OK

This is only a Preview!

You must Publish this diary to make this visible to the public,
or click 'Edit Diary' to make further changes first.

Posting a Diary Entry

Daily Kos welcomes blog articles from readers, known as diaries. The Intro section to a diary should be about three paragraphs long, and is required. The body section is optional, as is the poll, which can have 1 to 15 choices. Descriptive tags are also required to help others find your diary by subject; please don't use "cute" tags.

When you're ready, scroll down below the tags and click Save & Preview. You can edit your diary after it's published by clicking Edit Diary. Polls cannot be edited once they are published.

If this is your first time creating a Diary since the Ajax upgrade, before you enter any text below, please press Ctrl-F5 and then hold down the Shift Key and press your browser's Reload button to refresh its cache with the new script files.

ATTENTION: READ THE RULES.

  1. One diary daily maximum.
  2. Substantive diaries only. If you don't have at least three solid, original paragraphs, you should probably post a comment in an Open Thread.
  3. No repetitive diaries. Take a moment to ensure your topic hasn't been blogged (you can search for Stories and Diaries that already cover this topic), though fresh original analysis is always welcome.
  4. Use the "Body" textbox if your diary entry is longer than three paragraphs.
  5. Any images in your posts must be hosted by an approved image hosting service (one of: imageshack.us, photobucket.com, flickr.com, smugmug.com, allyoucanupload.com, picturetrail.com, mac.com, webshots.com, editgrid.com).
  6. Copying and pasting entire copyrighted works is prohibited. If you do quote something, keep it brief, always provide a link to the original source, and use the <blockquote> tags to clearly identify the quoted material. Violating this rule is grounds for immediate banning.
  7. Be civil. Do not "call out" other users by name in diary titles. Do not use profanity in diary titles. Don't write diaries whose main purpose is to deliberately inflame.
For the complete list of DailyKos diary guidelines, please click here.

Please begin with an informative title:

THURSDAY NIGHT IS HEALTH CARE CHANGE NIGHT, a weekly Daily Kos Health Care Series

The prevalence of mental health disorders among adolescents in the justice system is alarming: federal studies estimate that 50-75% of incarcerated kids have diagnosable mental health disorders and nearly half have substance abuse problems. Many of these kids might have avoided the justice system altogether if they had been able to access mental health services. Instead, children are incarcerated, where poor conditions and mistreatment exacerbate mental health conditions and behavioral problems. One study revealed that only 4% of adjudicated adolescents receive a mental health placement. National reform is imperative in order to provide mental health screening, comprehensive evaluation and appropriate treatment for these children.
When my son was in his early teens and I needed a place for him to go when he was out of control, mental health professionals kept asking me if he had a probation officer and recommended calling the sheriff's department when he lost control until he got one.
Intro

You must enter an Intro for your Diary Entry between 300 and 1150 characters long (that's approximately 50-175 words without any html or formatting markup).

I offer that by way of introduction because my experience is not all that uncommon.  Tucson, AZ, had no mental health emergency shelter beds, and only two inpatient units which only admitted children who were actively suicidal or violent (now only one).  When I called the sheriff's department enough times, a deputy told me he would have to call DCF if I continued.  As an adoptive parent, I had a dread of all social service agencies.  Another deputy had told me on the phone that these things were a matter of environment, and I was responsible for my son's environment.  Yet it was only when we finally went before a juvenile judge that I felt understood and truly supported as his parent.  My son and his judge developed a strong positive relationship that was instrumental in his being able to complete his probation, and wanting to do better.  

We also were one of the first families in Tucson accepted into the program that was part of a grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) of HHS.  Thus I became acquainted with the Systems of Care approach to mental health services for children and families.  This grant was for the treatment of children who interacted with at least two agencies dealing with children (mental health, developmental disabilities, foster care, juvenile justice, corrections, special education), known as complex needs.  

The Arizona program had been developed because of a lawsuit, as many progressive programs around the country are.  This led to the Arizona principles of care, that treatment should be child centered, family driven, community based, strength based, culturally appropriate, inclusive of all providers of services, supporting the child and family with community support systems both professional and non-professional.  Planning centers around the child and family team, made up of people important to the family as well as all relevant professionals.  It is the idea of bringing services to the child and family, rather than bringing the child and family to the services.

We were involved during the first two years of the program, and had a mixed experience.  I will not go into details.  Our involvement ended when my son turned eighteen, which was six years ago.  

For writing this diary, I interviewed Joannie Rosenberg, a social worker at Tucson's only inpatient unit for children and adolescents.  She pointed out several contradictions in the system.  First, it is better, if you live in Arizona, not to have private health insurance.  (This is not true for adults.)  The public system, made up of the regional authority (for both children and adults) and four contracting agencies for children - three in Tucson, and one for the communities to our south, provides an array of services.  One agency has a satellite in Sells, on the Tohono O'odham reservation.  Two agencies have contracted to provide non-traditional services based in the home and community.  After discharge from the hospital, a child is seen by a psychiatrist within five to ten days.  If you have private insurance, it can take as long as two months to schedule an appointment, and the whole array of services is not available.  Insurance companies generally do not pay for non-traditional services.  

A second contradiction is that, as the emphasis is on community based treatment, fewer higher-level services are available locally.  As I said, there is only one inpatient unit in Tucson.  All local residential treatment centers have closed.  Most children needing residential treatment have to go to other states, most often Texas or Colorado, which restricts family involvement.  It also means that all relationship of the child with the community (e.g. field trips and use of public recreational facilities, or church attendance) are cut off.  

There are also improvements.  A major addition is a transitional/respite facility, where a child can go for up to ten days while transitioning out of the hospital or needs to be in a secure setting but does not meet the requirements for hospitalization.  This has to be in place from the start.  This was one of the most serious deficits when we were involved in the system, and is a greatly needed service.  And there seems to be greater flexibility on the child and family teams and on the part of the providers.  

If you want to learn more about child and adolescent mental health and systems of care, including symptom lists and access to resources in your area, these links are a beginning:

http://mentalhealth.samhsa.gov/...
http://www.physiciansforhumanrights.org/...
http://ysb4kids.org/...

 

Extended (Optional)

Originally posted to ramara on Thu Feb 19, 2009 at 05:26 PM PST.

EMAIL TO A FRIEND X
Your Email has been sent.