Provision of Appropriate Behavior and Mental Health Services

EFFECTIVE BEHAVIOR AND MENTAL 

HEALTH INTERVENTIONS 

IN SECURE CARE: 

CURRENT PRACTICES AND FUTURE 

DIRECTIONS 

2010 JUVENILE JUSTICE EDUCATION INSTITUTE & 

SOUTHERN CONFERENCE ON CORRECTIONS (JJEI/SCC) 

AUGUST 1, 1:40-2:40PM • GRAND HYATT TAMPA 

Kristin Murphy, M.S., Ed.M., University of Florida 

David Houchins, Ph.D., Georgia State University

Agenda 

! Guiding Questions 

! Student Characteristics in Secure Care 

! Major Issues: Policy vs. Practical Realities 

! Intake and Assessment 

! Provision of Appropriate Behavior and Mental Health 

Practices 

! Strategies for Treatment 

! Uses of Disciplinary Sanctions 

! Recommendations for Provision of Appropriate Behavior/ 

Mental Health Practices

Purpose 

! To investigate the alignment of mental health and 

behavior policy with practice at the facility level.

Data Collection: 

Multiple Sources of Evidence 

Documents 

Direct 

Observation 

Note. Adapted from Yin (1994) 

Personal File 

Review 

Student Behavior 

and Mental Health Treatment 

Within Secure Care: 

Current Practices 

Focused 

Interviews 

Surveys

Document Review 

! Student Documents 

! Student Handbook 

! Student Behavior Motivation Program Handbook, 

Related documents (violation form, “Do Right” form) 

! Student Guidance Services Request form 

! Faculty Documents 

! Faculty Handbook 

! Staff Job Descriptions 

! Facility Behavior Management Plan

Personal File Review 

! Faculty Credentials 

! Functional Behavioral Assessments, behavior 

intervention plans and associated data that 

indicates implementation for 15 students 

! Current list of all students who are on 

psychiatric/psychotropic medication currently 

and the medication(s) they are on 

! In-school suspension records, including offense, 

name of youth, and dates in and out of ISS for 

10 students

Personal File Review cont. 

June 1-30 snapshot of: 

! All segregations (including administrative 

segregations), indicating whether the infraction 

was in school or the living unit, and the length of 

time in segregation 

! All major/minor offenses received by students 

while at school and sanctions received for the 

offense 

! List of manifestation determination hearings, 

subsequent actions taken, and data that was used 

to assess progress 

! Documentation for student grievances filed !

Case Study 

! Case study design was selected: 

! to explore the impact of the juvenile 

correctional setting on the provision of mental 

health and behavior treatment 

! To inform facility-level practice and policy-level 

decisions regarding mental health and behavior

Guiding Questions 

! To what extent do mental health and behavior 

policies and procedures in secure care align with 

NCLB, IDEIA, and Florida Statutes? 

! What barriers impact implementation of mental 

health and behavior policies in secure care? 

! To what extent are mental health and behavior 

policies and procedures implemented in secure 

care? 

! What facilitates appropriate implementation of 

mental health and behavior policies in secure care?

Student Characteristics in Secure Care 

! Students in secure care have unique mental 

health and behavioral needs: 

! The rate of E/BD in secure care is approximately 

six times that of regular public schools 

(U.S. Department of Education, 2009) 

! Prevalence of students with multiple behavior 

and mental disorders in secure care: 

! It was recently reported that 60% of youth with 

mental disorders in secure care met the criteria 

for 3 or more disorders (Shufelt & Cocozza, 2006).


! Abuse and neglect of students with E/BD 

! An estimated 38% were physically or sexually abused 

! 41% were neglected 

! Over 50% were victims of emotional abuse (Oseroff, 

Oseroff, Westling, & Gessner, 1999) 

! Over 90% have witnessed or been victims of violence 

( Abram et al., 2004; Teplin et al., 2002) 

! Substance Abuse 

! Approximately 45% of students in secure care 

have substance abuse problems 

(Loeber, Burke, & Lahey, 2002; McClelland, Elkington, Teplin, & Abram, 2004)


! Suicide 

" Rates of suicidal ideation in incarcerated 

youths have been found to be approximately 

10%, with lifetime rates of 34% reported 

(Vermeiren, Jespers, & Moffitt, 2006) 

