From the Cincinnati Enquirer,  a very thorough, very good review of self-mutilation, also called self-injury and “cutting.” The article includes a description of the SAFE Alternatives (Self Abuse Finally Ends) structured in-patient program designed to treat self-mutilative behavior. SAFE Alternatives gets about 1,000 calls a month for information. A new short video program for parents, teachers, social workers and others that discusses self-injury and self-esteem is available from SAFE. (“Cutting through the pain,” The Cincinnati Inquirer, July 28, 2002 )

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Developing Mental Health Systems for Children can be heard on the NCSL web site at www.ncsl.org. You’ll need to click on “Public User” to access the conference. If you’d prefer, tapes are available from NCSL for $5.

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National Center for Mental Health and Juvenile Justice (NCMHJJ) )

OJJDP and the John D. and Catherine T. MacArthur Foundation sponsor this organization/web site and it’s Initiative on Mental Health and Juvenile Justice. All kinds of good MH/JJ resources here. Take a look at these representative pages (there are more) from the site:

New and Noteworthy – Among a number of other events and resources, see “At Risk: Youth on Probation in the P.A.R.K. Program.” This is a video from AACAP ( American Academy of Child and Adolescent Psychiatry). It features a day treatment program with close collaboration among all organizations involved.

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An interview with the presiding judge of CITA, the Court of Individualized Treatment of Adolescents, in Santa Clara County, Calif., Judge Raymond Davilla by KQED, the local PBS station, on lessons learned in the first year of the court’s existence. Judge Davilla notes that the court has lowered the recidivism rate to seven percent compared to the 25 percent rate for the general juvenile population in the county.

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Parents and Teachers as Allies: Recognizing Early-onset Mental Illness in Children and Adolescents

This little booklet from the National Alliance for the Mentally Ill (NAMI) is a good deal. For $1 plus postage and handling you get serious information on the signs of early-onset mental illnesses in children and adolescents plus resources and references. 25 pages packed with good information. Call NAMI at 703-524-7600, fax at 703-524-9094, or write NAMI c/o Lynne Saunders, Colonial Place Three, 2107 Wilson Blvd. Ste 300, Arlington VA 22201-3042. Sorry, couldn't find it on the NAMI web site publications pages. 

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Videos to Educate About Mental Illness

The Idaho Department of Health and Welfare and Idaho Public Television received awards in 2001 from the National Alliance for the Mentally Ill (NAMI) for two video documentaries on mental illness the two organizations coproduced. I haven't viewed either video, but intend to purchase both for our video lending library. Descriptions of both videos are up on the web. 

Hearts & Minds: Teens and Mental Illness features interviews  with real Idaho teens who experience mental illness and their families. It confronts the stigma of mental illness head on, explains the biological basis of mental illnesses and their treatment, teaches the signs and symptoms of major mental illnesses. In Our Own Voice features interviews with adults with mental illnesses .

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GAINS Center Web Site

The National GAINS Center for People with Co-Occurring Disorders in the Justice System has a new website up and running. It includes a number of special pages with information pertinent to juvenile justice. The juvenile projects section features three GAINS projects: 

Juvenile Regional Forums

National Survey of Juvenile Diversion Programs for Youth with Mental Health and Substance Us Disorders 

Re-Entry Standards for Youth with Mental Health and Substance Use Disorders Who are Transitioning into the Community

The GAINS Center has a goodly number of publications available for ordering at the site (as near as I could tell, at no charge), and some of them are downloadable pdfs.

The Fact page has a section with handy facts specific to juveniles.

