Mental Health Youth Within the Juvenile Justice

SystemSERVICES AND RESOURCES

Total Unduplicated Youth

Youth with Mental Health Diagnosis %

2007 6718 375 5.58%

2008 6218 573 9.22%

2009 5638 781 13.85%

2010 5155 722 14.01%

Youth with a Mental Health Diagnosis2007 - 2010Calendar Year

Serious emotional disturbance (SED) means with respect to a youth from age 6 through 17, that the youth has been determined by a licensed mental health professional as having a mental disorder with a primary diagnosis falling within one of the DSM-IV (or successor) classifications when applied to the youth's current presentation (current means within the past 12 calendar months unless otherwise specified in the DSM-IV) and the diagnosis has a severity specifier of moderate or severe.

Serious Emotional Disturbance

41-5-1503. Medical or psychological evaluation of youth -- urinalysis. (1) The youth court may order a youth to receive a medical or psychological evaluation at any time prior to final disposition if the youth waives the youth's constitutional rights in the manner provided for in 41-5-331. Except as provided in subsection (2), the youth court shall pay for the cost of the evaluation from its judicial district's allocation provided for in 41-5-130 or 41-5-2012.      (2) The youth court shall determine the financial ability of the youth's parents or guardians to pay the cost of an evaluation ordered by the court under subsection (1). If they are financially able, the court shall order the youth's parents or guardians to pay all or part of the cost of the evaluation.      

Youth Court Act

(3) Subject to 41-5-1512(1)(o)(i), the youth court may not order an evaluation or placement of youth at a state youth correctional facility unless the youth is found to be a delinquent youth or is alleged to have committed an offense that is listed in 41-5-206.      (4) An evaluation of a youth may not be performed at the Montana state hospital.      (5) In a proceeding alleging a youth to be a delinquent youth, upon a finding of an offense related to use of alcohol or illegal drugs, the court may order the youth to undergo urinalysis for the purpose of determining whether the youth is using alcoholic beverages or illegal drugs.

41-5-1503. Continued

41-5-1504.  Finding of suffering from mental disorder and meeting other criteria -- rights -- limitation on placement. (1) A youth who is found to be suffering from a mental disorder, as defined in 53-21-102, and who meets the criteria in 53-21-126(1) is entitled to all rights provided by 53-21-114 through 53-21-119.(2)  A youth who, prior to placement or sentencing, is found to be suffering from a mental disorder, as defined in 53-21-102, and who meets the criteria in 53-21-126(1) may not be committed or sentenced to a state youth correctional facility.(3)  A youth who is found to be suffering from a mental disorder, as defined in 53-21-102, and who meets the criteria in 53-21-126(1) after placement in or sentencing to a state youth correctional facility must be moved to a more appropriate placement in response to the youth's mental health needs and consistent with the disposition alternatives available in 53-21-127.

53-21-506. No commitment to Montana state hospital. An individual who is under 18 years of age may not be voluntarily admitted or committed by a court to the Montana state hospital unless an information has been filed in district court pursuant to 41-5-206.

Dispositional Options / Limitations

FY10 DOC Placement Budget: $5,918,641

COST CONTAINMENT POOL - $1,000,000◦ $188,624 – Expended◦ $811,376 – Unexpended (Funds transferred to the OCA

intervention and prevention account)

Program Evaluation - $25,000

DOC (Juvenile Parole 11%) - $520,727

JUDICIAL DISTRICTS ANNUAL ALLOCATIONS - $4,372,914◦ $2,361,057 – Expended◦ $2,011,857 – Unexpended (Funds transferred to the OCA

intervention and prevention account)

Juvenile Delinquency Intervention Program (JDIP)

JDIP and PIF (intervention and prevention account)◦ Can be used for services, programs and placements◦ Requirements for youth over 18 (CCRP)◦ Can’t be used when youth is transferred to District

Court◦ JDIP funds have a 1-year life cycle and PIF have a 2-

year life cycle Medicaid

◦ Can’t be used if youth is in detention or correctional facility

◦ If primary diagnosis is Conduct Disorder or a Sexual Disorder, MT Medicaid does not pay

Funding Limitations

Percentage of funds a district receives is based upon the number of unduplicated youth and referrals from the previous year.

