MISSOURI ALLIANCE FOR YOUTH: A PARTNERSHIP BETWEEN

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MISSOURI ALLIANCE FOR YOUTH A PARTNERSHIP
BETWEEN DMH AND JUVENILE JUSTICE
MISSOURI ALLIANCE FOR YOUTH A PARTNERSHIP
BETWEEN DMH AND JUVENILE JUSTICE
Vol. 1, 2004
Childrens Mental Health Reform Act of 2004
Senate Bill 1003 which, in part, creates a
Childrens Comprehensive Mental Health System was
the first bill signed into law this session by
the Governor on March 10, 2004 This legislation,
sponsored by Senator Gibbons received solid
support both in the House and Senate as it
creates a very collaborative approach to working
with children, youth and families and can help
address such issues as preventing families from
having to relinquish custody of their children to
access mental health services. Both nationally
and within Missouri, examination of childrens
mental health services have revealed a fragmented
and inadequate service system. Services were
provided by multiple agencies creating confusion
and gaps for families attempting to access
services for their children.
One of the most painful decisions some families
faced was having to voluntarily relinquish
custody of their child to the Childrens Division
to be able to access or afford mental health
services. The Childrens Mental Health Act of
2004 follows up on legislation previously passed
including Senate Bills 923 in 2002 and 266 in
2003 that addressed this issue. SB923 created in
statute that the juvenile/family court could take
jurisdiction of child when the child is in need
of mental health services and the parent,
guardian or custodian is unable to afford or
access appropriate mental health treatment or
care (211.031.1(1)d RSMo). It allowed that a
parent relinquishing custody under this section
would not have their name placed on the child
abuse registry. This bill also added that
pursuant to subsection 2 of section 211.081, that
the court can order that an individualized
treatment plan be developed by the applicable
state agencies including necessary services and
agencies fiscal responsibilities for those
services subject to appropriations
(211.181.1(5)RSMo). SB266, in part, held that
the Departments of Mental Health and Social
Services were to jointly prepare a plan to
address the need for the mental health services
and supports for (1) children in the custody of
the DSS due exclusively to a need for mental
health services, and where there is no instance
of abuse, neglect or abandonment and (2) youth
determined by the court to require mental health
services pursuant to 211.181.1(5) as noted in
SB923. The plan DSS and DMH developed begins to
examine federal funding, including waivers the
budgetary and programmatic impacts of meeting the
mental health needs of youth and a feasibility
study related to securing federal funds. In line
with these efforts the Childrens Division, Dept.
of Mental Health, Office of State Courts
Administrator, Citizens for Missouris Children,
parents and local agencies developed a protocol
to attempt to divert youth from having to come
under the jurisdiction of the court to access
mental health services (see article in previous
edition Preventing Parents from Having to
Relinquish Custody to Access Mental Health
Services and article in current edition). The
Childrens Mental Health Reform Act of 2004
recognizes that to adequately meet the mental
health needs of children multiple state agencies
must be involved and coordinated leadership and
funding are needed. This legislation establishes
a coordinated, integrated delivery system for
services that preserves families and provides
appropriate mental health services to children
and youth. This legislation does not create a
new system, rather it ties together best
practices in the areas of service delivery,
funding, policy and accountability developed in
Missouri over the past 15 years creating a
comprehensive and more efficient and effective
system. The actual bill includes multiple steps
and action plans. Based on SB266, the
Departments of Mental Health and Social Services
will now identify those youth currently in the
custody of the Childrens Division exclusively
due to the need for mental health services.
Along with the youths parents, these agencies
will develop individualized services plans to
present to the court for approval. The judge may
then return custody of the child to the childs
family with services provided by DMH with
financial support offered by DSS. An analysis
commissioned by the Dept. of Mental Health and
completed with input from DSS identified
approximately 600 youth currently in the custody
of the Childrens Division exclusively to access
mental health services with no instance of abuse,
neglect or abandonment. The Childrens Mental
Health Reform Act of 2004 also establishes in
statute that the department of mental health
shall develop, in partnership with all
departments represented on the childrens
services commission, a unified accountable
comprehensive childrens mental health service
system. To achieve this end DMH shall establish
a Comprehensive System Management Team comprised
of representatives from family organizations,
child advocacy organizations, Dept. of Health and
Senior Services, Dept. of Social Services
including CD, DYS and DMS, DESE, DMH including
the Divisions of Comprehensive Psychiatric
Services, Mental Retardation and Developmental
Disabilities and Alcohol and Drug Abuse, DPS,
OSCA, and the juvenile justice system.