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Recommendations for Juvenile Justice Reform (scroll down to mid-page)

The American Academy of Child and Adolescent Psychiatry published this 73 page report last October. The report covers, in individual chapters - none of which is more than three or four pages long - the following subject areas:

forensic evaluations of children and adolescents; competency to stand trial; standards for juvenile detention and confinement facilities; healthcare in the juvenile justice system; females in the juvenile justice system; disproportionate minority confinement; seclusion and restraint standards in juvenile corrections; meeting the educational needs of incarcerated youth; waiver of juvenile cases to criminal court; juvenile sex offenders; juvenile death sentences: AACAP policy statement; alternatives to adjudication: drug courts, mental health courts, peer courts; model program - the Island Youth Programs

The Executive Summary provides a brief summary on the AACAP position on each of these subjects. It ends on page 15 of the report. 

While I was roaming around on the AACAP site I discovered their Facts for Families series of brief one or two page fact sheets intended for parents and caregivers. There are 80-some fact sheets, covering the perils of raising kids from A to Z. As an example, here are few representative fact sheets:

 Children of Alcoholics

The Child With Autism

Obsessive-Compulsive Disorder in Children and Adolescents

Children with Learning Disabilities

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The Omaha-World Herald Series on Mental Health and Kids 

Thanks to a Nebraska subscriber I have been reading a newspaper series on juvenile and children’s mental health issues that began last Sunday and will run through tomorrow (Saturday). The Omaha World-Herald has undertaken a thorough examination of a complex issue and done it very well. The articles in this series include features about children with mental illnesses and their families; articles about Nebraska’s system of mental health care for the young – and the lack of it; a very nice glossary of terms that appears daily; and a variety of other information, all to do with the primary topic.

You won’t be able to read this in five minutes. If you’re interested in reading some or all of this series, I suggest you do so within the next three weeks. It appears that the series will be moved then to some other location. I downloaded the whole shebang for my files and am willing to share it with you if you’d like to have it to read. Just send me an email.

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One section of the National Mental Health Association’s web pages contains position papers published by that organization on a variety of mental health-related subjects. Here are three I found of interest.

Mental Health Courts

Children With Emotional Disorders in the Juvenile Justice System

The Use of Psychotropic Medication to Treat Children’s Mental Health Needs

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Children's Mental Health Publications from SAMHSA

SAMHSA has published three new volumes in its series Systems of Care: Promising Practices in Children’s Mental Health. The series focuses on the needs of children with serious emotional disturbances. The new volumes:

Wraparound: Stories from the Field

Learning from Families, Identifying Service Strategies for Success and

Promising practices in Early Childhood Mental Health.

All are available by linking to SAMHSA and clicking on "Children’s Campaign." You can also obtain them from the Center for Mental Health Services at 800-789-2647.

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OJJDP's Mental Health Initiatives

This two-page OJJDP Fact Sheet reviews OJJDP’s current mental health initiatives.

Projects include:

Assessing Alcohol, Drug, and Mental Disorders Among Juvenile Juvenile Detainees

Researchers are studying alcohol, drug, and mental disorders among a large sample of juvenile detainees in the Cook County Detention Center in Chicago. Includes a longitudinal study. See OJJDP Fact Sheet: Assessing Alcohol, Drug, and Mental Disorders in Juvenile Detainees.  Scroll down to the entry. 

Intergenerational Transmission of Antisocial Behavior

An examination of the development of childhood antisocial behavior in a three-generation prospective panel study. This study focuses on the children of current participants in OJJDP’s Rochester NY Youth Development Study, a longitudinal study begun in 1987-88 of 1,000 Rochester youth and their parents. By the time they reached 21, 40 percent of the original Rochester youth participants were parents. No published materials yet.

Mental Health-Juvenile Justice: Building an Effective Service Delivery Model 

This initiative’s purpose is to create a model for the delivery of mental health and related substance abuse services to youth involved with the juvenile justice system. The model, when developed, will be replicated and evaluated at several sites. This is the largest mental health initiative ever undertaken by OJJDP. Research is under way.