" Of facilities who detained youth awaiting 

mental health services, 48% reported that 

there were suicide attempts among those 

youth 

(United States House of Representatives Committee on Government 

Reform-Minority Staff Special Investigation Division, 2004)

Data Collection 

! In a randomized sample of 15 IEPs: 

! Primary Disability: 

" 7 EBD, 7 Specific LD, 1 Intellectual Disability 

! 13 out of 15 are described as demonstrating behavior 

that impedes the learning of others 

" Of those 13 students, 5 have a FBA or BIP (4 of those 

students are described as SLD, 1 as EBD) 

! 9 standard diploma, 6 special diploma 

! 1 enrolled in a self-contained class, 14 enrolled in 

general education classes with support


Approximately 57 students 

out of ~140 are on psychotropic 

medication, with a range of 

1-4 medications per student. 

The most common reasons for 

medication include depression (22), 

mood stabilization (20), anxiety 

(19), and ADHD (18).

Intake and Assessment: Policy 

! IDEIA: Requires accurate assessment and 

identification of students requiring mental health and 

behavior services upon admission 

Failure to identify students and provide services 

for eligible youth can have a serious impact on 

the student, and put the facility out of 

compliance with federal and state law. 

(Leone, Krezmien, Mason, & Meisel, 2005).

Intake and Assessment: Practical 

Realities 

! Accurate identification of students in correctional 

settings is difficult 

! often times prior to admittance they had not 

attending school for a long time. 

! It is difficult to access records from a child’s home 

school 

! Many students may have never been diagnosed, 

but actually meet guidelines for service


! Intake and Assessment: 

“The assessment process begins the 

moment you arrive” 

–Student Handbook 

! At intake, all students are assigned to a therapist and a case 

manager.!


! Intake and Assessment 

! Psychosocial – within 24 hours students meet with a 

therapist to complete a psychosocial assessment, they also 

meet with a licensed mental health professional 

! DJJ Comprehensive Mental Health/Substance Abuse 

Evaluation: A face-to-face interview with therapist will be 

held after students have been in the program for 10 days, 

they begin meeting with therapist immediately


! Needs Assessment – within 2 weeks in program, you 

meet with your treatment team to develop treatment 

plans. Parent/legal guardian, JPO, a rep from the 

school, Medical rep, therapist, and case manager 

! After needs assessment meeting, students receive 

individual performance plan, mental health/ 

substance abuse treatment plan, and IEP.

Provision of Appropriate Behavior and 

Mental Health Services: Policy 

IDEIA (2006, 34 C.F.R. 71. Sec 300.34(c)(10) 

! Administering and interpreting psychological and educational 

tests, and other assessment procedures; 

! Integrating this information into plans for student learning 

! Consulting with different school personnel in planning 

! Managing a program of psychological services, including 

psychological counseling for children and parents; and 

! Assisting in developing positive behavioral intervention 

strategies.

Provision of Appropriate Behavior and 

Mental Health Services: Practical Realities 

! DOJ has recognized a lack of mental health and 

other services for incarcerated youth. 

" Findings revealed numerous violations in the area of mental 

health services in JC facilities. 

" In many cases, unqualified staff are providing mental health 

services. 

" In some cases, no mental staff exists at all (Krezmien, et al., 2008)


! Provision of Appropriate Mental Health & 

Behavior Practices 

! Within 14 days of admittance, students receive a needs 

assessment. 

! All students have daily life/social skills groups – they may 

also have to attend treatment groups on items such as 

substance abuse, relapse prevention, thinking errors. 

! Students may have the option of coordinating a family 

session with their therapist

Strategies for Treatment: Policy 

" The IEP team must (i)in the case of a child whose 

behavior impedes the child's learning or that of others, 

consider the use of positive behavioral interventions and 

supports, and other strategies to address that behavior 

(IDEIA (2006, 34 C.F.R. 71. Sec. 300.324(a)(2)(i) 

! Juvenile corrections service providers are charged with 

accurately identifying youth with special education or 

mental health needs, and must provide required 

services without delay to children with identified needs 

under the IDEIA 

(Krezmien, Mulcahy, & Leone, 2008, p. 446)

Strategies for Treatment: Practical Realities 

! The juvenile justice system is overwhelmed with providing 

adequate mental health services for the large number of 

students needing treatment (Teplin, Abram, McClelland, 

Dulcan, & Mericle, 2002)


! Strategies for Treatment: 

! Treatment Team: 

" Consists of student, case manager, therapist, teachers, 

administrative staff, youth care workers in their dorm. 

