Objective A: Provide for the treatment needs of special populations of children and youth with mental and emotional disorders.
Discussion
Child Abuse Victims: Being a victim of child abuse, including sexual abuse, frequently leads to a variety of severe mental health problems which can significantly impact the child's life in a variety of different ways. It can lead to dissociative disorders, post traumatic stress disorder, substance abuse, suicide, health problems and other serious disorders. Some victims may become perpetrators or otherwise involved in the juvenile correctional system. Treatment for child victims needs to be adequately funded and mental health providers need to have the skills to provide the treatment. Services need to be available statewide.
Actions
26. Develop closer collaboration between the Division of Family and Youth Services and mental health service providers to ensure child sex abuse victims get needed treatment.
Responsible party: Division of Family and Youth Services, Division of Mental Health and Developmental Disabilities
27. The Department of Health and Social Services and the Department of Corrections will work together to minimize the numbers of sex offenders who repeat their offenses against children and youth.
Responsible party: Division of Family and Youth Services, Department of Corrections
28. Mental health providers must be trained to identify child sex abuse victims and to work with these children and youth. Their care should be considered an emergency need under the Division of Mental Health and Developmental Disabilities' grants to community mental health centers and other service providers.
Responsible party: Division of Mental Heath and Developmental Disabilities
29. Research the relationship between child sexual abuse and youth/adult mental health, substance abuse problems and criminal system involvement.
Responsible party: Children's Mental Health Work Group
30. Seek funding for a pilot project to target child sex abuse victims for intensive mental health services and to provide longitudinal data.
Responsible party: Division of Mental Health and Developmental Disabilities, Alaska Mental Health Board
31. Consider funding pilot programs to mobilize sex abuse intervention teams to work with domestic violence shelters, homeless shelters, emergency shelters and schools.
Responsible party: Alaska Mental Health Board
Discussion
Sexually Assaultive Behavior: Historically, sexually aggressive or exploitive behaviors in childhood have not been dealt with in an accountable manner. Too often, common adult responses have been non-specific disciplinary, punitive or minimizing measures which have failed to confront exploitive behaviors or to teach appropriate behaviors. Many responses to childhood sexuality, as well as aggressive or exploitive sexuality, have not prompted communication or understanding at a cognitive level but rather have led to secrecy at a behavioral level. Many adult and adolescent sexual offenders have recalled that society often minimized the existence or importance of early offending behavior, as much as they did themselves. Sexual learning prior to puberty often occurs without the influence of societal norms. A variety of factors seem to put children and youth at risk of developing deviant sexual behaviors. These factors have been identified retrospectively in work with adolescent and adult sex offenders.
Actions
32. Develop a system of service delivery which is goal directed and enhanced by greater coordination of efforts and treatment interventions supported by a common treatment philosophy across all child serving systems.
33. Arrange for an intensive training agenda that is designed to prepare a variety of service providers with skills in early identification and treatment recommendations and interventions for children as young as three years old.
Responsible party (actions 1-2): Division of Mental Health and Developmental Disabilities, Division of Family and Youth Services
Discussion
Runaway Youth: Runaway youth remain a chronic problem in Alaska. Often fleeing homes with patterns of abuse or dysfunctional relationships, these youth place themselves at risk of harm and may, in time, slip into the offender population. An unknown percentage may be mentally ill and need treatment. Sometimes the Division of Family and Youth Services and parents place runaway youth in psychiatric hospitals for lack of alternative placements. Regretfully, no analysis of the runaway problem has been conducted in Alaska since 1983. While the federally-funded runaway shelters managed by Juneau Youth Services, Fairbanks Native Association and Anchorage's Alaska Youth and Parent Foundation do maintain some statistics, there is no provision for collection of statewide statistics on runway and homeless youth. These youth fall outside the child protective service system and the youth corrections system unless there are other circumstances and charges unrelated to their runaway status that would bring them within those systems.
Actions
34. Strengthen communication between state, federal, and privately funded agencies that serve Alaska's runaway population.