Multisite, Multimodal Treatment Study of Children With ADHD 

 NIMH began a study of the long-term efficacy of stimulant medication and intensive behavioral and educational treatment for children with attention deficit hyperactivity disorder (ADHD). OJJDP began in 1998 to help fund continued investigation into these children’s delinquent behavior and contact with the legal system, including arrests and court referrals. See OJJDP Fact Sheet: A Treatment Study of Children With Attention Deficit Hyperactivity Disorder which describes study findings. You'll need to scroll down to the entry. 

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How America’s Mentally Ill Teens are Trapped in Juvenile Lockups

A Brevity subscriber alerted me to this excellent four-part series on juvenile justice and mental health published in the Pittsburgh Post-Gazette in July. This series of articles is about as thorough as a newspaper ever gets. If you have any interest in the subject at all you’ll find this to be an informative and interesting read. 

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The Justice Policy Journal

The Justice Policy Institute has just published the first issue of its new Justice Policy Journal.  The purpose of the Journal is to provide a vehicle for researchers and practitioners to address critical publish policy issues in the field of criminology and criminal justice. The Journal is web-based and will be published twice yearly. This article from the first issue may be of interest to readers:  Critical Challenges in Addressing the Mental health Needs of Juvenile Offenders, Daniel P. Mears, The article addresses these issues,  among others:  

• the unmet mental health needs of juvenile offenders,  
• increasing recognition of juvenile offender mental health needs, 
• the purpose and uses of assessments, 
• identifying resource and service gaps and promoting diversion, 
• and encouraging collaboration.

21 pages. Downloadable.

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In October 2000 the Attorney General of Minnesota, Mike Hatch, filed a lawsuit against Blue Cross Blue Shield of Minnesota alleging that the company was engaging in a pattern of misconduct in denying medically necessary health care treatment recommended by physicians for Minnesota children and young adults suffering from mental illness, eating disorders, and chemical dependency.

The Attorney General said "The insurance company routinely attempts to sidestep its coverage obligations by inappropriately shifting the cost of caring for such children to taxpayers and/or families, including instructing parents to have their children suffer ‘legal consequences’ or to make ‘use of the juvenile justice system.’" The complaint alleged that Blue Cross Blue Shield of Minnesota cost the state $14 million.

Blue Cross Blue Shield settled with the State of Minnesota in June. It will pay the State of Minnesota $8.2 million as well as agreeing to a number of ground-breaking settlement provisions.

Key provisions of the settlement:

• The settlement creates a three person review committee to be implemented within 90 days. One member of the committee will be appointed by the Attorney General, one by the chief judge of Hennepin County, and one by Blue Cross. The committee, within one business day, may vote to overturn or uphold a claim upon the vote of any two members.
• The settlement also allows the Attorney General to appoint an auditor to enter Blue Cross’s premises every six months for up to two weeks and obtain "full, timely, complete and unrestricted access to its books, records and personnel to assess the information ad processing flow with respect to benefits."
• Blue Cross will pay for treatment that is ordered by a court of law based on an evaluation and recommendation of a health professional.
• Blue Cross will provide "parity" for mental health and chemical dependency treatment so that, when Blue Cross includes such coverage in a contract, the contract must include both inpatient and outpatient treatment at the same level as for medical services.

For more details see the report from the Minnesota Attorney General’s Office web site.

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The subject of parents relinquishing custody of their children in order to get mental health services for them is one largely unaddressed throughout the country. I recently assisted a reporter for The Progressive Magazine, Anne-Marie Cusac, in her research for an article on this subject which has now been published. While I am by no means an expert on this subject I found the article to be well-balanced, informative and objective...and interesting too. You can read and/or download Arrest My Kid: He needs Mental Health Care.

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Blamed and Ashamed: The Treatment Experiences of Youth with Co-occurring Substance Abuse and Mental health Disorders and Their Families -  In an interesting related issue, The Federation of Families for Children’s Mental Health has published this new report critical of the treatment and services received by children with co-occurring disorders and their families. The report makes these points:

• Mental health and substance abuse services are funded separately at all levels of government; and have separate agencies dealing with them.
• Inconsistent professional jargon is used to identify mental illnesses and substance abuse
• Agencies like to implement what they already know how to do, and staff like to implement what they were trained to do. Even if current services are not working, they say, "We’ve always done it this way. We’ve never done it that way.
• Agencies know what they are doing does not work, but say a new system would cost too much. "It would overburden us and we’re already doing all we can."

