MENU TITLE:  Challenge Activities Program Areas: Challenge Activity A.

Series: OJJDP
Published: Fall 1995
26 pages
51,599 bytes

Challenge to the States

The 1992 reauthorization of the Juvenile Justice
and Delinquency Prevention (JJDP) Act of 1974 added
Part E, State Challenge Activities, to the programs
funded by OJJDP. The purpose of Part E is to
provide initiatives for States participating in the
Formula Grants Program to develop, adopt, and
improve policies and programs in 1 or more of 10
specified Challenge areas.

------------------------------

Challenge Activity A

Developing and adopting policies and programs to
provide basic health, mental health, and
appropriate education services, including special
education, for youth in the juvenile justice system
as specified in standards developed by the National
Advisory Committee for Juvenile Justice and
Delinquency Prevention prior to October 12, 1984.

Background

Across the country, class action litigation, damage
suits, and judicial orders in individual cases have
drawn attention to the problems of providing
adequate medical, mental health, and educational
services in juvenile correctional facilities.
Overcrowding and understaffing are major obstacles
to successful "habilitative" services that enable
youth to stop their delinquent behavior.

To address this problem, the National Advisory
Committee for Juvenile Justice and Delinquency
Prevention, prior to October 12, 1984, established
the Standards for Administration of Juvenile
Justice. The standards served as a baseline for
provision of services to juveniles. The primary
standards relevant to Challenge Activity A are
listed in the appendix of this document. Further
background information and commentary on the
standards are available in the Standards for the
Administration of Juvenile Justice.

Experts agree that there is no model juvenile
correctional facility in the country.[1] Training
schools have had difficulty maintaining excellence
in any component of their programs. An outstanding
medical, mental health, or educational program may
exist in a juvenile correctional facility for a few
years, only to suffer the loss of talented staff or
funding cutbacks that reduce "unnecessary"
expenditures. The program may decline when the
target population is changed, without the program
being altered accordingly, or if overcrowding
compromises the individualized approach that is so
important in innovative services. Nevertheless,
evidence shows that effective interventions can
help delinquent youth change their lives, provided
that youth needs are matched with services.[2]

Adequate medical, mental health, and educational
services in a juvenile correctional facility must
be defined by the needs of the young people housed
in it. Traditional delinquent assessment protocols
tend to be deficit driven and typically lead to
similar treatment plans for all youth.[3]
Incarcerated youth are sometimes presented with
proposed treatment goals, but they do not want what
social workers, teachers, and other staff believe
they need. The institutional treatment plan, for
example, may send the young person to work in the
laundry, attend history class, and participate in a
social skills group, all of which he or she might
find insulting or irrelevant. Traditional treatment
plans for delinquents fail because a conflict
arises between professional judgments and
undisclosed client goals. Assessments that include
the input of clients can help delinquent youth
examine their strengths and identify what they need
to stop their delinquent behavior. All people feel
better when their strengths are appreciated.
Services based on strengths are more effective than
those driven by deficits. Youth who go to a job,
class, or group because they believe that it will
meet their needs are more likely to change
positively during incarceration.[4]

Although standards and case law have clarified what
is unacceptable, it is difficult to describe
adequate medical, mental health, and educational
care in a juvenile facility without reference to
the needs of the young people being served. Instead
of encouraging replication of model institutional
programs, this challenge grant offers the
opportunity to develop needs-driven institutional
medical, mental health, and educational services
for the particular delinquent population in the
State requesting funds.

Health Needs of Youth in the Juvenile Justice
System

While youth in the juvenile justice system have
many of the same health problems as other
adolescents, they are particularly at risk for
having sexually transmitted diseases (STD's),
unexpected pregnancies, and drug or alcohol
dependencies. 

Youth in the juvenile justice system engage in
sexual activity more often and at younger ages than
do other adolescents.[5] Many have histories of
childhood sexual abuse, and many have been
victimized sexually during their adolescent
years.[6] With limited exposure to pregnancy and
STD prevention programs, these youth often hold
unrealistic views about sexuality and
childbearing.[7]

Juvenile offenders are also more likely to
jeopardize their health by smoking, drinking, and
using drugs.[8] They appear to be more susceptible
to, and often more dependent on, controlled
substances to help maintain peer relationships and
cope with stress and depression.[9] 
Many adolescents engage in alcohol- and
drug-involved delinquent behavior, for which they
are then arrested. When they are subsequently
admitted to secure facilities (police stations,
jails, juvenile detention facilities), they are
under the influence of intoxicants.[10] In such
facilities, intoxicated juveniles must be
identified upon admission to guard against severe
toxic or withdrawal reactions, depression, and
suicide.[11]
 
