The Indiana Juvenile Mental Health Screening, Assessment, and Treatment Project (Project) is aimed at early assessment of mental health issues facing children who enter juvenile detention. It is already helping children access needed services.
Benefits Observed by Detention Centers and Courts
Some of the recognized benefits of the Project include:
- a better understanding of the youth on the part of detention center staff,
- improved staff and youth safety,
- early identification of potential suicide risk and physical and sexual abuse,
- cost savings with the ability to target evaluations and provide services in an informed way, and
- youth already in care are able to be connected or reconnected with their providers well before they come to court for a disposition.
“This program has increased our credibility in areas like mental health evaluations and Department of Child Services (DCS) referrals,” explains Kathy Cullison, Assistant Director of Kinsey Youth Center in Howard County. In Howard County, mental health screening is a first step that can lead to referrals for trauma-informed care and trauma-informed cognitive behavioral therapy.
Alison Cox, Director of the Porter County Juvenile Detention Center, sees a significant benefit from mental health screening, particularly in the area of traumatic events. Ms. Cox explained: “Through the screening, we have discovered more abusive situations, rape, and physical abuse, which manifests as depression and somatic complaints. We’ve been able to get DCS immediately involved and give referrals for help.”
Clark Circuit Court # 4 Judge Vicki Carmichael observed: “Before this project, the mental health inquiry in detention consisted of a few questions asked of the juvenile by the intake officer. ‘Do you feel suicidal?’ ‘Have you been treated for mental health issues in the past?’ The answers to those questions determined whether the child was then seen by a mental health professional. Not much of a screening! Intake officers now have a much better tool, the Massachusetts Youth Screening Instrument (MAYSI), to determine mental health needs of the child. As a judge, I am aware earlier in the process if a child needs services in order to resolve cases in a manner that benefits the child.”
Development of the Project
Nationally, up to 70% of youth in the juvenile justice system suffer from mental health disorders, which are severe enough to impair the ability to function in over 20% of them. Without appropriate services, these children risk longer incarceration, higher rates of recidivism, and difficult reintegration into the community. The Indiana Project is a collaborative effort that successfully addresses one aspect of this problem by instituting routine mental health screening, assessment and treatment for youth entering detention centers.
The Project was a product of the Indiana State Bar Association’s “Children, Mental Health and the Law Summit” held in August of 2004. The Summit resulted in a published report that noted Indiana lacked statewide systematic mental health screening at an early intervention point in the juvenile justice system. Although a few counties had systems of identifying children with mental health needs, most were not conducting routine mental health screening.
A Title II federal grant awarded by the Indiana Criminal Justice Institute (ICJI) provided initial start-up funds for the pilot project in 2006. It was modeled on a highly successful screening project in Pennsylvania.
The Juvenile Detention Centers’ Association of Pennsylvania Mental Health Grant and Indiana’s Project implemented the “Comprehensive Model for the Identification and Treatment of Youth with Mental Health Needs in Contact with the Juvenile Justice System,” developed by Kathleen R. Skowyra and Joseph J. Cocozza, PhD in 2007. The Project has implemented the model’s ten recommended actions for addressing identification and treatment.
The Advisory Board
The project’s Advisory Board had these goals:
- include experts in key disciplines including those with hands-on experience with youth in the juvenile justice system and detention, and
- include key agencies responsible for the care, rehabilitation and treatment of youth in the juvenile justice system.
The Project acknowledges the critical importance of direct input from participating detention centers in decisions made at the state level so representatives from each project site serve on its Advisory Board.
The Advisory Board is chaired by Porter Circuit Court Judge Mary Harper, and the vice-chair is JauNae Hanger, an Indianapolis attorney serving as the Indiana State Bar Association (ISBA) representative. The Board includes critical stakeholders such as American Academy of Pediatrics, IN Chapter; Indiana Council of Community Mental Health Centers; Indiana DCS; Indiana Department of Correction; Indiana Department of Mental Health and Addictions; Indiana Juvenile Detention Association; Indiana Minority Health Coalition; IU Medical School; and Probation Officers Professional Association of Indiana.
