiatives

  • Purpose of ESCs is to help schools operate efficiently and implement legislative directives
  • Region 4 has developed significant capacity for school mental health supports
  • Addressing mental health should fall along a continuum:
    • Tier 1) Protective factors, foster personal self-worth, safe and supportive school environments
    • Tier 2) Mental health programs and community interventions
    • Tier 3) Individualized interventions, including direct counseling
  • Price – Does Region 4 ESC follow up with organizations they train to determine potential focuses
    • Region 4 ESC does maintain a close relationship with districts and other ESCs
    • However, no requirement exists to follow up, merely best practices
  • In Texas, ratio of students to professionals is greater than recommended by support organizations, school employees cannot and should not be the sole providers of mental health support
  • Texas Behavior Support network coordinates ESCs to expand care and support mental health of all students, initiated two new projects in 2015-2016 to integrate support network and school operations
  • TBS also looks to apply PBIS, a database support to assist in equitable and efficient schooling based upon the previously discussed tier system of support
  • Interconnected Systems Framework looks to connect PBIS and school mental health and focuses on integrating family, community, and school based care
  • Effective partnerships are crucial to expanding access to care
  • Price – Does Region 4 suggest to other ESCs that they work collaboratively with LMHAs to provide effective service
    • Many ESCs knew about the LMHAs and the funding pipeline, many also trained their own staff using their own funds
  • Region 4 believes it is important to support evidence-based mental and behavioral healthcare, educators will see it as more effective and meaningful
  • Legislature should also ensure that public schools and officials have the resources to address the mental health needs of students
  • Partnerships with school districts are an effective road to provide support
  • Best outcomes have come from schools with mental and medical support
  • ESC service centers also provide support to bus drivers, food and nutrition personnel, etc. not just teachers, ESCs are thus natural partners for many initiatives
  • ESCs are willing to partner to expand access to care

 
Craig Shapiro, Tracy Spinner, and Dr. Elizabeth Minne, Austin Independent School District

  • David Crockett high school was deemed academically unacceptable in 2007-2008, a series of reforms over the next three years helped improved the campus
  • In 2011 Crockett was asked to pursue a pilot program and open a mental health clinic on campus, school culture and climate greatly improved very quickly
  • The program focused also on improving the quality of instruction and the quality of the school environment
  • Crockett shows that focus on improving instruction, environment, and mental health is a collaborative process and can dramatically increase outcomes
  • Evidence shows that the mental health clinic on campus was the catalyst that allowed other reforms to be effective
  • 1115 waiver extension is necessary to continue the reforms
  • Price – How much weight do you give having a mental health center on campus to improving the condition of the campus?
    • Major weight, dramatic increases only came after implementation of mental health program
    • Many school reform programs die off relatively quickly, mental health center allowed the reforms to be effective
  • Moody – Can you explain the dropout and graduation rate date, seems to be negative trends right at implementation of the mental health clinic
    • Tends to be a brief negative trend once reforms are implemented, trended upwards once the positive effects started proliferating
  • Crockett mental health clinic works with parents and students to provide a wide base of mental and behavioral healthcare and collaborates with other services to create wrap around support
  • Austin ISD has received roughly $2.4 million for mental health services under the 1115 waiver
  • Austin ISD has also spent roughly $400,000 of district funds to secure a contractor, VitaHealth, to provide mental health support
  • Turner – How campuses does Austin ISD have compared to campuses with counseling centers
    • 120 campuses total, 18 campuses have counseling services
    • 1115 waiver had certain guidelines for pilot program eligibility, factor include percentage of free and reduced lunch, number of class failures, etc.
  • Turner – Is there a need in AISD to replicate the programs in the 18 campuses in the rest of the campuses
    • Absolutely, every campus needs similar support
  • Turner – Is there an increase of incidents of self-injurious behavior or are we just doing a better job of identifying problems
    • Students are becoming more comfortable coming forward and data tracking has improved
  • Price – What happens if you do run out of 1115 waiver funding
    • AISD is asking that exact question, unsure
  • AISD counseling focuses on referrals by school personnel and families, each campus center receives around 100 students per year and treats many issues including anxiety, depression, and other more severe mental health problems
  • Thompson – What percentage of students experience issues
    • Over 90%
  • AISD counseling can address problems effectively that otherwise might be considered situational problems or troublemaking
  • To increase access, AISD counseling would like to be included as in-network providers
  • Bonnen – Is AISD not currently recognized by provider boards and state government?
    • Not currently, many networks have said that they do not need more providers despite arguments that AISD counseling is a different type of program
  • Bonnen – Are students then actually paying for these services?
    • In some capacity
  • Bonnen – Does some DSRIP funding go towards the program?
    • That’s a completely different area
    • AISD will definitely be on Medicaid, but private insurance has proven a major hurdle
  • Bonnen – This sounds like a network adequacy issue
  • Bonnen – Other programs started out thinking of when funding would run out, has been very impressed by these programs and their push to drive investment at the outset from communities and municipalities
    • AISD counseling is currently in conversation with some community providers and is looking at ways to capture support and expand access
  • Moody – Is there data as to how many clinic students qualify for special education services, how many show history of abuse and neglect, how many of their families have criminal histories?
    • Not at the moment
  • Moody – Would be useful to have these numbers considering TJJD involvement
  • Bonnen – If you can make the case that without this program more costs would be incurred, other entities will definitely buy in
  • Turner – Asks after statistics presented to the committee
    • Most of these statistics involve abuse, neglect, etc. other serious issues
    • Sever family conflict is very common amongst students coming into the clinics