The Office of Juvenile Justice and Delinquency
Prevention's (OJJDP) 1992 study on confinement
conditions in juvenile correctional facilities
found significant gaps in health care available to
youth. Less than one-half of youth in institutions
are given health screenings within 1 hour of
admission as required by nationally recognized
standards, such as the American Correctional
Association Standards for Accrediting Juvenile
Facilities, as amended in 1991; the National
Commission on Correctional Health Care Standards,
1984; and the American Bar Association/Institute
for Judicial Administration Standards, 1980.
One-fifth of youth in juvenile detention facilities
do not have full health examinations within a week
of admission, and one-third are screened by staff
who have no professional medical training. More
than 30 percent are in facilities where no tests
are given for tuberculosis, and more than 40
percent are in facilities where no tests are given
for STD's.[12]

Full health examinations of juveniles in detention
and corrections facilities soon after admission are
important. These examinations uncover unknown
health problems and prevent the spread of disease
among confined youth and facility staff. They are
also an opportunity for staff to provide youth with
needed health education and referral to community
health resources.[13]

A juvenile correctional facility's medical services
must also meet youth's acute and chronic health
needs. Acute needs include injuries, infections,
dental emergencies, and pregnancy. The ability to
implement an effective prevention strategy against
epidemics is also essential. Chronic needs include,
but are not limited to, substance abuse, asthma,
juvenile diabetes, sickle cell, and HIV. Routine
dental care must also be provided. Furthermore,
juvenile correctional medical services must
dispense a wide variety of medications, including
psychotropics that require close monitoring of side
effects and dosage, as well as regular blood tests.
For youth with chronic health needs, an important
function of the medical unit is to arrange
continuing care when young people are released from
the institution.

Although nonmedical staff may be trained to perform
some of these acute and chronic care functions,
many health services must be provided by medical
professionals: technicians, nurses, physician
assistants, dentists, and physicians (including
psychiatrists). The responsibilities of the medical
and nonmedical staff must be clearly defined. 

The Echo Glen Children's Center, a State-operated
facility in Smoqualmie, Washington, has a strong
medical unit that provides acute and chronic
services for 200 incarcerated delinquents. The
clinic logs approximately 1,200 visits each month
and has a nurse on duty 24 hours a day. A physician
is on the center's grounds every weekday and a
dentist is there 4 days a week. Three part-time
psychiatrists carefully follow youth on
psychotropic medications. Postdoctoral students
from the University of Washington Medical School
rotate shifts at the facility; one of these
students works with a physician's assistant to
provide special services to the program's female
delinquents. 

Contact:

Mary LaFond 
Echo Glen Children's Center 
33010 Southeast 99th Street 
Smoqualmie, WA 98065 
202-624-6514 

Other juvenile facilities have strengthened their
medical units by contracting with a hospital to
operate them.

Mental Health Needs of Youth in the Juvenile
Justice System

Severe Symptoms. The prevalence of mental disorders
for youth in the juvenile justice system is
considerably higher than in the general
population.[14] Common diagnoses of juvenile
offenders include conduct disorders, attention
deficit disorders, and affective disorders.[15] The
occurrence of psychotic disorders among juvenile
offenders ranges from 1 to 6 percent. Although this
is a relatively small number, psychotic youth need
immediate and intensive services.[16] Many youth
have substance abuse disorders that co-occur with
significant mental disorders.[17]

Confined youth do not fit neatly into a single
diagnostic category.[18] Their multiple mental
health needs often result from, or have been
intensified by, a history of physical abuse, sexual
abuse, or severe emotional neglect.[19] Depression
is probably their most common mental health
problem. It is often expressed through angry,
hostile feelings and aggressive, belligerent, or
suicidal behavior; withdrawal from others; and
weight and sleep problems. Depressed youth are
often mistakenly judged to have low
intelligence.[20]
 
Approximately 15 to 20 percent of confined
juveniles experience hallucinations. Many of the
hallucinations are anxiety related: the youth feel
scared, threatened, or punished. Others have
command hallucinations in which they hear voices
directing them to engage in antisocial
behaviors.[21] 

The most serious consequences of untreated or
inadequately treated mental disorders are suicidal
thoughts and attempts. An assessment of suicidal
indicators should be conducted with each youth upon
admission into custody to alert mental health staff
to the need for intervention and to provide each
youth with an opportunity to request
assistance.[22] OJJDP's 1992 juvenile confinement
study found, however, that only half of all
confined juveniles are held in facilities that
monitor suicidal youth every 4 minutes, the length
of time after which permanent brain damage can
occur in an attempted hanging -- the most common
method of suicide attempt in juvenile facilities.
About 25 percent are in facilities that do not
screen juveniles for indicators of suicide risk at
admission, and approximately 25 percent are in
facilities that do not train staff in suicide
prevention.[23]
 
Young people sometimes become severely depressed,
suicidal, or psychotic because of their
confinement. Staff may have little prior indication
that a young person will deteriorate rapidly,
sometimes because of homesickness, fears, and
sensory deprivation or overload. Youth placed in
isolation are particularly at risk of depression. A
recent study found that youth in a locked unit
became significantly more angry, depressed, and
paranoid than they had been before they were
admitted.[24]

Chronic, Widespread Symptoms. Whereas severe
depression or psychosis may affect less than
one-fifth of the youth in a juvenile correctional
facility, many incarcerated youth need help because
they experience chronic hopelessness and anger.[25]
These feelings contribute to a lack of empathy for
their victims, including other residents or staff
against whom they may lash out over apparently
trivial disagreements. Past victimization may lead
these youth to "thinking errors" that allow them to
continue to justify their antisocial behavior. The
use of drugs and alcohol not only requires
immediate medical treatment in institutions but
also requires mental health services that teach
delinquents less self-destructive ways to manage
their hopelessness and anger.