Each district decides how the funds will be used, some limitations apply.

Community programs and services are encouraged over out-of-home placements.

Can’t be used to supplant what other entities are required to pay, i.e., detention.

JDIP and PIF

Alternative Education Programs Anger Management Classes Assessments Case Management Counseling – Individual, Group and Family Drug and Alcohol Treatment – Outpatient Evaluations Family Support Services Therapeutic Aide Wraparound (High Fidelity)

Types of Services Provided with JDIP and PIF

Authorization Required Inpatient psychiatric services provided in hospital settings or

residential treatment facilities; outpatient partial hospitalization programs are available in some locations

Community-based services, such as therapeutic foster care and therapeutic group homes (not including room and board expenses);

Mental health center community-based outpatient services, including individual, group and family therapy; psychotropic medication management; assessment; case management; youth day treatment; community-based psychiatric rehabilitation and support services (CBPRS); and comprehensive school and community treatment (CSCT); and

Services provided by mental health professionals, including licensed psychologists, social workers, licensed certified professional counselors, advanced practicing RN’s; and licensed psychiatrists or medical doctors.

Medicaid Funds

In addition to authorization, a Certificate of Need (CON) is required for many services;

Required for:• Acute Inpatient Psych hospital; Partial Hospital

Program, Psychiatric Residential Treatment Facility, PRTF waiver program; Therapeutic group home, Therapeutic Foster Care, and Therapeutic Family Care.

• CON is based on determination by inter-disciplinary team that has knowledge of youth’s situation.

• Must be signed by the physician member and the licensed mental health professional.

Certificate of Need

Montana is one of 10 states to receive the PRTF Waiver . The purpose of the PRTF Waiver is to support a youth in need of Psychiatric Residential Treatment care to remain in their homes with their family. Youth already living in a Psychiatric Residential Treatment Facility may discharge and transition to the Waiver.

The Wraparound Service Delivery Model of the PRTF Wavier will be family driven, team based, community based, strength based, individualized, culturally competent, and built on communication, collaboration, partnerships, and natural family supports.

Billings, Missoula, Helena, Great Falls

Psychiatric Residential Treatment Facility Waiver (PRTF Waiver)

HOME-BASED THERAPY Community-Based In–Home TherapyRESPITE Unskilled Respite CareEDUCATION & SUPPORT Training & Education Services Related To

Care & Treatment Of Disabling Mental Health Problems

NON-MEDICAL TRANSPORTATION Non-Emergency Transportation

Services Provided in PRTF Waiver Program

CONSULTATIVE CLINICAL AND THERAPEUTIC SERVICES

Telephone Call TO A PSYCHIATRIST By A Physician or Mid-Level Practitioner For Consultation

CUSTOMIZED GOODS & SERVICES Therapeutic Items and SuppliesFAMILY SUPPORT SPECIALIST Family Support Specialist ServiceCARE GIVER PEER-TO-PEER SUPPORT SPECIALIST

SERVICE Care Giver Peer-to-Peer Support Specialist ServicesWRAPAROUND FACILITATION SERVICE Wraparound Facilitation Service

PRTF Waiver Services Cont.

Wraparound is a planning process which is strength based and family driven and helps make sure youth grow up in their homes and communities. It is a planning process that uses a team approach and brings together people known to the family whom they trust. With help from one or more facilitators, people from the family’s life work together, coordinate their activities, and blend their perspectives of the family’s situation.

What is Wraparound?

Who makes this determination◦  (16) "Professional person" means:

     (a) a medical doctor;      (b) an advanced practice registered nurse, as provided for in 37-8-202, with a clinical specialty in psychiatric mental health nursing;      (c) a licensed psychologist; or      (d) a person who has been certified, as provided for in 53-21-106, by the department.

Unfit to Proceed