Additionally representatives from continued
on page 3
Table of Contents
Division of Alcohol and Drug Abuse (ADA) Divisio
n of Comprehensive Psychiatric Services (CPS) Div
ision of Mental Retardation and Developmental
Disabilities (MRDD)
Childrens Mental Health Act P. 1 Preventing
Parents from Having to Relinquish Custody - Part
II P. 2 MO MAYSI Project - Intake Report P.
3 MH/JJ Training Challenge Grant P.
4 Resources P. 5
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Preventing Parents from Having to Relinquish
Custody Part II
In the last edition of the MH/JJ Alliance
Newsletter, an article outlined the efforts of
the Department of Mental Health, Childrens
Division, Office of State Courts Administrator,
Citizens for Missouris Children, parent
representatives and local juvenile office and
mental health providers in developing a protocol
to divert families from having to voluntarily
relinquish custody of their children to access
mental health services. In October of 2003 this
protocol was piloted in the 12th and 21st
Circuits. Training was provided in both sites to
staff from the local juvenile office, Childrens
Division Office, community mental health centers
and Regional Centers on implementation of the
protocol. In the first three months of
implementation approximately 18 families were
referred to a community mental health center for
an assessment as part of the Custody Diversion
Protocol. Only one child was placed in the
custody of the Childrens Division after
implementation of the protocol. Two-thirds of
the children were served in their home and
community with only three children requiring a
placement outside of their familys home for any
amount of time. A follow-up meeting with
representatives from both of these sites helped
highlight issues related to the implementation of
the protocol. The major finding was the
importance of the local child-serving agencies
understanding the roles and responsibilities of
other agencies and how to access those services
for any child. Sites found it very helpful to
have dialogues with staff from other agencies
related to eligibility, intake, crisis services,
and funding mechanisms which allowed them to
assist families in accessing mental health
services independent of their custody status.
Recommendations were also made for changes to the
protocol which addressed flow of communication
and insuring a feedback loop. Based on these
positive results, the DMH and CD elected to expand
implementation of the Custody Diversion protocol
to the existing system of care sites adding
another 8 circuits in which the protocol would be
implemented (21st/22nd Circuits 31st/38th/39th
Circuits, 2nd Circuit, 23rd Circuit, 16th
Circuit, and 36th Circuit). In March, training
through a videoconference was conducted to these
sites which included representatives from the
involved juvenile offices, local Childrens
Division office, community mental health centers
and regional centers. The revised protocol was
introduced along with sharing lessons learned
from the original pilot sites. These sites were
encouraged to schedule follow up interagency
meetings to identify how the protocol would be
implemented in their area and share information
on resources, intake procedures, and eligibility
with implementation to begin as soon as possible.
Additionally each site was encouraged to meet
with residential and psychiatric inpatient
facilities to discuss the issue of parents not
having to relinquish custody to access mental
health services, share what intensive community
based services are available in that area that
can assist families in keeping their children in
the home and community as an alternative to
out-of-home placements and to encourage exploring
with parents upon admission what the child and
familys needs will be at discharge so that
planning could begin during the admission and not
result in a crisis on the day of discharge.
Both the Childrens Division and the Department
of Mental Health are committed to taking this
protocol statewide in the very near future and to
continue to work jointly on developing resources
that can keep families together and children in
their homes and communities with the services and
supports they need to be successful.