35. Use updated state data and existing data to allocate resources where the need is greatest.
36. Train runaway youth providers to identify child abuse, mental health, sex offender and domestic violence issues.
37. Develop closer relationships between runaway youth programs and the Division of Family and Youth Services, the Division of Mental Health and Developmental Disabilities and law enforcement agencies to facilitate service delivery and family reunification, and to reduce institutional placement.
38. Seek funding to conduct a statewide needs assessment to determine the service needs of this population.
39. Monitor and evaluate existing locally based runaway initiatives to determine best practices for creating safe environments for runaway youth and best practices for linking youth with psychiatric disorders with needed services.
40. Coordinate funding and resource availability with private, school district, state and other government agencies to ensure continuing and expanded services for runaway youth.
41. Assure advocates and mental health professionals have adequate input into Division of Family and Youth Services regulations governing the licensure of secure and semi-secure treatment facilities.
Responsible party (actions 1-8): Division of Family and Youth Services
Discussion
Mentally Ill and Emotionally Disturbed Youth in Detention Facilities: Delinquent mentally ill and emotionally disturbed youth in detention facilities pose significant management issues because they need more intensive and specialized staffing as well as different kinds of treatment than is needed by other delinquent youth. Most common diagnoses for these residents include: major depression with suicidal ideation, defiant disorder, schizophrenia and borderline personality disorder. Mentally ill delinquents are almost always in the facility more as a function of their emotional or psychiatric disorders than their actual delinquency. Their history often includes multiple admissions to psychiatric hospitals. Alaska has not provided adequate services to these adolescents and they have defaulted into the juvenile correctional system. Correctional facilities are not currently staffed to meet the needs of emotionally disturbed and mentally ill adolescents or to provide for their care on discharge.
Actions
42. Develop programs that treat mentally ill and emotionally disturbed youth in detention (see Goal I, Objective D; Goal II, Objective B).
Responsible party: Division of Family and Youth Services
43. The Department of Health and Social Services and The Alaska Mental Health Board will request funds for adequate staffing of juvenile detention facilities to assure that juveniles receive assessment, diagnosis and treatment appropriate to their conditions.
Responsible party: Department of Health and Social Services, Alaska Mental Health Board
44. Assure careful input by advocates and mental health professionals into the development of regulations for secure and semi-secure treatment facilities licensed by the Division of Family and Youth Services. Program data should be reviewed by an intra-departmental and Alaska Mental Health Board workgroup to assure appropriate use of secure and semi-secure treatment facilities.
Responsible party: Division of Family and Youth Services, Alaska Mental Health Board
Discussion
Children with Fetal Alcohol Syndrome/Fetal Alcohol Effects (FAS/FAE): Nationally, secondary emotional/psychiatric disabilities are highly correlated to FAS/FAE, in the 90% and above ranges. Since Alaska has so many FAS/FAE children and youth, we need to focus on prevention of these secondary disabilities, many of which appear to be a result of or related to the inappropriate expectations we have of these children and youth, many of whom appear "normal." Frustration, anger, hurt, etc. can be a potent mix that lead to emotional disorders and encounters with the juvenile justice system. Preventive care will take the efforts of a wide range of professionals, including teachers who have developed expertise in working with FAS/FAE children and youth, mental health professionals who have similar expertise, and other helping professions.
In Alaska's government planning and advocacy system, responsibility for children and youth with neurological disorders is shared by the Governor's Council on Disabilities and Special Education, the Advisory Board on Alcoholism and Drug Abuse and the Alaska Mental Health Board. The first joint board meeting, held in response to A Shared Vision I, targeted the needs of Fetal Alcohol Syndrome/Fetal Alcohol Effects children and youth for particular coordinated approaches. Since that time, the Boards sponsored a Summit on FAS/FAE where representatives came to agreement on future actions that need to be taken.
Actions
45. State and community providers will ensure that children and youth with Fetal Alcohol Syndrome/Fetal Alcohol Effects (Alcohol Related Neurological Deficits) and other neurological disorders receive appropriate early diagnosis, support, and treatment, by: increasing in-state diagnostic capability; training physicians in the diagnosis and management of FAS/FAE and other neurological conditions; and providing training opportunities for mental health providers, educators, and members of the legal and justice systems.
