Summary
Recent news articles in over 30 states describe the difficulty many parents have in accessing mental health services for their children, and some parents choose to place their children in the child welfare or juvenile justice systems in order to obtain the services they need. GAO was asked to determine: (1) the number and characteristics of children voluntarily placed in the child welfare and juvenile justice systems to receive mental health services, (2) the factors that influence such placements, and (3) promising state and local practices that may reduce the need for child welfare and juvenile justice placements.
Child welfare directors in 19 states and juvenile justice officials in 30 counties estimated that in fiscal year 2001 parents placed over 12,700 children into the child welfare or juvenile justice systems so that these children could receive mental health services. Nationwide, this number is likely higher because many state child welfare directors did not provide data and we had limited coverage of county juvenile justice officials. Although no agency tracks these children or maintains data on their characteristics, officials said most are male, adolescent, often have multiple problems, and many exhibit behaviors that threaten the safety of themselves and others. Neither the child welfare nor the juvenile justice system was designed to serve children who have not been abused or neglected, or who have not committed a delinquent act. According to officials in the 6 states we visited, limitations of both public and private health insurance, inadequate supplies of mental health services, limited availability of services through mental health agencies and schools, and difficulties meeting eligibility rules for services influence such placements. Despite guidance issued by the various federal agencies with responsibilities for serving children with mental illness, misunderstandings among state and local officials regarding the roles of the various agencies that provide such services pose additional challenges to parents seeking such services for their children. Officials in the states we visited identified practices that they believe may reduce the need for some child welfare or juvenile justice placements. These included finding new ways to reduce the cost of or to fund mental health services, improving access to mental health services, and expanding the array of available services. Few of these practices have been rigorously evaluated.
Recommendations
Our recommendations from this work are listed below with a Contact for more information. Status will change
from "In process" to "Implemented" or "Not implemented" based on our follow up work.
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Recommendations for Executive Action
Recommendation: To determine the extent to which children may be placed inappropriately in the child welfare and juvenile justice systems in order to obtain mental health services, the Secretary of Health and Human Services (HHS) and the Attorney General should investigate the feasibility of tracking these children to identify the extent and outcomes of these placements.
Agency Affected: Department of Health and Human Services
Status: Implemented
Comments: HHS addressed this recommendation through its work with the Coordinating Council on Juvenile Justice and Delinquency Prevention, an interagency working group of which HHS is a member. The Council aims to coordinate federal juvenile delinquency prevention programs and activities. Beginning in March 2004, the Council began discussing how to respond to our recommendations at its quarterly meetings. They decided to convene an interagency working group comprised of representatives from several agencies, including the Substance Abuse and Mental Health Services Administration, the Family and Youth Services Bureau, DOJ and Education, for the purpose of addressing the recommendations. With HHS as the lead agency, the working group met in October 2004. They discussed the feasibility of tracking children to identify the extent and outcome of their placements. Agency representatives identified how they collected information and concluded that their data collection systems were so disparate that it would be infeasible to track such information.
Agency Affected: Department of Justice
Status: Implemented
Comments: The Coordinating Council on Juvenile Justice and Delinquency Prevention, an interagency working group led by DOJ, addressed this recommendation. Beginning in March 2004, the Council discussed how to respond to the recommendations in our report at its quarterly meetings. They decided to convene an interagency working group comprised of representatives from several agencies, such as the Substance Abuse and Mental Health Services Administration, the Family and Youth Services Bureau, and DOJ, for the purpose of addressing our recommendation. The working group met in October 2004 and discussed the feasibility of tracking children to identify the extent and outcome of their placements. Agency representatives identified how their agencies collected information and concluded that their data collection systems were so disparate that it would be infeasible to track this information.
Recommendation: To help reduce misunderstandings at the state and local level, the Secretaries of HHS and Education and the Attorney General should develop an interagency working group (including representatives from the Centers for Medicare and Medicaid Services, the Substance Abuse and Mental Health Services Administration, and the Administration for Children and Families) to identify the causes of these misunderstandings and create an action plan to address those causes.