THE MO MAYSI PROJECT JUVENILE OFFICE COMMUNITY
INTAKE REPORT
The third report of the MO MAYSI Project will
soon be distributed. This report provides data
on youth referred to a juvenile office for intake
from the community. The two previously
distributed reports provided data on youth who
were detained and youth committed to the Division
of Youth Services. For this third report data
is presented on approximately 285 youth who were
referred from the community to the juvenile
office on a status or delinquent offense and
administered the Massachusetts Youth Screening
Instrument 2nd Edition (MAYSI-2). The MAYSI -2
is a brief self-report screening tool designed to
be utilized within the juvenile justice system to
identify youth with signs of mental/emotional
disturbance or distress. There are seven
different scales on which a youth can fall in the
non-significant, caution or warning range.
Juvenile justice staff with no clinical training
can administer and score the MAYSI-2. If a youth
falls within the caution or warning range on one
or more scales, staff may wish to ask probing
questions, provide additional supervision/monitori
ng or refer for a complete assessment. Scoring
in the caution or warning range does not mean the
child has a mental health diagnosis. Entry into
the juvenile justice system can cause some
transient stress which may impact the youths
responding leading to temporary elevations on
scales. Due to the limited number of juvenile
offices submitting data on community intake,
these youth represent an urban circuit and a
rural circuit only. Fifty-nine percent of the
youth were male, 44 were Caucasian and 41 were
Black/African-American. Twenty-two percent of
the youth were under the age of 13, 68 were
between the ages of 13 and 15, and 11 were over
15 years of age. Thirty-seven percent were
referred for a status offense. Twenty-three and
nineteen percent were referred for theft and
assault respectively. Although for over a
third of the youth information regarding a
history of mental health treatment was not
provided, of those youth for which information
was available approximately 62 had a history of
mental health treatment. For 77 of the youth,
no information was provided on history of use of
psychotropic medications however for those youth
for which information was provided 66 had been
prescribed some type of psychotropic medication,
stimulants being the most frequently cited type
of medication.
On the profile scales the following percentage of
youth fell within the caution or warning range
Somatic Complaints 52 Suicidal Ideation
33 Thought Disorder 43 (males only)
Alcohol/Drug Abuse 9 Angry/Irritable
61 Depressed/Anxious 52
On the Traumatic Experiences Scale, males
reportedly endorsed experiencing an average of
1.98 events and females endorsed
experiencing 2.02 events. As many youth present
with a co-occurring substance abuse problem along
with an emotional/psychiatric problem, the
following is the percentage of youth who scored
in the caution or warning range on Alcohol/Drug
Abuse and also scored in the caution or warning
range on continued on page 4
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Childrens Mental Health Reform Act of
2004 continued from p. 1
local agencies of state team members will
participate on the team. A stakeholder advisory
committee will also provide input to the
Comprehensive System Management Team. The Dept.
of Mental Health in partnership with the state
departments on the Childrens Services Commission
and the stakeholders advisory group will develop
the state comprehensive childrens mental health
service system plan and submit it to the
governor, the general assembly and the childrens
Services Commission by December 2004. This plan
will include

• Provide community-based mental health services in
  the context in which the children live and attend
  school
• Respond in a culturally competent and responsive
  manner
• Emphasize prevention, early identification and
  intervention
• Assure access to a continuum of services designed
  to educate the community, address unique
  physical, behavioral, emotional, social,
  developmental and educational needs of children
• Provide a comprehensive array of services through
  an integrated service plan
• Provide services in the least restrictive
  environment that meet the needs of the child and
  are appropriate to the developmental needs of
  children
• Include early screening and prompt intervention
  to identify and treat the mental health needs of
  children and to prevent further deterioration
• Address the unique problems of paying for mental
  health services for children including access to
  private insurance coverage, public funding and
  private funding and services
• Assure a smooth transition from child to adult
  mental health services when needed
• Coordinate a service delivery system inclusive of
  services, providers and schools and
• Be outcome based

• A description of the mental health service and
  support needs of Missouris children and their
  families
• Define a comprehensive array of services
• Establish short and long term goals, objectives
  and outcomes
• Describe the parameters for local implementation
  of this system
• Emphasize and define the role of families
• Outline costs and funding mechanisms,
• Describe the coordination of services across
  child-serving agencies and at critical transition
  points emphasizing the involvement of local
  schools
• Describe methods for service, program and system
  evaluation
• Describe the need for and approaches to training
  and technical assistance, and
• Describe the roles and responsibilities of the
  state and local child serving agencies in
  implementing the comprehensive childrens mental
  health care system.