The report makes these recommendations to mental health providers:

• Listen carefully to youth and families, and use what they hear to make recommendations.
• Involve youth in designing and evaluating programs. Offer them access to information and a voice in decisions about their treatment.
• Include families. Extend treatment to parents and provide whole-famly treatment. Link the family to post-treatment services, and help them set realistic goals.
• Offer individualized services. Offer choices and include information about the benefits and risks associated with each one. Focus on the length of time the youth needs treatment instead of the length of time insurance will cover it or families can pay for it.

The report is based on a series of focus groups conducted between 1997 and 1999 in eight states and the District of Columbia. Youth and parents were divided into separate groups.

Click here for more information about the Federation and what it does. To order a copy or for more information about the report call them at 703-684-7710 or write Federation of Families for Children’s Mental Health, 1101 King St., Suite 420, Alexandria, VA 22314.

Addressing the Issue of Parental Custody Relinquishment to Obtain Mental Health Services for their Children - The Bazelon Center for Mental Health law has several publications addressing this issue. Publications include Relinquishing Custody: The Tragic Result of Failure to Meet Children's Mental Health Needs and Staying Together: Preventing Custody Relinquishment for Children's Access to Mental Health Services. Litigation Strategies, with extensive citations, is available free in PDF format online at the Bazelon Center web site. Publications can be ordered online.

Other resources at the Bazelon Center site include advocacy resources on involuntary treatment, managed care, children's services, fair housing rights, ADA, and the "criminalization" of people with mental illness. Of particular interest, the Children's Issues Page and the Mental Health Issues Page. Visit the Bazelon Center site

Framework for evaluating performance and outcomes in behavioral-health services

The American College of Mental Health Administrators has released a report that provides the framework for evaluating performance and outcomes in behavioral-health services. A Proposed Consensus Set of Indicators for Behavioral Health presents a conceptual framework developed by the five major behavioral-health accrediting bodies. It addresses 35 indicators in the areas of access, process and outcome. Most of the indicators focus on the consumer perception of the experience of care. As an example, access indicators may include the rate of patients reporting that they received the services they need; the rate of patients reporting that transportation was not a barrier to recovery; the rate of utilization of services at each level of care. The report is available by contacting the ACMHA website. Hardcopies may also be purchased from ACMHA at 412-820-0670.

The death penalty for offenders with mental retardation

Beyond Reason: The Death Penalty and Offenders with Mental Retardation - This new report from Human Rights Watch calls for the States of United States to pass laws to ban the practice of executing persons with mental retardation. Thirteen states have passed laws to exempt mentally retarded persons from the death penalty. The report notes that at least 35 mentally retarded people have been executed in the United States since 1976 and estimates two to three hundred are currently awaiting execution.

See a brief summary of the report and/or order it online (for $7.00)

For a more detailed discussion see this article at the Human Rights site on About.com.

Mental Health and Substance Abuse Insurance Coverage for Children and Adolescents - Thirteen medical and family advocacy organizations have issued a statement calling for more comprehensive insurance to increase access to treatment for children and adolescents with psychosocial problems such as substance abuse and mental illness. According to the American Academy of Pediatrics, the rate of child psychosocial problems has increased from seven to 18 percent while the number of mental health and substance abuse programs has decreased. Among the recommendations:

• Parity should be established between medical health services and mental and behavioral health and substance abuse services.
• Mental health and substance abuse professionals should be accessible and available to families within a reasonable distance and time frame. 
• The process required for children and adolescents to receive treatment should be simplified, shortened and unified. 
• Family and purchasers of family health care plans should be clearly informed about the adequacy of their mental health coverage, and no one should be excluded from care because of a pre-existing condition or chronic disorder. 