Agency Affected: Department of Education
Status: Implemented
Comments: The Coordinating Council on Juvenile Justice and Delinquency Prevention, an interagency working group established to coordinate federal juvenile delinquency prevention programs and activities, initiated a response to this recommendation. The Council includes several federal agencies, including the Department of Education. In March 2004, the Council discussed how to respond to GAO's recommendations. They developed an interagency working group with designated representatives from the federal agencies, including the Departments of Education, Justice and many HHS components (e.g., the Substance Abuse and Mental Health Services Administration, the Centers for Medicare and Medicaid Services, ACF) to discuss our recommendations. The interagency group began meeting in October 2004. They discussed the issue of parents relinquishing custody of their children who are in need of mental health services and the causes of misunderstandings in inappropriate placements. They identified actions to mitigate this problem, such as including state-level agencies in the interagency plan, asking states to consider their information-sharing, technical assistance, and program-related goals in relation to this issue, and asking practitioner members to communicate their concerns and suggestions about this issue directly to HHS. They also agreed on the need to take action to increase the amount of mental health services for children to prevent inappropriate placements or, if already in the system, to ensure that they receive treatment and exit the system as soon as possible.
Agency Affected: Department of Health and Human Services
Status: Implemented
Comments: The Coordinating Council on Juvenile Justice and Delinquency Prevention, an interagency working group established to coordinate federal juvenile delinquency prevention programs and activities, initiated a response to this recommendation. The Council includes several federal agencies, including HHS. In March 2004, the Council discussed how to respond to GAO's recommendations. They developed an interagency working group with designated representatives from the federal agencies, including the Departments of Education, Justice and many HHS components (e.g., the Substance Abuse and Mental Health Services Administration, the Centers for Medicare and Medicaid Services, ACF) to discuss our recommendations. HHS took the lead and convened a meeting of the interagency working group in October 2004. They discussed the issue of parents relinquishing custody of their children who are in need of mental health services and the causes of misunderstandings in inappropriate placements. They identified actions to mitigate this problem, such as including state-level agencies in the interagency plan, asking states to consider their information-sharing, technical assistance, and program-related goals in relation to this issue, and asking practitioner members to communicate their concerns and suggestions about this issue directly to HHS. They also agreed on the need to take action to increase the amount of mental health services for children to prevent inappropriate placements or, if already in the system, to ensure that they receive treatment and exit the system as soon as possible.
Agency Affected: Department of Justice
Status: Implemented
Comments: The Coordinating Council on Juvenile Justice and Delinquency Prevention, an interagency working group established to coordinate federal juvenile delinquency prevention programs and activities, initiated a response to this recommendation. The Council includes several federal agencies, including DOJ. In March 2004, the Council discussed how to respond to GAO's recommendations. They developed an interagency working group with designated representatives from the federal agencies, including the Departments of Education, Justice and many HHS components (e.g., the Substance Abuse and Mental Health Services Administration, the Centers for Medicare and Medicaid Services, ACF) to discuss our recommendations. The interagency group began meeting in October 2004. They discussed the issue of parents relinquishing custody of their children who are in need of mental health services and the causes of misunderstandings in inappropriate placements. They identified actions to mitigate this problem, such as including state-level agencies in the interagency plan, asking states to consider their information-sharing, technical assistance, and program-related goals in relation to this issue, and asking practitioner members to communicate their concerns and suggestions about this issue directly to HHS. They also agreed on the need for efforts to increase the amount of mental health services for children to prevent inappropriate placements or, if already in the system, to ensure that they receive treatment and exit the system as soon as possible.
Recommendation: The Secretaries of HHS and Education and the Attorney General should continue to encourage states to evaluate the child mental health programs that they fund or initiate and that these agencies determine the most effective means of disseminating the results of these and other available studies to state and local entities.
