Call to Order and Roll Call
The2nd meeting of the Task Force on the Unified Juvenile Code was held on Wednesday, July 3, 2013, at 1:00 PM, in Room 169 of the Capitol Annex. Senator Whitney Westerfield, Co-Chair, called the meeting to order, and the secretary called the roll.
Members:Senator Whitney Westerfield, Co-Chair; Representative John Tilley, Co-Chair; Hasan Davis, Glenda Edwards, Steven Gold, Teresa James, Lisa P. Jones, Bo Matthews, Mary C. Noble, Pamela Priddy, and John Sivley.
Guests: Representative Dennis Horlander; Mary Tansey, Cabinet for Health and Family Services; Nathan Stewart, North Laurel High School; Christa Wiley, Ramey Estep; Stephanie Kazee, Ramey Estep; Wayne Young, Kentucky Association of School Administrators; Denise Perry, Kentucky Association of School Administrators; Karen Kirby, Kentucky Association of School Administrators; David Johnson, Kentucky Association of School Administrators; Sylvia Kustie, Department of Juvenile Justice; Ron Sheets, Kentucky Association of School Administrators; Clyde Caudill, Kentucky Association of School Administrators.
Approval of Minutes
A motion by Senator Westerfield, seconded by Justice Noble and Commissioner Davis, was approved by voice vote to adopt the minutes of the June 5, 2013 meeting.
Screening/Assessment – Where we are and where we are headed
Commissioner Teresa James of the Department of Community Based Services (DCBS) introduced the importance of a standardized screening tool for all Kentucky children in need of services. She stressed the need for an assessment of children within the child service system in order to prevent unnecessary removal of the child and to meet the needs of those requiring services.
Rachel Bingham, Manager of Family and Juvenile Services for the Administrative Office of the Courts (AOC), testified about improvements in screening tools, and ways that communication about such results could be better utilized. Screening tools allow child services to perform a preliminary screening request and help to identify the child’s options for diversion. The AOC worked with mental health and other services to streamline screening tools to make sure providers and families benefit from a new system. As a result, AOC began utilizing the Global Appraisal of Individual Needs (GAIN) tools, which included four instruments: Short Screener, Quick, Initial, and Monitoring. GAIN is not a diagnostic tool, but an initial screening tool designed to identify the need for referral to treatment or additional assessment. Each instrument is available online for free, although there is a cost for integrating these into existing data systems.
Responding to a question from Senator Westerfield, Ms. Bingham stated that despite its availability online, the GAIN system is not self-administered within the AOC’s services.
Ms. Bingham suggested two ways that the screening tools could be improved by opening the language of KRS 630.060 and 635.010. The first is to create a statute stating that information gathered from screening tools is confidential unless it is in the best interest of the child to release it. The second is to allow Preliminary Intake Inquiries to be submitted to the courts. The goal of these workable solutions is to better share information from the GAIN system with courts.
After Glenda Edwards expressed concern that sharing GAIN information could affect a child’s privacy and honesty, Ms. Bingham said that AOC workers are trained in interviewing children, and that the goal of the GAIN program is to provide the children with the resources they need.
Commissioner Hasan Davis of the Department of Juvenile Justice (DJJ) discussed the range of assessment and screening tools that DJJ utilizes. All youth within DJJ are evaluated by staff, and certain types of offenders, such as those with sexual charges, undergo additional assessments; each of these tests takes into account static and dynamic issues the child may be experiencing.
Commissioner Davis talked in-depth about certain assessment tools DJJ used. The Massachusetts Youth Screening Instrument, 2nd version (MAYSI-2) is an assessment meant to identify mental or emotional disturbances of distress in youth. It is given within 48 hours of admission to determine where the child will be placed within the larger DJJ population. MAYSI-2 has 7 subscales, all but one of which are normative based on the general population, and the results indicated normal, caution, or warning status of the youth.
The Youth Level of Service/Case Management Inventory (YLS/CMI) is another tool, which is an evidence-based assessment that evaluates certain risk factors correlated with crime. All but one of the 8 subparts for evaluation are dynamic, and the tool is used as a basis for case planning, treatment, and security. This tool is issued regularly, and the child is continually reevaluated to account for shifts in risk factors. Responding to a question from Senator Westerfield, Chairman Davis said that each factor within YLS/CMI is weighted equally, although anecdotal information may override the results in certain cases. Information is gathered through interviews, reviews of the youth’s records, and 42 yes/no questions; the results are compiled to present an overall score for the child ranging from low-risk to very high-risk.
The CRAFFT tool is used for all probated or committed youth to quickly identify those who are high risk and in need of more comprehensive evaluations. Similarly, the GAIN-Q tool identifies those with various life problems who are in need of larger, more detailed assessment. Both tools help staff make more effective referrals and placements, as well as allowing certain youth to benefit from brief interventions. The Child and Adolescent Service Intensity Instrument (CASII), a product of the American Academy of Child and Adolescent Psychiatry, is used on youth with mental issues to determine if a child needs to be admitted to a mental health facility.
Additionally, the Juvenile Sex Offender Assessment Protocol (JSOAP II) is utilized for male sex offenders between the ages of 12-18, which helps identify the risks associated with sexual and/or criminal offenders based on 16 static and 12 dynamic factors. The Estimate of Risk of Adolescent Sexual Offense Recidivism, 2nd version (ERASOR) identifies sexual risks through certain categories. Finally, STATIC-99 and MNSOT-R are actuarial tools used for males over age 19, which measures the probability of reoffending within a certain timeframe.
Responding to questions from Senator Westerfield and Ms. Priddy, Commissioner Davis stated that the assessment tools are conducted through interviews. Rather than a question and answer session with the child, the interviewees are holding conversations. This allows for subjective or additional questions or to make further assessments before their final determinations. Because state law prevents agencies from sharing certain information, children are often required to repeat screenings or assessments as they are moved to another agency.