The statement also contains recommendations on coordination of care issues and service monitoring.A copy of the consensus statement is available online at the American Academy of Pediatrics web site. 

Nation's First Juvenile Mental Health Court

The nation’s first juvenile mental health court was launched on February 14, 2001 in Santa Clara County Superior court, San Jose, Calif. Here’s the press release announcing the new court:

"The Santa Clara County superior Court has assumed a national leadership role in addressing the issues of juvenile mental health by holding the nation’s first Juvenile Mental Health Court (JMHC) on Wednesday, February 14, 2001, thus increasing effectiveness of community mental health treatment for juvenile offenders who are accused of less serious offenses. Supervising Judge Raymond J. Davilla, Jr. will preside over this specialized court every second and fourth Wednesday afternoon of the month.

"The juvenile justice system has become a common pathway for many youth with serious mental illness who have had a protracted involvement with the juvenile justice system. Through early identification of available resources for those youth suffering from developmental disabilities, organic brain syndromes, and brain conditions with a genetic component, the goal of effective juvenile rehabilitation and community safety is addressed as well as expediting the processing within the juvenile justice system for youth with serious mental illness. The Court has accomplished this feat through a collaborative effort involving judicial officers, prosecutors, public defenders, mental health representatives, juvenile probation, and treatment provider representatives.

"Judge Davilla’s JMHC will effect a more humane treatment of juveniles with serious mental illness, help relieve the over crowding of detention facilities, and decrease recidivism among youth. Judge Davilla states, "The JMHC will give us many more options in the proper treatment of these youth as well as the protection of our community. This is truly a team effort which will continue to adjust as we better define the needs of our juvenile population."

UCLA’s Center for Mental Health in Schools

This is the most amazing place. An extraordinarily comprehensive web site with a wealth of resources easy to navigate and to use.

I clicked on the Quick Find button and asked about at-risk youth education. This is what I got back.

Take a look at the Gateway to a World of resources for Enhancing Mental Health in Schools section. It is organized into five areas of organizations that provide access to relevant resources on the internet.  There are a LOT of links here. 

All kinds of publications, special reports, and briefs can be either downloaded or ordered at the site. Briefs include Financing Mental health for Children and Adolescents and Integrating Mental health in Schools: Schools, School-Based Centers, and Community Programs Working Together.

The Clearinghouse section offers introductory packets of materials on key topics. These include such topics as Social and Interpersonal Problems Related to School Aged Youth and Conduct and Behavior Problems in School Aged Youth. Packets can be downloaded (if you’re up to downloading 100+ pages) or ordered in hard copy for prices ranging from $3 to $10.

Wraparound Milwaukee

Wraparound Milwaukee and Multisystemic Services (MST) were featured in the Coalition for Juvenile Justice’s recently published annual report as outstanding examples for the delivery of mental health services to children. MST was featured in last week’s newsletter. This week’s feature is Wraparound Milwaukee.

"An excellent example of an approach in a managed care setting is "Wraparound Milwaukee,. . . a coordinated system of community-based care and resources for families of children with severe emotional, behavioral, and mental health problems, . . . operated by the Children and Adolescent Services Branch of the Milwaukee County Mental Health Division. The features of this care management model are:

• a provider network that furnishes an array of mental health and child welfare services;
• an individualized plan of care;
• a care coordinator management system to ensure that services are coordinated, monitored and evaluated;
• a Mobile Urgent Treatment Team to provide crisis intervention services;
• a managed care approach including preauthorization of services and service monitoring;
• and a reinvestment strategy in which dollars saved from decreased use of inpatient or residential care are invested in increased service capacity.

(In simpler terms, instead of shoehorning a child into whatever services are available, the individual needs of the child determine the type and duration of services -- which are wrapped around the child and his or her family as necessary.)

