Challenges in Health Care Delivery: Juvenile Corrections in Texas
Parikh, Rajendra C., Henry, Judith, Slott, Nancy, Gadow, Dianne, Corrections Today
Access to affordable, high-quality health care is the subject of the latest political debate in the U.S. This debate also holds center stage for juvenile corrections officials across the nation. Rehabilitation of youths and their successful community reintegration are fundamental goals in juvenile corrections. Achieving these goals can be greatly facilitated by providing comprehensive health care services to ensure that each youth achieves his or her best physical and mental health in order to participate in rehabilitation, with the ultimate goal of reintegration into society as future productive citizens. The challenge, however, is balancing the demands of quality health care with the realities of ever-increasing medical costs and shrinking budgets.
The juvenile correctional system in Texas is facing the same health care dilemmas as the federal government: balancing health care costs while enhancing access and providing comprehensive high-quality health care for everyone, in this case, each youth at the Texas Youth Commission. It is compounded further by a shortage of health care professionals willing to provide health care in correctional facilities, often in locations away from major metropolitan centers.
Texas Youth Commission
The roots of the juvenile justice system in Texas originated in the 1850s when the Texas Legislature passed laws to exempt children under age 13 from criminal prosecution in certain situations and authorized a separate facility to house children. Since the mid-1800s, there have been many changes in the form, function and mission of the Texas juvenile justice system, and in 1983, the format of the current system was christened as the Texas Youth Commission (TYC) by the Texas Legislature.
In 2007, widespread allegations of abuse, neglect and flaws in the application of the agency's treatment programming led the Texas Legislature to mandate sweeping reforms that have fundamentally transformed TYC. These reforms culminated in: the creation of a new general treatment program called CoNEXTions; the formation of the Release Review Panel to ensure youths are not held in TYC for a period longer than deemed beneficial to the rehabilitation process; the reduction of the maximum age of confinement from 21 to 19; the elimination of misdemeanant commitments to TYC; the reduction of residential populations; and the adoption of a parents' bill of rights.
The impact of the 2007 reforms on the TYC residential population can be seen in Figure 1. From 2004 through the third quarter of fiscal year 2009, the residential population at TYC institutions was effectively cut in half, from 4,883 youths in fiscal year 2004 to 2,057 at the end of the third quarter of fiscal year 2009.
[FIGURE 1 OMITTED]
Legislative reforms mandated that the make-up of the youth population be changed dramatically. Misdemeanant commitments to TYC stopped in 2008. The commitment profile for new commitments in fiscal years 2004 and 2008 are shown in Table 1. Besides a reduction in the total number of new commitments, the primary differences are an increase in the percentage of violent offenders and a substantial decrease in the percentage of general offenders.
Table 1. Commitment Profile for New Commitments, 2004 and 2008 Category Fiscal Year 2004 Number Percentage Sentenced Offender 176 7% Type A--Violent Offender 114 5% Type B--Violent Offender 548 22% Chronic Serious Offender 44 2% Controlled Substances Dealer 27 1% Firearms Offender 82 3% General Offender 1,535 61% TOTAL 2,526 Category Fiscal Year 2008 Number Percentage Sentenced Offender 105 7% Type A--Violent Offender 84 5% Type B--Violent Offender 516 33% Chronic Serious Offender 25 2% Controlled Substances Dealer 21 1% Firearms Offender 49 3% General Offender 782 49% TOTAL 1,582
TYC currently operates 12 secure facilities in 10 locations and nine halfway houses across the state (see Figure 2). …