Commissioner James discussed the assessment tools and needs of DCBS. Unlike other agencies, DCBS contracts for services, with over half of their youth in therapeutic foster or residential care and the rest in DCBS foster care. Additionally, DCBS contracts programs to assess children, which can limit the amount of information the agency receives due to the urgency of a high-risk situation. Each child within DCBS requires a screening to create their case plan, with mental health needs built into the system. DCBS is working with the Department of Behavioral Health to choose screening tools that they can utilize. However, selecting one simple and quick screening process is difficult for several reasons. First, it must be covered by Medicaid so that all Kentucky children can consistently be funded. Second, it must have multiple assessment tools to account for variations in age, development, situation, drug/alcohol use, or mental health. Commissioner James asserted that it is essential that a screening tool meet these criteria because the first assessment, treatment, and placement of a child are critical to the child’s development and situation.
HIPAA and its impact on child welfare services
Commissioner James and Mary Tansey, Assistant Counsel at the Cabinet for Health and Family Services, testified about the ways in which the Health Insurance Portability and Accountability Act (HIPAA) limits DCBS’s ability to share information. HIPAA was the first federal law to standardize protection for health information by regulating how covered entities use and disclose protected health information. According to Ms. Tansey, DCBS is required to operate under HIPAA requirements because it is considered a “covered entity.” These are health plans, providers, and clearinghouses that provide necessary treatment services. Although DCBS does not offer treatment, the Service Regions Divisions within DCBS are in charge of neglect and child protection and are thus considered a covered entity.
Ms. Tansey described the details of HIPAA restrictions. For example, protected health information (PHI) is individually identifiable details that deal with demographic, financial, or health information. In general, the release of PHI requires the consent of the individual, although exceptions do exist. Under KRS 620.030, there is a mandatory reporting provision for investigators to report abuse or neglect. Other HIPAA direct consent exceptions include treatment, intervention, and public-health related functions. However, the information acquired through HIPAA is confidential; agencies and individuals are limited in their authority to re-release information they receive. If a child is in DCBS custody, information can be shared if it pertains to treatment or safety. Furthermore, in regards to instances involving deaths, HIPAA entities are only able to identify the location, identity, and cause of death.
Responding to questions from Senator Westerfield and Dr. Sivley, Commissioner James stated that DCBS and other agencies operating under HIPAA are unable to release necessary information to schools because schools are not considered treatment centers. Even though the details could be helpful to school officials, disclosing the information could violate the rights of the child or parents and requires parental consent.
Addressing Ms. Priddy’s question, Ms. Tansey clarified that even though a child may be in DCBS custody, the parent is still the primary caregiver, and DCBS cannot consent to the release of information.
In response to a question from Mr. Gold, Ms. Tansey stated that information collected from screening and assessment tools is protected; however, PHI can be shared with other agencies if it is being used to aid in treatment of the patient.
Responding to a question from Dr. Sively, Ms. Tansey said that HIPAA and state laws work alongside one another. When one is more restrictive than the other in the release of PHI, it is the applicable rule.
Teachers and school administrators: concerns and recommendations
Several school administrators spoke about how the education system encounters addresses child behavioral, emotional, and personal issues.
Denise Perry, Director of Pupil Personnel at Henry County Schools, discussed the steps educators take to identify potential problems students are experiencing and the limitations school systems face in rectifying them. She testified that school is the safest place for many troubled students and an education is their ticket out of deplorable conditions. While teachers and administrators are able to recognize certain behaviors as normal adolescent actions, they are concerned about students who are habitually truant or not actively engaged in class participation. Parents are notified and given opportunities to address the truancy or behavioral issue. However, after all options have been exhausted, court action is all that the schools are able to do to get the student in the classroom.
David Johnson, Assistant Superintendant and Director of Pupil Personnel at Owensboro Independent Schools, expanded on Ms. Perry’s discussion of court action. He emphasized that referring a student to youth detention is a difficult decision for administrators and that the problems resulting in a court appearance are often unresolved due to their complexity. School systems continue to use court services, though, because it is a national security and economic issue for children to jeopardize their education due to truancy and behavioral issues. Youth respond to consequences and high expectations and that the tool of detention is a last but necessary option for the education system.
Executive Director Wayne Young of the Kentucky Association of School Administrators discussed the need for the education sector to work with child services, the courts, and legislators to address truancy and detention issues for children. He stated that it is imperative that these agencies work together to improve the system and break down barriers to better help children.
The Task Force members discussed the implications of youth detention. Commissioner Davis stated that detention is not a treatment and that money would be better invested into addressing the needs of the community. Justice Noble noted that the consequences of child detention are significant, and that all schools should implement a uniform policy for dealing with behavioral and truancy issues. Mr. Gold expanded on this concern by stating that detention creates future criminals and dropouts, and that this tool is ineffective and should be replaced with evidence-based, early intervention tools. Ms. Perry responded to these concerns by agreeing that preventive programs could be created and implemented but noted that they cost money. Mr. Johnson said that such programs have been introduced to younger children, and the effects will be seen in the future.
Next meeting date and agenda
Senator Westerfield announced that the State Interagency Council will hold a session regarding financial mapping on July 24 at 10 a.m. at the Department of Behavioral Health.
He also noted that, in light of the Governor calling an Extraordinary Session of the General Assembly, Senate President Stivers and Speaker of the House Stumbo have cancelled all August meetings unless they are held during the week of the special session. To accommodate this change, the next meeting for the Task Force will be held on Thursday, August 22 at 10 a.m. in the Annex.
The meeting was adjourned at 3:35 p.m.