Shairi Turner MD, MPH Boss Medicinal Chief September 25-26, 2007 Walter A. McNeil, Secretary.


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Enhancing Results for Youth in the Adolescent Equity Framework Shairi Turner MD, MPH Boss Therapeutic Chief September 25-26, 2007 Walter A. McNeil, Secretary The Workplace of Wellbeing Administrations Initially settled in 2005
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Enhancing Outcomes for Youth in the Juvenile Justice System Shairi Turner MD, MPH Chief Medical Director September 25-26, 2007 Walter A. McNeil, Secretary

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The Office of Health Services First settled in 2005 Role: To give oversight to the conveyance of medicinal, psychological wellness, substance misuse and formative inability administrations to the young mediated reprobate. Larger part of administrations conveyed by contracted suppliers.

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The Office of Health Services Serves Over 150,000 youth 4 Major Program Areas All of Headquarters 55 State Clinical Staff

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The Office of Health Services

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Office of Health Services Responsibilities Data Collection Staff Training Surveillance Quality Assurance Interagency Collaborations Clinical Assistance Policy and Rule Development Contract Enhancement and Standardization Legislative Support

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A Profile: Who Are Our Youth? Bankrupted Minorities Males Mentally Ill Substance Abusers (Co-Occurring Disorders) Medically perplexing and disregarded High Risk practices (STDs, Teen Pregnancies) Developmentally Disabled Disenfranchised families in emergency Delinquent and Dependent

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Primarily…… Non-fierce minority guys alluded for wrongdoing offenses

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Our Girls One of three youth alluded to the Department for misconduct is a young lady. 45% of those alluded are African-American Girls 21% of Detention confirmations Extensive injury histories 50-75% experience the ill effects of PTSD Unique wellbeing needs

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3 Primary Issues: Medical Mental Health/Substance Abuse (Co-Occurring Disorders) Developmental Disabilities

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Medical

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I have 2 outside pacemakers for my heart, one works and alternate does not, I pull on them to get the staff worked up * I give myself additional insulin so I can eat more nourishment Their words…

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Overlying Concerns: Complex conditions Limited assets Ensuring responsibility with privatization Systemic Barriers

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Services Provided to Youth Obstetrical Services (pre and post-natal) Gynecological Services Infant consideration Emergency Services Health Education Intake Screenings Physical Assessments Sick Call Encounters Immunizations Medication Management Acute and Chronic Disease Management

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The Health Status of Incarcerated Youth Baseline Health Asthma Diabetes Dermatologic Problems Dental Caries Hypertension Obesity Seizure Disorders Traumatic Injuries Orthopedic Injuries Greater Risk for Sexually transmitted ailments Hepatitis B and C HIV/AIDs Teen Pregnancy TB presentation Mental Illness Substance Abuse

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Complex Conditions Cardiac Disorders Cystic Fibrosis Inflammatory Bowel Disease Existing and New Cancers/Tumors Sickle Cell Disease Kidney Failure *A Medically Underserved Population*

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Limited Resources Insufficient doctor and nursing administrations Over-dependence on direct care staff Diversion to State-worked projects No particular subsidizing for dental administrations *Inadequate treatment *

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Ensuring Accountability Medical Services Privatized Monitoring through contracts Laypeople administering medicinal suppliers Limited specialized help *Insufficient Oversight*

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Systemic Barriers Youth in any State-Operated Detention or Residential offices OR any High/Maximum danger projects lose Medicaid Eligibility* Youth who get to be ineligible are disenrolled not suspended from Medicaid** * Federal Regulations ** State Regulations *Continuity of consideration jeopardized*

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Addressing: Complex Conditions Proposed Recommendations Small projects with 24 hour nursing administrations and extended doctor scope for restoratively complex youth. Preoccupation of therapeutically complex youth into group based treatment programs.

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Addressing: Limited Resources Proposed Recommendations Increased financing for restorative and dental administrations. State utilized restorative staff

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Addressing: Accountability Proposed Recommendation State-utilized Clinical staff to give help, oversight and enhanced responsibility.

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Addressing: Systemic Barriers Proposed Recommendations: Suspension of Medicaid rather than dis-enlistment . Enhanced joint effort with the Department of Children and Families upon release.

