Kentucky's Juvenile Mental Health Services Evolve
Heffron, William M., Corrections Today
In 1995, Kentucky entered into a consent decree agreement with the U.S. Department of Justice that required the creation of a juvenile justice department in the state. The intended goals were to provide quality assessment and treatment, develop a continuum of care, hire and train sufficient staff, and develop tighter administrative control of the department. By the end of 1996, a new commissioner had been hired and various existing community and residential programs had been combined into the new department. As part of the process of enhancing services, a chief of mental health services was hired in 1997 along with three doctorate level psychologists. Their function was to develop mental health treatment services and to oversee how they were implemented.
In 1997, most services were provided in a residential setting with very little effort made to develop aftercare services or to provide continuity of care. Only two of the 11 residential programs had a mental health clinician on staff. Psychiatric services were provided by private practitioners who contracted their services but could not spend much time at the facilities. Community services, group homes and day treatment programs would send youths to the local community mental health centers. Detention centers, which were under county administration at that time, also contracted with community mental health centers. By 2008, though, all detention centers except Louisville were state operated.
The mental health administrators met frequently to work on a variety of issues. They developed a standard format for mental health evaluations, refined the treatment planning process, created a process for making mental health referrals both in the department and to outside agencies, and began to design policies on mental health issues. Of particular concern from the consent decree was the development of processes to deal with suicidal youths and youths who required restraints or isolation.
To upgrade mental health services, the department began hiring clinicians with master's degrees (primarily in psychology) to be treatment directors at the residential programs. This process took about two years. In addition, the psychiatric services at facilities were slowly turned over to the psychiatry departments at the University of Kentucky and the University of Louisville. All the psychiatrists providing services now are child psychiatrists or child psychiatry residents. That change was completed in 2009 as existing providers retired or chose to leave.
The facility treatment directors conduct a mental health evaluation on every youth entering the residential programs. They review intake screenings. All youths entering residential programs are given the MAYSI-2 (Massachusetts Youth Screening Instrument), which was developed to identify potential mental health and substance abuse problems in youths involved in the justice system. (1) They also run treatment team meetings and provide overall direction on how to approach youths with mental health or behavioral issues. The treatment directors all review the quality of treatment plans and perform quality checks on counselor notes. They also conduct individual and group therapy on occasion. They hold staff trainings on a variety of issues ranging from various mental health disorders to dealing with youth management issues.
By the end of 2000, the department met the requirements of the consent decree, and it was terminated. It had been apparent for some time that mental health practitioners in the community were, for the most part, not interested in providing sex offender services, and others who were providing services were not working well with the department's community staff. Department staff decided to create a mental health branch that would primarily provide sex offender counseling but also some substance abuse treatment and mental health services in areas that lacked sufficient providers. …