JSA Health Telepsychiatry is proud to have been chosen by the Southeast Region Texas Juvenile Justice Department to provide exclusive telepsychiatry services to 16 counties in the region. This is an exciting and innovative program … part of the TJJD commitment to ensure that the most severe of juvenile justice dispositions are limited to youth with the highest risk of recidivism … including those with behavioral health disorders. With the addition of telepsychiatry, diversion can now be pursued with regards to detention facilities and inpatient psychiatric treatment by providing community based telepsychiatry interventions with JSA telepsychiatrists.

 

Montgomery and Brazos Counties are not participating in this project at this time.

The Southeast Texas Region is made up of 24 jurisdictions covering 29 counties. There are two large counties (Harris, and Fort Bend), eleven medium counties (Montgomery, Brazoria, Galveston, Jefferson, Brazos, Angelina, Orange, Liberty, Polk, San Jacinto, and Trinity) and sixteen small counties (Jasper, Newton, Sabine, San Augustine, Hardin, Waller, Chambers, Wharton, Walker, Matagorda, Austin, Grimes, Houston, Tyler, Leon, and Madison). The total juvenile population of the region is 878,165 or 27.6 percent of the State of Texas juvenile population.

The region hosts five secure post-adjudication correctional facilities: • Brazoria County Residential Treatment Facility (males/females); • Fort Bend County Juvenile Leadership Academy – Secure (males); • Galveston County Post-Adjudication Center (males/female); • Burnett Bayland Rehabilitation Center – Harris County (males); • Leadership Academy (males/females); and • Harris County Youth Village (males/females).In fiscal year 2015, the Southeast Texas Region placed 4,238 youth in post-adjudication correctional facilities and non-secure placement programs.

 

From the TJJD website regarding Diversion:

 

TARGET POPULATION FOR DIVERSION The goal of regionalization is to reduce the number of TJJD commitments and, at the same time, ensure that the most severe juvenile justice dispositions are limited to youth with the highest risk of recidivism. From a research-informed perspective, the appropriate target population for TJJD commitments is youth with high risk of recidivism for which less restrictive alternatives have been utilized prior to TJJD commitment. Consequently, an important focus of regionalization is to divert youth with a risk of recidivism assessed as low and medium from TJJD commitment.

 

The Risk-Needs-Responsivity principle guided discussions and analyses of the target population for regionalization. An initial analysis of the risk levels of youth receiving an indeterminate commitment in fiscal year 2014 showed that 28 percent (n=203) had a risk level of “medium” on the community risk assessment tools and another 7 percent (n=49) had a “low” risk of recidivism. A similar pattern of committing low or medium risk level youth was evident in the fiscal year to date 2015 data.

Additional analyses of youth committed to TJJD made it clear that medium and low risk youth for which less restrictive options had not been used, but with high levels of service needs, should be the initial target population for regionalization. For example, of youth committed to TJJD in fiscal year 2014, 30 percent had not been receiving a residential placement option prior to TJJD commitment. Also, more than 30 percent of youth committed to TJJD had less than two prior adjudications. These proportions were similar for large, medium, and small counties and across regions.

At the same time, the low and medium risk youth showed a high need for specialized treatment and other services. Of 385 youth committed in fiscal year 2014 and scoring low or medium on the TJJD risk assessment, 98 percent had at least one specialized treatment need and 70 percent had two or more specialized treatment needs. Specifically, close to half of the youth had a high need for alcohol or other drug treatment, and 50 percent had a need for some level of mental health treatment. Almost two thirds had a high or moderate need for capital, serious, violent offending treatment and about 16 percent needed some level of sexual behavior treatment.

Furthermore, the 385 youths scoring low or medium on risk to recidivate had need for trauma-informed care and extensive educational services. Close to 40 percent of the youth were indicated as victims of abuse or neglect, 28 percent were special education eligible, and on average, they were five grade levels behind in math and close to four grade levels behind in reading. Overall, the data analyses and input from probation leaders pointed to service gaps and lack of resources locally as important contributing factors to commitments of youth with low or moderate risk for recidivism.

The regionalization task force therefore decided that improving services and directing diversion efforts to youth with low and moderate risk levels had to be the priority during the initial implementation of regionalization. The unique characteristics of youth were also considered. Certain youth may best be served outside a restrictive correctional setting. Young children have developmental needs that differ from older adolescents and respond best to curriculum designed with these needs in mind, delivered by staff that have specialized training, along with same-aged peers.

Similarly, youth with complex mental health needs and developmental or intellectual disabilities may benefit most from treatment in a setting that can best accommodate their unique needs. Non-violent youth who do not pose a threat to their homes and communities should be prioritized for remaining in their homes when suitable treatment is available.

And finally, research supports the notion that low to moderate risk youth are best served at lower levels of the juvenile justice continuum. After careful consideration of the above mentioned variables, the Task Force defined the initial target population of youth appropriate for regionalization diversion as all youth who are eligible, and under consideration, for commitment to TJJD. In order to qualify, the juvenile probation department must demonstrate a prior effort to provide appropriate intervention with priority given to the treatment needs of the youth. Interventions should be commensurate with county resources.

Youth who may be especially appropriate for diversion include: • younger offenders (those between the ages of 10-12); • youth with a serious mental illness; • youth with a developmental or intellectual disability; • youth with non-violent offenses; and • youth with low to moderate risk levels for re-offense. As the requirements for commitment to TJJD are changed, risk and needs assessments improve placement, and programming decisions for youth and local programming and services are developed and improved, TJJD expects to see a change in the youth counties are committing to state facilities and those they are seeking to divert through regionalization diversion.

As these changes occur, TJJD will reevaluate the target population and application parameters for regionalization diversion to include more high and moderate high risk youth. All departments in Texas were asked to complete a Juvenile Probation Department Resource Inventory (Appendix F). Using the department inventories, the presidents of each region then developed a Regional Resource Inventory and Plan (Appendix G). One key component of the plan was for the region to establish: • which youth within the target population may be best served given the current availability of resources; and • which additional portion of youth within the target population the region could serve next if provided additional resources within this biennium and future biennia.

The task force acknowledged the variability of resources and treatment options available to each of the 166 departments across the state and agreed that every department must demonstrate efforts to rehabilitate youth consistent with their current practices and aligned with available resources. The target population was designed in an effort to accommodate all departments, allowing for the consideration of the unique needs of each youth rather than be driven by region or department size.

 

 

JSA is looking forward to this project to further help persons with behavioral health disorders in Texas. Our thanks to Palo Pinto General Hospital for the opportunity.

 

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JSA Health Telepsychiatry is a behavioral health telemedicine practice that provides 24/7 access to high quality telepsychiatry care for a wide variety of settings including emergency departments, community health clinics, educational institutions, correctional facilities and a wide variety of distant locations including cruise ships throughout the world’s oceans. We use high-definition HIPAA compliant telemedicine technologies to connect patients and healthcare organizations to experienced mental health professionals. For more information please call 1-888-792-7122 or email at info@jsahealthmd.com.