Agency Affected: Department of Education
Status: Implemented
Comments: The Departments of Education, HHS, and DOJ have helped to review state and local child mental health programs and have disseminated the results in various ways. These agencies, along with representatives from several other federal agencies and practitioner members, comprise the Council on Juvenile Justice and Delinquency Prevention, which worked to address this recommendation. This included holding a series of regional conferences where state, local, and other practitioners shared promising practices on preventing the inappropriate placement of mentally ill children in the juvenile justice and welfare systems. The Council also produced "Community Guide," an on-line guide to successful programs, tools and resources that states and localities can use to treat mental health and other disorders in youth. In 2006, HHS's Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Prevention developed the National Registry of Effective Programs and Practices (NREPP) to catalogue and rate mental health prevention and treatment programs, which was posted on-line. The site rates state, local and other mental health treatment programs and catalogues them as Model Programs, Effective Programs and Promising Programs. In this way, the results of programs that are proven to be effective can be disseminated widely to states and localities. NREPP also serves as a vehicle for previously unrecognized, yet innovative, high-quality community-based programs.
Agency Affected: Department of Health and Human Services
Status: Implemented
Comments: Working through the Coordinating Council on Juvenile Justice and Delinquency Prevention, HHS led an effort to address this recommendation, resulting in a series of regional conferences where participants--including state and local practitioners--shared promising practices on mental health programs for youth. The Council also produced "Community Guide," an on-line guide to successful programs, tools and resources that states and localities can use to treat mental health and other disorders in youth. In 2006, HHS's Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Substance Abuse Prevention developed the National Registry of Effective Programs and Practices (NREPP) to disseminate best practices and posted it on-line. The site rates state, local and other mental health treatment programs and catalogues them as Model Programs, Effective Programs and Promising Programs. The programs have been reviewed and rated by independent reviewers. The purpose of the registry is to speed the transfer of scientific knowledge to the field and make it readily and widely available. NREPP also serves as a vehicle for previously unrecognized, yet innovative, high-quality community-based programs.
Agency Affected: Department of Justice
Status: Implemented
Comments: DOJ worked with the Coordinating Council on Juvenile Justice and Delinquency Prevention to address this recommendation. In Congressional testimony, DOJ noted that the Council was addressing our recommendation and they were planning a series of regional conferences. At the conferences, state, local and other practitioners shared promising practices on preventing the inappropriate placement of mentally ill children in the juvenile justice and welfare systems, leading to a series of regional conferences where participants--including state and local practitioners--shared promising practices on mental health programs for youth. In Congressional testimony, the Director of the Office of Juvenile Justice, DOJ, cited our report and described a series of planned regional conferences to allow opportunities for state, local, and other practitioners to share promising practices for preventing the inappropriate placement of children with mental illness in the juvenile justice and welfare systems. The Council also produced "Community Guide," an on-line guide to successful programs, tools and resources that states and localities can use to treat mental health and other disorders in youth. DOJ developed and posted an on-line guide, "Screening and Assessing Mental Health Disorders Among Youth in the Juvenile Justice System: A Resource Guide for Practitioners" on its web site in 2004. States and localities can also access HHS' new National Registry of Effective Programs and Practices (NREPP), which rates state, local and other mental health treatment programs. This widely accessible registry will speed the transfer of scientific knowledge to the field. In addition, OJJDP funded research to identify promising practices and programs for providing mental health services to youth in contact with the juvenile justice system, targeted to state and county administrators. Based on the data, they developed a comprehensive model for providing a broad range of mental health services to these youth, which is described in: "Blueprint for Change: A Comprehensive Model for the Identification and Treatment of Youth with Mental Health Needs in Contact with the Juvenile Justice System." Issued in 2006, this publication was made available on-line and through its clearinghouse. OJJDP continues to use its JUSTJUV listserve and clearinghouse to disseminate information to states and communities.