The Dept. of Mental Health has already begun
working on many of these issues in partnership
with the Dept. of Social Services which will help
to improve services to Missouris children, youth
and families. To obtain the complete bill you
can go to http//www.senate.state.mo.us/04INFO/bi
lls/SB1003.htm
The Comprehensive Childrens Mental Health
Service System will have the following
characteristics

• Child-centered, family-focused, strength-based
  and family driven

CHALLENGE GRANT MENTAL HEALTH AND JUVENILE
JUSTICE TRAINING
The Department of Mental Health recently received
a challenge grant through the Department of
Public Safety, the Missouri Juvenile Justice
Advisory Group and the Office of Juvenile Justice
and Delinquency Prevention to provide training to
juvenile justice and mental health professionals
on meeting the mental health needs of youth in
the juvenile justice system. The MO Alliance for
Youth A Partnership Between DMH and Juvenile
Justice Steering Committee is working on the
development of the content and format of this
training. In an attempt to obtain feedback on
critical areas of need and interest from mental
health and juvenile justice professionals across
the state, a brief survey was developed and
distributed at the Fall MJJA Conference as well
as to community mental health centers and
regional centers. This information was collected
and reviewed by the Steering Committee. The top
three topics picked by juvenile justice
professionals were 1) Youth with a serious
emotional disturbance 2) Screening for mental
health issues and 3) Mental health assessments.
For mental health professionals the top three
topics were 1) Youth with co-occurring disorders
2) Evidenced-based treatment and 3)
Developmental Disabilities. Both groups seemed
to prefer regional trainings as opposed to a
statewide training conference. With this
information the Steering Committee will proceed
with developing a curriculum that can best meet
the needs of the professionals working with youth
in the juvenile justice system with mental health
issues. Information about this training should
be available this summer. If individuals have
additional comments they wish to share on the
development of the curriculum please contact
Patsy at 314/877-0379 or patsy.carter_at_dmh.mo.gov
or Liz at 573/636-6101 or liz_at_mjja.org.
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MO MAYSI PROJECT
continued from p.2
another scale.
CORRECTION FOR MAYSI-2 DETENTION
REPORT Subsequent to the release of the report
An Examination of the Mental Health Needs of
Youth in the Juvenile Justice System related to
youth in detention, an error was discovered in
the analysis. This impacts Table 17 in this
report. The corrected data is listed below.
Number of Profiles in Caution or
Warning Zone 0
1 2 3 4 5
TOTAL of youth 414 310 232
209 153 93 1411
29.3 22.0 16.4 14.8
10.8 6.6 100 Based on this data 69.7
of youth screened as positive in one or more
areas on the MAYSI-2.
Angry/Irritable 24 Depressed/Anxious 23 Somati
c Complaints 19 Suicide Ideation 15 Thought
Disorder (males only) 10
Finally the data revealed that 81 of the youth
scored in the caution or warning range on one or
more of the scales. The University of Missouri
Columbia Educational and Counseling Psychology
Department is currently working on the last
report of the MO MAYSI Project which will compare
and contrast the MAYSI data on all three group of
youth in the juvenile justice system (detention,
DYS and community intake). To obtain additional
information on the MAYSI-2 as a screening
instrument you can go to http//www.umassmed.edu/n
ysap/MAYSI2/

CHILDRENS SYSTEM OF CARE COOPERATIVE AGREEMENTS

• In the Spring of 2003, the Department of Mental
  Health was awarded a 9 million dollar
  cooperative agreement through the Substance Abuse
  and Mental Health Services Administration
  (SAMHSA) to enhance the infrastructure and
  service capacity for the system of care in
  Greene, Taney, Stone, Christian, Barry and
  Lawrence counties . A similar cooperative
  agreement was awarded to DMH in the Fall of 2003
  to enhance the system of care in St. Louis City
  and County. Each site developed a proposal that
  was based on the areas specific needs. The
  project in the Southwest is call the Show-Me Kids
  Project and focuses on improving access and
  service integration for youth with SED,
  especially those with co-occurring diagnoses
  expanding access to, and capacity of, culturally
  relevant mental health services in rural areas
  with particular attention to the burgeoning
  Hispanic/Latino population earlier
  identification and intervention with young
  children with mental health problems who are
  at-risk for SED both within and across systems
  and evaluating the effectiveness of the system of
  care and its components. The project in the St.