46. Agencies will explore development of programs to support the parenting skills of Fetal Alcohol Syndrome/Fetal Alcohol Effects individuals when they become parents.
47. Implement the recommendations of the Fetal Alcohol Syndrome Summit as stated in Fetal Alcohol Syndrome: A Time for Action, February 1998.
Responsible party (actions 1-3): Fetal Alcohol Syndrome/Fetal Alcohol Effects Coordinator, Department of Health and Social Services
Discussion
Adolescents in Transition to Adult Services: The Alaska Mental Health Board has been concerned for several years about the need for adequate transition between the child, youth and adult mental health treatment systems. The AMHB's Children and Youth Task Force authored a paper on transition which was given wide distribution within the Department of Health and Social Services and among mental health stakeholders. School districts are required by law in Special Education Individualized Education Plans to plan for transition for 14-22 year olds. However, for most 18-22 year olds, transition does not occur and the adult system is not ready to receive youth who have become ill as children. It is difficult for normal 18-22 year olds to transition into adulthood; it is dangerous for mentally ill and emotionally disturbed youth to transition without support. Without adequate support many mentally ill and emotionally disturbed adolescents transition into the criminal justice system.
Planning for transition to adult services should begin several years before a child becomes an adult. For children and youth classified as serious emotionally disturbed in school, Special Education laws require that transition begin no later than age 16. There is also a need for transition planning for those adolescents who are not receiving services under an Individualized Education Plan.
Actions
48. Promote and support collaboration between state and local government, schools, mental health agencies (child and adult), courts, criminal justice, etc. that will integrate federal/state Individuals with Disabilities Education Act guidelines for transition services through Individualized Education Plans.
49. Increase awareness and build support by educating all levels of the provider community regarding the needs and benefits of transition services.
50. The Department of Health and Social Services will implement the Children and Youth Task Force Transition Paper recommendations that all youth with brain disorders leave school and the children's mental health system with the skills, support and knowledge required to help them participate in adult life, including being able to work, learn and live in the area of their choice.
51. Clarify confidentiality laws and regulations pertaining to youth and adult service systems.
52. Train child/adult agencies and providers, together, to provide seamless transition services.
53. Establish a statewide policy (standards of care) for transition age youth.
54. Empower youth (young adults) and their families to be active in planning and implementing individualized transition services.
55. Coordinate funding sources, including finding grants that are specifically intended for transition services for education, housing, etc.
56. Involve adult service agencies early, as transition plans are being made.
57. Ensure that transition services are geared to the need of the individual and ensure success rather than arbitrary age or categorical "cut off."
58. Make certain that the process for transition planning is automatic for every child (not just per request).
59. Begin the transition process early (14-16 years of age).
Responsible party (actions 1-12): Department of Health and Social Services, Department of Education
Discussion
Children with Mental/Emotional Disorders and Substance Abuse Treatment Needs: Neither the mental health nor the alcohol treatment systems accept full responsibility for children and youth who have mental and emotional disorders and substance abuse treatment needs. However, these issues are very interrelated. Funding is often categorical and mutually exclusive, i.e., alcohol funding cannot be used for mental health treatment. Accreditation and licensing are restrictive to the extent that substantial redundancy must be tolerated to be licensed/accredited in both areas.
Research indicates that children are beginning to experiment with alcohol and other drugs at younger ages. This experimentation, coupled with mental health issues for severely emotionally disturbed children, illustrates the need for combined mental health/substance abuse treatment.
National organizations and research support the importance of integrating these services. Since children and youth with mental and emotional disorders are over-represented in substance abuse programs, the National Institute of Mental Health recommends early intervention for children and youth with mental and emotional disorders as a promising primary prevention program for substance abuse.
Actions
60. Obtain support/validation from advocacy groups who have traditionally supported only one area (mental health or substance abuse).
61. Develop a planning/collaboration/communication process between the Division of Mental Health and Developmental Disabilities, the Division of Alcohol and Drug Abuse, the Alaska Mental Health Board and Governor's Advisory Board on Alcoholism and Drug Abuse on planning issues.
Responsible party (actions 1-2): Alaska Mental Health Board
62. Develop a planning/collaboration/communication process between providers of children and youth's mental health and substance abuse services.