Project Growth
The Project officials recruited pilot sites throughout Indiana to implement the model. Mental health screening has since become institutionalized in the pilot sites and the Project has grown to include most of the detention centers in the state. Six original pilot counties implemented the Project on January 1, 2008, when routine screening began.
As results began to demonstrate effectiveness, additional counties joined. Indiana has twenty two juvenile detention centers. The number of participating sites has grown to seventeen sites (sixteen juvenile detention centers and one juvenile intake facility): Lake, Marion, Bartholomew, Johnson, Porter, Clark, Grant, Delaware, LaPorte, Howard, Tippecanoe, Hamilton, Dearborn, Elkhart, Vigo, Knox and Jackson Counties.
Henry County was a participating site, but has since closed its detention center. Most of the sites are county-operated detention centers, but two of the sites are run by county Sheriff’s departments and two sites are private facilities.
As a result of the Project, there have been over 35,000 mental health screenings conducted on youth entering detention in Indiana. The Project utilizes the Massachusetts Youth Screening Instrument Version 2 (MAYSI-2), a screening tool designed to identify youth who are in need of further evaluation. The MAYSI-2 screen is a self-report inventory of fifty-two questions divided into seven scales.
The project follows guidelines from the developers of the MAYSI-2. A youth is considered to have screened above the cut-off on the MAYSI-2 if they score 1) in the caution or warning range on the suicide ideation scale, or 2) in the warning range on two or more other scales. If the youth is above the cut-off score, the seriousness of their symptoms is considered “clinically significant” and high enough to require some form of follow-up response. In 2008, the first project sites conducted 5,771 mental health screens with 25.7% of youth screened scoring above the cut-off requiring a response. In 2012, 6,621 screens were conducted, and approximately 21% of youth scored above the cut-off.
The youth and their families face continuing problems with mental health care once the children have been discharged from detention. The IU Medical Center, the Indiana Department of Correction, the Pediatrics Association, the Indiana Department of Mental Health and Addictions, the Indiana State Bar Association, Indiana DCS, and the National Alliance on Mental Illness (NAMI) Indiana responded by forming a Connections to Care Workgroup. This Workgroup has been meeting regularly over the past year and half and has provided information and made recommendations to the Commission on Mental Health and Addiction.
Local Collaboration and Documentation
The juvenile court judge, probation department, county prosecutor, defense bar, detention center and mental health providers in each county participating in the project have demonstrated their support and cooperation for the Project. Youth Law T.E.A.M. of Indiana, the Project’s Director, continues to recruit the remaining sites around the state to further the goal of including all of Indiana’s twenty-two detention centers in this statewide project.
Consistency in the application of the screening tool and utilization of the information obtained has been addressed through the adoption of Protocols and Guidelines for the Implementation and Administration of the MAYSI-2. Each county site has also adopted their individual Local Protocols.
What We Have Seen
The Project has developed assessment capacity in order to respond to mental health treatment needs of those youth identified. Project data has allowed sites to make informed funding decisions for services. Sites have changed the way they contract for mental health services based on the need shown through Project data. Some sites have increased or changed programming based on the data, including the institution of an onsite anger management program in one county.
The Project also promotes collaboration and cooperation among detention centers, courts, juvenile defense advocates, prosecuting attorneys, probation officers, and mental health providers. Participating counties have their own local advisory boards. At the state level, the Project promotes collaboration and cooperation among state agencies and between disciplines. Local stakeholders have significant input when they meet with their fellow Advisory Board members who represent state agencies and child-serving institutions. Project data provides guidance by identifying both the need for mental health services and the barriers to accessing mental health care.
Not long ago, our state lacked systematic mental health screening for youth in the juvenile justice system. By responding to this challenge creatively and communally, Indiana is realizing far-reaching and lasting benefits for youth, families and our communities.