"Since its inception in 1994, one of the goals of the program has been to blend funding streams. Wraparound Milwaukee operates as a behavioral health care "carve-out" that blends funds from a monthly capitation rate from Medicaid, a case rate from county child welfare and juvenile justice funds, and a Center for Mental Health Service child mental health services grant. The Wrapround Milwaukee capitated rate of approximately $4,300 covers all mental health and substance abuse services, including inpatient hospitalization. Additional funds from child welfare and/or juvenile justice are used for children with serious emotional disturbances in the child welfare and juvenile justice systems in Milwaukee County to cover residential treatment, foster care, group home and shelter care costs, and nontraditional mental health community services (e.g., mentors, job coaches, after-school programs.: Wraparound Milwaukee is at "full risk" for all services costs, meaning it is responsible for charges in excess of the capitated rate. The average monthly costs, including administrative costs, are $3,400 per child. Medicaid-eligible children constituted 80 percent of the population served by the program in 1998."From the Mental Health Report of the Surgeon General, Chapter Three: Children and Mental Health, Service Delivery Section, released December 1999.

Wraparound Milwaukee’s blended funding streams: 

• $3,300 month per child from child welfare
• $8 million from juvenile justice
• $1478 per month per child from medicaid
• a federal grant
• The total budget is $27 million per year.
• The average cost per child is $3,400 per month.

For more details about the program, its funding, and its services, see the Wraparound Milwaukee Profile at the Center for Effective Collaboration & Practice.

For a more complete picture of Wraparound Milwaukee read Wraparound Milwaukee: Aiding Youth With Mental Health Needs by the program’s director, Bruce Kamradt, in the April 2000 issue of Juvenile Justice.

For an interesting application of the wraparound approach, look at the Multnomah County, Oregon (Portland) Mental Health Design Team document, "A Recovery Oriented Mental health Service System - Draft #3, 7/24/00. Includes ten requirements for the implementation of wraparound services and the obstacles to implementing them. From that document:

"To begin to structure services based on individual needs, promoting optimal functioning, requires a breakdown of old narrow funding strategies, partnerships across systems, flexible and creative collaboration that will ultimately be accountable to producing measurable outcomes."

Which brings to mind this tongue in cheek definition of collaboration: Collaboration means you change. I don’t.

Surgeon General’s Report on Children’s Mental Health - This just released report calls children’s mental health a "crisis." Based on proceedings from a conference held in September 2000, it provides a framework for addressing children’s mental health in the U.S. The report identifies both goals and action steps to achieve those goals.

Goals:

1.  Promote public awareness of children’s mental health issues and reduce stigma associated with mental illness.
2.  Continue to develop disseminate, and implement scientifically-proven prevention and treatment services in the field of children’s mental health.
3.  Improve the assessment and recognition of mental health needs in children.
4.  Eliminate racial/ethnic and socioeconomic disparities in access to mental healthcare.
5.  Improve the infrastructure for children’s mental health services including support for scientifically-proven interventions across professions.
6.  Increase access to and coordination of quality mental healthcare services.
7.  Train frontline providers to recognize and manage mental health issues, and educate mental health providers in scientifically-proven prevention and treatment services.
8.  Monitor the access to and the coordination of quality mental healthcare services.

Points of interest:

• Insurance parity for mental health care with physical health treatment is not addressed
• Although juvenile justice is not specifically addressed in any of the goals, the Department of Justice has assumed that all eight goals apply to the juvenile justice system. (See Youth Violence: A Report of the Surgeon General, released January 17, below)
• How the report will be received by the new leadership in the White House is as yet unknown.
• It was only two to three years ago that federal attention became focused on mental health issues.

The complete text of the report is downloadable at the Surgeon General’s site. Load up your printer. The report is 60 pages long: Report of the Surgeon General’s Conference on Children’s Mental Health: A National Action Agenda.