" The team meets in full once a month. 

" A positive review is given for demonstrating progress on 

goals and a negative review is given for not meeting 

progress. Positive reviews are associated with level 

promotion, and obtaining a recommendation for release 

from the program.


! Strategies for Treatment 

! Case Management: 

" Case Manager keeps the student in touch with family and 

provides Progress Reports to Judge, DJJ probation officer, 

and to parents/guardians. 

" Coordinates any required community service 

" Meets regularly with students to monitor progress in 

between Treatment Team meetings 

Peer Counselors: Students have the opportunity to 

become peer counselors. One of the benefits of 

this is that this position will be mentioned in monthly 

summaries to a student’s Judge.

Uses of Disciplinary Sanctions: Policy 

! NCLB and FL State Statutes may conflict with IDEIA 

when it comes to behavior management of students: 

" A student’s disability must be taken into account when 

determining discipline – behavioral difficulties should 

be addressed through positive behavior interventions 

and supports (IDEIA 34 C.F.R. Sec. 300.324 (a)(2)(i) 

" NCLB has emphasized the importance of school 

safety as a means of promoting student success. All 

schools must provide records of school safety plans. 

" However, NCLB and FL State Statutes allow for 

teachers to have disruptive students removed from 

the classroom for behavior management intervention.

Uses of Disciplinary Sanctions: Practical 

Realities 

! Utilizing approaches that are punitive in nature or 

segregation are commonplace and often used in place 

of evidence based mental health practices. 

! Students with disabilities in secure care frequently do 

not receive appropriate academic and behavioral 

accommodations and typically spend more time in 

disciplinary confinement (Leone, 1994). 

! Disciplinary practices in school tend to remove students 

from instruction, having a negative impact on academics


Use of Disciplinary Sanctions 

! This facility works on a level system – allowing more privileges as 

a student progresses through levels based on Prosocial behavior. 

! Students “move” across levels based on # of days violation free 

or major violation free, and positive performance reviews during 

treatment team 

" Level suspension occurs if a student does not maintain requirements of 

a certain level. 

! Privileges range from additional phone calls and participation in 

student council, to getting to wear a special uniform and 

permission to attend off-campus activities. 

! “Do Right” – Students can receive “Do Right” forms during the 

day, for demonstrating prosocial behaviors. The form indicates 

what they did. Top ten students in each dorm with the most “Do 

Rights” get to participate in a weekly “Top Ten Night.”


! “Anti-social or negative behavior” results in Minor, 

Serious, or Major Violations. 

" Staff member writes up violation, student can sign and 

comment on violation. 

! Disciplinary Review Board Hearings 

" Held twice weekly to quickly address serious behavior or 

treatment concerns. If necessary, addendums to the IEP or 

IPP may result from these meetings. 

" Addendums are additional goals that students must complete 

before they are released.

Recommendations 

! Use of a comprehensive screening protocol for all 

students upon admittance to the facility 

(Krezmien, Mulcahy, & Leone, 2008): 

! Academic 

! Mental health 

! Medical History, Medication Use 

This would result in accurate identification of student 

needs, improve and accelerate the provision of 

educational and mental health services and ensure 

alignment with IDEIA requirements.

Recommendations 

! Implementation of Schoolwide Positive Behavior 

Interventions and Supports (SWPBIS) 

(Gagnon, Rockwell, & Scott, 2008) 

! Cognitive Behavioral Therapy (CBT) 

! Therapeutic Orientation of Treatment 

(Greenwood & Turner, 2009) 

! These should be combined with other practices such as 

group and individual counseling (Guerra, Kim, & Boxer, 2008).

Recommendations: Systems of Care 

Approach 

Collaboration across educational, correctional, and 

mental health staff, in addition to personnel 

preparation programs, researchers and policy 

makers, is necessary for success!

Questions or Comments? 

Kristin Murphy: kristin.murphy@ufl.edu 

Dr. David Houchins: epedeh@langate.gsu.edu 

For additional information, and to download a copy 

of this presentation, please visit: 

http://coe.ufl.edu/Projects/liberate

References 

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