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Mental Health and Substance Abuse

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My mom put cigarette butts out on my head when I was 2 years of age. * I can\'t let you know how often my dad assaulted me when I returned home from school. * I began smoking maryjane with my guardians at 8 years old. Their words…

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Services Provided to Youth Specialized Treatment Beds Mental Health Overlay Behavioral Health Overlay Substance Abuse Overlay Sex Offender Services Intensive Mental Health Comprehensive Mental Health Re-Engineering in progress PACT Risk Needs Assessment MST/FFT Suicide Screenings Psychological Assessments Counseling Crisis Intervention Psychiatric Services Medication Management

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Overlying Concerns: Complex conditions Limited assets Ensuring responsibility with privatization Systemic Barriers

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Complex Conditions Our overview on DJJ youth in Need of Specialized Services 49% of youth in DJJ projects had an analyzed DSM-IV emotional sickness and an extra 14% exhibited practices which recommended a psychological well-being issue (63%) 35% of the adolescent had an analyzed DSM-IV substance-related issue and an extra 30% showed practices which proposed a substance misuse issue (65%) 52% of the kids reported for all substance-related issue had a determination of Substance Abuse AND 36% had a finding of Poly-substance Dependence.

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50 Boys 40 Girls 30 Percent 20 10 0 MDD PTSD Conduct D/O Diagnosis identified with Physical Abuse Diagnosis identified with Sexual Abuse Dual Diagnosis Mental Illness and Girls DJJ Diagnosis by Gender

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Limited Resources Lack of Specialized Early Intervention Programs Detention financed for emergency intercession not treatment Long sits tight for claim to fame MH/SA beds Residential Programs under-supported, not expected for complex rationally sick youth. Extensive Mental Health beds in DJJ have a routine set of expenses about HALF of the state inpatient psychiatric per diems. *Inadequate treatment *

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Ensuring Accountability Mental Health, Substance Abuse and Psychiatric Services Privatized Monitoring through contracts Laypeople directing psychological well-being and substance misuse suppliers. Restricted specialized help *Insufficient Oversight*

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Systemic Barriers Lack of Mental Health Infrastructure in Florida. Folks press charges versus kid to get to psychological well-being administrations in DJJ. Constrained access into Statewide Inpatient Psychiatric Placements (SIPPs) Mental Health Issues interface with Zero Tolerance Policies.

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Systemic Barriers Lack of preoccupation (or less prohibitive) options in the group. Restricted Aftercare Services Inadequate release arranging Medicaid Reform and Access

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Addressing: Complex Conditions Proposed Recommendations Culturally Competent Services Evidence-Based studies use white youth Comprehensive Gender Specific Programs Effective young ladies programming not yet accomplished Trauma part basic Equivalent administrations dedicated to MH and SA needs.

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Addressing: Limited Resources Proposed Recommendations Reduction sought after for administrations by redirection of okay youth to group based projects Diversion of rationally sick/substance manhandling youth to option group programs Advancement of Risk-Needs instrument to guarantee legitimate position and advancement.

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Addressing: Accountability Proposed Recommendation State-utilized Clinical staff to give help, oversight and enhanced responsibility.

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Addressing: Systemic Barriers Proposed Recommendations Inter-office and group joint effort to guarantee proper: Placement Aftercare Case administration

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Developmental Disabilities

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Their Words… * What is a treatment objective and why is it keeping me from going home? * I am not idiotic, I just can\'t take in the way they are showing me.

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National Data 70% of every adolescent reprobate have instructive inabilities (LD or ED). Youth are more than twice as liable to submit a reprobate offense as their non-impaired associates. Youth with learning handicaps mediated at about double the rate as non-handicapped youth, and LD youth have more noteworthy recidivism rates.

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Complex Conditions Youth have formative inabilities AND Mental wellbeing/substance misuse issues.

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Limited Resources Currently few beds to serve Developmentally Disabled youth. Particular preparing needed for staff to associate with formatively handicapped AND rationally sick youth. No particular subsidizing for handicap overlay administrations

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Systemic Barriers Incompetent to Proceed Process Youth can spend up to 379 days in an ITP program and be discovered “Non-restorable”. Private APD suppliers

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Addressing: Developmental Disabilities Proposed Recommendations Additional Resources to serve incapacitated youth Multi-disciplinary workgroup to audit ITP process

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For these are every one of our youngsters. We will all benefit by, or pay for, whatever they get to be. - James Baldwin .:tsli

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