 
Andrea Richardson, Bluebonnet Trails Community Services, Dr. Douglas Killian, Hutto ISD, and Dr. Jodi Duron, Elgin ISD

  • Bluebonnet Trails Community Services LMHA created an 1115 waiver mental health clinic pilot program to address the needs of Hutto ISD and Elgin ISD
  • Before the program implementation, Hutto ISD was experiencing a slow deterioration of school and community quality
  • Hutto ISD believes that a major benefit of the clinic is its combined mental and physical health components, addresses counseling, therapy, vaccination, screening, etc. needs
  • Hutto wants to expand the program and the 1115 waiver is extremely important to this
  • Elgin ISD is focused on community access to care, plans to add a dental component to the current clinics
  • Price – Have you experienced the same type of beneficial effect as Crockett high school from having the clinics?
    • Dropout data is not yet available, but impact is clear through attendance and it is good to have the services available
    • Discipline data is also showing a positive trend
  • BTCS believes that this model can work in many different communities, brought both Hutto and Elgin to show effectiveness in suburban and rural areas
  • BTCS is focusing on suicide prevention and has been effective in addressing Hutto and Elgin incidents and while they do not come through DSHS or HHSC they are onsite for crisis management

 
Dr. Billy Phillips, Texas Tech University Health Science Center

  • Presents on the Telemedicine, Wellness, Intervention, Triage, and Referral Project (TWITR)
  • Texas Tech is looking for solutions to meet the needs of rural citizens, TWITR took a year to plan and develop
  • Rural counties tend to have drastic personnel shortage for counseling services and this has historically made this difficult to implement mental health clinics for schools
  • Texas Tech makes a presentation to each selected school district over the capabilities of health screening through telemedicine and attempts to involve all personnel possible in the referral process to the licensed professional counselor
  • TWITR screens for a variety of common conditions, including depression factors and behavioral problems
  • If a student meets a certain number of criteria during the screening, the program connects the student to a child psychologist via telemedicine
  • TWITR also educates and trains students and teachers about mental health issues
  • Telemedicine can be an effective and safe way to deliver care, however some conditions require face-to-face care and some communities might have differing needs

 
Juvenile Justice
David Reilly, ED Texas Juvenile Justice Department

  • Provided handouts to the committee which gave an overview of the agency and quickly reviewed them
  • Staffing capacity has increased in last year and a half – 1,700 capacity and currently is at 1,200 kids and using existing staff capacity and with current level of funding
  • Started seeing levels of increase since 2015 and says there appears to be an increase of violent crime in the state in Texas and in other parts of the country
  • Currently about 6% over projected number
  • Reviewed history of reforms and notes they have worked reducing the number of youth in the system
  • Almost 70% of children committed have been placed out of the home at least one time
  • Almost 40% have CONFIRMED cases of abuse and neglect
  • The issue of raising the age is still open – system changed back when system lowered age from 20 to 18 and that it is now felonies only and this has contributed greatly to the reduction
  • Kids coming into the system go into orientation and assessment center firsts and then treatment needs will drive system and proximity to home will drive what facility they will go to
  • All facilities provide a level of mental health treatment

 
Tushar Desai, Director of Medical Services Texas Juvenile Justice Department

  • After evaluations are complete then individualized treatment needs are determined and facility that will meet those needs in consideration with location of their home
  • Many need multiple specialized treatments
  • When any youth arrives at assessment facility with medication they do see a psychiatrist at the facility and have contracted with UTMB to provide those services
  • McLennan County Facility have a residential treatment center within the facility
  • Moody – Concern on PBSI model for school and being implemented in correctional facility
    • Reilly interjects on a question regarding the PBSI model – staff is working with this model (normally in education vs correctional) and is rolling it out
    • Reilly – Small issue is cultural shift that needs to occur – normalizing life and providing positive incentives and there may be hurdles to provide those incentives but they have high hopes for the program and do not yet have list of needs to make this program successful
  • Appointments set within 30 days of release from the facility to continue monitoring and provide 30 days of psychotropic medication upon release
  • Youth that have specialized treatment needs – parents can make the call and there are services to help the families when the youth are released

 
Judge John Hathaway

  • Provided materials to the committee
  • Strongly believe to protect public safety is to have effective holistic interventions for the children and their families
  • Reviewed COPE program – treatment plan is developed, informal atmosphere allows whole team to discuss with parents and helps them fulfill role as a parent and children leave with an aftercare plan
    • Gave example of mother daughter case and the difference it made (in home counseling, changes on behavioral intervention plan, helped with school issues and interventions for the mother such as a parent coach, respite care and individual care)
  • Handouts provided numbers on recidivism rates
  • Thinks the COPE program could be replicated across the state
  • Murr – in rural areas with limited resources, is there a way to alter the COPE program to make it more applicable to a rural setting?
    • Yes – reallocating docket resources and maximize resources that are available

 
Daniel Hoard, Travis County Juvenile Probation Department

  • Looking to identify early on children and what they need so they do not go all through the system
  • Reviewed evidence based early effective interventions
  • Target high risk youth, etc – those with traumatic histories are essential to identify
  • PTSD looks different in youth and have taken significant steps to be attentive to those issues
  • Thompson – what are the % with PTSD
    • 80% have documented experience with traumatic exposure and believes the number may be higher than that
  • Thompson – asked about other conditions such as bipolar?
    • Those who have been previously identified may actually have trauma backgrounds