63. Identify funding sources within both divisions (or other resources) which do not carry specific categorical service restrictions. With a portion of these funds issue requests for proposals (RFPs) for joint pilot projects.
64. With a portion of these funds (identified in Action 4), develop an educational program which identifies and validates the overlap of these co-occurring conditions.
Responsible party (actions 3-5): Division of Mental Health and Developmental Disabilities, Division of Alcohol and Drug Abuse
Discussion
Children and Youth in Out-of-State Placements: In 1985 the Alaska Youth Initiative (AYI) was developed by the Department of Health and Social Services and the Department of Education in response to the increasing practice of sending seriously emotionally disturbed youth out of state for services. AYI's goal was to bring children and youth back to Alaska and prevent future out-of-state placements by providing in-state treatment alternatives. Since 1995, this problem has re-surfaced, with at least 40 youth currently in state custody placed in out-of-state treatment facilities. Scores of other children and youth are in out-of-state foster care and many children and youth not in state custody are also in out-of-state placements. Work on this issue has identified inconsistent state statutes and regulations regarding prioritization of mental health services for children and youth, leading to service gaps and confusion at the service delivery level. The work also found: inadequate review processes for cases under consideration for out-of-state placement; inadequate in-state treatment resources; less costly out-of-state services; long waiting times for admission to AYI; and inadequate access to crisis services.
Actions
65. Conduct an in-depth analysis of children and youth in out-of-state placement to identify services needed in Alaska.
66. Conduct a formal review of Alaska Youth Initiative, including its ability to prevent out-of-state placements.
67. Develop a standardized system to identify children and youth needing services not available in Alaska and to review their cases prior to a placement decision.
68. Develop treatment protocols/approaches for children and youth with difficult-to-serve mental disorders who are at risk for out-of-state placement.
69. Identify funding for mental health services for youth in detention facilities and for delinquent youth in state custody, and their families.
70. Investigate the ability of the Children's Service Delivery Model Pilot Project to prevent out-of-state placements.
71. Develop specific training for community mental health services staff, focusing on best practices to reduce out-of-state and out-of-community placement.
72. Investigate the feasibility of a form of secure residential care as an alternative to out-of-state placement for some children and youth.
73. Explore the development of Department of Health and Social Services' regulations to facilitate the integration of children and youth's services provided by more than one departmental division.
74. Support the development of a full system of care for mental health and medical care needs of children and youth in Alaska, with emphasis on the least restrictive alternative.
75. Assure that families are supported when children and youth are returned to home and that this support continues.
76. Assure full participation of the Department of Education in Alaska Youth Initiative and out of state placement decisions, as well as in development of treatment plans.
77. Develop and distribute residential selection guidelines for use by parents of children and youth who are not in state custody.
78. Develop additional needed policies and procedures to prevent unnecessary out-of-state placements.
Responsible party (actions 1-14): Division of Mental Health and Developmental Disabilities, Division of Family and Youth Services, Alaska Mental Health Board
Discussion
Culturally Appropriate Treatment: Alaska's children and youth come from many different ethnic backgrounds. Service providers need to be familiar with and sensitive to each family and culture. In addition, special emphasis needs to be placed on Alaska Native youth receiving mental health services in both rural and urban areas that is consistently culturally respectful. Many urban youth have significant cultural ties and strong tribal identity which can serve as a strength or natural support, yet is minimized or overlooked when they reside in an urban area. Cultural appropriateness of treatment is a particular issue for youth sent from rural areas to urban centers for treatment, and is also an issue for some "urban" Alaska Native youth who lived in rural areas before relocating to an urban center. A treatment goal is often to return to the community of tie where there may be family support, or the youth may reach 18 and decide to return to his/her community of tie.
Actions
79. The Division of Mental Health and Developmental Disabilities will structure grants to address rural and urban agencies' plans for cross cultural training, employment of Alaska Native staff and consultants and other minority staff appropriate to the locale. Quality Assurance standards will ensure mental health practitioners provide culturally relevant treatment. Follow up for compliance will occur during scheduled quality assurance reviews.
Responsible party: Division of Mental Health and Developmental Disabilities