  Louis area is called Transitions and focuses on
  helping children and youth successfully navigate
  the most traumatic transitions they experience
  within the child welfare system including their
  initial removal from their homes due to
  abuse/neglect other times of changes in
  placement which may include separation from their
  siblings and as older adolescents transitioning
  from state custody into adulthood. Crider Center
  received similar funding for a county based
  program that in partnership with families, and
  local providers, integrates services for
  underserved youths with serious emotional
  disturbances who are either at risk for, or
  currently experiencing, juvenile justice contact.
  Future editions of this newsletter will provide
  specific information related to these projects,
  however the focus of this article is the broad
  purpose and intent of these cooperative
  agreements in developing a comprehensive
  childrens mental health system. This information
  was obtained from the SAMHSA website which can be
  accessed at http//www.mentalhealth.samhsa.gov/pub
  lications/allpubs/CA-0013/default.asp
• Comprehensive Community Mental Health Services
  Program for Children and Their Families
• The Comprehensive Community Mental Health
  Services Program for Children and their Families
  was first authorized in 1992 to encourage the
  development of intensive community-based services
  based on a multi-agency, multi-disciplinary
  approach involving both the public and private
  sectors. The program builds on earlier successes
  of the Child and Adolescent Service System
  Program (CASSP) and other private
  sector-sponsored demonstrations (e.g., Robert
  Woods Johnson Foundation) by funding communities
  to provide a broad array of services within a
  developed infrastructure.
• Funds, which are available to sites for up to six
  years, are used to improve upon and expand
  previously developed infrastructure and to better
  provide the array of services necessary to fully
  meet the needs of the target population. The
  target population for these grants is children
  and adolescents (under 22 years of age) with
  diagnosable serious emotional, behavioral, or
  mental disorders and who require services from
  multiple agencies. The goals of the Comprehensive
  Community Mental Health Services Program for
  Children and their Families are to
• Expand the service capacity in communities that
  have developed an infrastructure for a
  community-based, interagency approach to
  serving children and adolescents in the target
  population
• Provide a broad array of mental health services
  that are community-based, family-centered and
  tailored to meet the needs of the child or
  adolescent through an individualized service
  planning process
• Ensure the full involvement of families in the
  development of local services and in the care of
  their children and adolescents.
• Funded service systems must include diagnosis and
  evaluation, outpatient, emergency, intensive
  home-based and day-treatment services,
  transitional and case management services, and
  respite care. It is essential to ensure the full
  involvement of families in the development of
  local services and in the treatment planning for
  the care of their children and adolescents.
• There is an extensive evaluation on the
  implementation and outcomes of this service
  program. Some of the outcomes that are being
  assessed in the program include school
  performance, involvement with the juvenile
  justice system, behavioral and mental health

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CHILDRENS SYSTEM OF CARE COOPERATIVE AGREEMENTS
continued from p.4
functioning, family satisfaction, and
system-of-care development. Preliminary data from
local level evaluations collected across the
country suggest reductions in out-of-home
placements for children with serious emotional
disturbance. For example, the ACCESS Program in
Alexandria, Virginia, showed a 48 reduction in
out-of-city residential placements for children
with serious emotional disturbance since that
program began in 1995. Some sites are showing
that acute psychiatric hospitalizations have been
reduced. The program in Sonoma County,
California, reported that the average number of
acute psychiatric hospitalizations per month
among children and youth was reduced by 34
during 1997. These reductions represented a 48
cost savings. Other sites showed that residential
lengths-of-stay have been reduced. An example of
this occurred in the Wraparound Program in
Milwaukee, Wisconsin, where the site found that a
child's average length-of-stay in residential
placements was 112 days compared with 270 days
before the Program began, a difference of 58
percent. Some sites show that fewer crimes were
committed by children in the program. For
instance, in a two year study, the Crossroads
Program of San Mateo County, California, reported
a 61 percent reduction in the number of crimes
committed by youth on probation in the 12 months
after entry into the program compared with the
twelve months prior to entry. Across the initial
22 sites funded in 1993, the percent of children
who were rated Average or Above Average in their
school performance improved by 12.3 percentage
points after six months in services, and by 19.0
percentage points after one year in services. In
regards to mental health functioning, the Total
Problem Score for children on the Child and
Adolescent Functional Assessment Scale (Hodges,
1994) improved by 16.5 after six months in
services and by 19.7 after one year in services.
Concerning juvenile justice outcomes, 33 percent
of the children across the sites were reported to
have some contacts with law enforcement in the
previous 12 months. After one year in services,
42 of these children with law enforcement
contacts were reported to have no contacts. With
respect to family satisfaction, 75.7 of families
were satisfied or very satisfied with services
after six months.
Resources
New Freedom Commission on Mental Health The final
report from the New Freedom Commission on Mental
Health, Achieving the Promise Transforming
Mental Health Care in America, is now available
on the Commission web site. http//www.mentalhealt
hcommission.gov/reports/FinalReport/toc.html SAMHS
As National Mental Health Information
Center Provides information on a variety of child
and adolescent mental health issues including
bullying, school violence prevention, child and
adolescent mental health, systems of care and
working with traumatized children
http//www.mentalhealth.samhsa.gov/child/childheal
th.asp OJJDP News _at_ a Glance January/February
2004 This volume focuses on truancy reduction
http//www.ncjrs.org/pdffiles1/ojjdp/203557.pdf OJ
JDP News _at_a Glance November/December 2003 This
volume focuses on mentoring http//www.ncjrs.org/
pdffiles1/ojjdp/202802.pdf Aftercare
Services    Bulletin Juvenile Justice Practices
Series, September 2003. Describes aftercare
services that provide youth with comprehensive
health, mental health, education, family, and
vocational services upon their release from the
juvenile justice system. http//www.ncjrs.org/pdff
iles1/ojjdp/201800.pdf Child Delinquency Early
Intervention and Prevention Bulletin Child
Delinquency Series, May 2003. Presents valuable
information on the nature of child delinquency
and describes early intervention and prevention
programs that effectively reduce delinquent
behavior. http//www.ncjrs.org/pdffiles1/ojjdp/18
6162.pdf
Missouri Alliance for Youth Steering
Committee Dolores Armstrong - Parent
Representative Patsy Carter, Ph.D.
DMH/Directors OfficeJulie Cole-Agee - MO
Juvenile Justice Association Ray Grush - 11th
Circuit Jim Harrison Childrens
Division Kathryn Herman - 22nd Circuit Julia
Kaufman MRDD/DMH Ed Morris CPS/DMH Gerald
Poepsel - 20th Circuit Mark Shields
ADA/DMH Dorn Schuffman DMH/Directors
Office Kip Seely - 21st Circuit Barb Smith - 33rd
Circuit Bill Vaughn - Division of Youth
Services Mike Waddle - 2nd Circuit Gary Waint -
Office of State Courts Administrator
The Missouri Alliance for Youth A Partnership
Between DMH and Juvenile Justice is dedicated to
improving services for youth with mental health
needs in the juvenile justice system. We hope to
use this forum to keep interested parties
informed on local, regional, state and national
happenings in the area of mental health and
juvenile justice. Comments and suggestions
regarding the format or content are always
welcome and can be sent to Patsy Carter,
Ph.D. Dept. of Mental Health 5400 Arsenal, MS
A413 St. Louis, MO 63139 314/877-0379 FAX
314/877-0392 patsy.carter_at_dmh.mo.gov
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The MO Alliance for
Youth A Partnership Between DMH and
Juvenile Justice