The Tom Ray Center, a secure mental health program
for violent young people in Charlotte, North
Carolina, uses techniques applicable in a juvenile
correctional facility. The treatment program in
this 24-bed, county-run center revolves around
social skills training through several daily
groups, intensive supervision, one-to-one staff
work with youth, and small special education
classrooms applying the same principles of
supporting youth to succeed.

Contact:

Elizabeth Levine
The Tom Ray Center
3430 Wheatley Avenue
Charlotte, NC 28205
704-336-4232

Many delinquents, to make peace with their pasts,
need mental health services. Although peer
acceptance is important in adolescence, delinquents
often look to their families when they make
decisions, especially regarding criminal
involvement. When juvenile correctional programs
ignore or criticize delinquents' parents, young
people typically defend their families by not
engaging in treatment. Delinquents may wonder, "If
what I come from is so bad, how can I be any good?"
Youth protect their parents' pride by not aspiring
to higher levels of school achievement than that of
other family members. A young person whose father
has been in jail most of his life may simply be
following in his father's footsteps when he sells
drugs. Although they may express anger at their
mothers, female delinquents also reject services
that make them feel disloyal to their families and
require caregivers that are sensitive to their
family relationships. Building on the strengths of
the family to support the young person's success is
a critical mental health service, even for youth
who are not returning home. As youth begin to
understand how their families have influenced their
development, they will learn how to cope with
family problems that are unlikely to change. 

The Family Services Research Center in Charleston,
South Carolina, operating in conjunction with the
Medical University of South Carolina, has
demonstrated an effective family- and
school-focused intervention for delinquents who
live in the community. Families are supported to
encourage positive behavior in youth and to guide
them away from poor judgment calls or
self-destructive choices. This technique could be
used with incarcerated delinquents. 

Contact:

Scott W. Henggeler
Medical University of South Carolina
Department of Psychiatry
Family Services Research Center
Annex 3
171 Ashley Avenue
Charleston, SC 29425-0742 
803-792-8003

Educational Needs of Youth in the Juvenile Justice
System

Most delinquents have failed in school, and their
lack of success in this important part of their
lives has contributed greatly to their antisocial
behavior. Some, barely able to read, have felt
since grade school that they have been shut out of
opportunities requiring basic skills. Others, bored
in school, have found only illegal applications for
their intelligence. Building on their individual
strengths, the educational component of the program
must enable young people to apply their cognitive
abilities to nondelinquent pursuits. Making this
component work requires using high-interest subject
matter, creating a nonthreatening environment,
using creative and motivational activities in the
classroom, and providing time each day for students
to practice reading and writing. 

Academic Needs of Youth With Disabilities. About 40
percent of incarcerated delinquents have
disabilities that make them eligible for special
education.[26] These youth have learning
disabilities, emotional problems that interfere
with learning, and/or low intelligence. At least
half of these youth, however, are likely never
identified during their incarceration. As a result,
they may not have individual educational plans
(IEP's) or may not have been provided with special
education services prior to their incarceration. To
address this neglect, the educational program in
juvenile correctional facilities must include
disabilities assessment, eligibility determination,
IEP development, and services specified in the
IEP.[27] For those youth whose disabilities were
identified in their home schools, arrangements must
be made to ensure prompt receipt of their IEP's at
the institution. The required student-teacher
ratios, special instructional methods, and support
services to implement IEP's for all incarcerated
youth with disabilities are clearly defined in the
Individuals with Disabilities Education Act. The
Act, which mandates a free and appropriate
education to all handicapped persons under the age
of 22, applies to correctional education programs.
The law requires that each disabled child receive
special education reasonably designed to meet his
or her unique needs.[28]

The provision of special educational services for
youth in the juvenile justice system should begin
with a system to diagnose youth's educational
disabilities and to identify their particular
needs.[29] An individualized education program
should be developed for each identified child, with
specific educational goals and timelines for
reaching those goals.[30] Related services
necessary for the child to benefit from special
education should also be provided, including such
services as psychological treatment, speech
pathology, and audiology.[31]

Academic Needs of Youth Who Are Ineligible for
Special Education. Many incarcerated youth do not
have disabilities, but they are illiterate or years
behind in their skill levels. Many nondisabled
delinquents, age 14 or older, who have reading
and/or math skills at the fourth-grade level or
below require significant remedial education.
Incarcerated youth with skills above the
seventh-grade level need instruction to prepare for
the high school equivalency examination (GED).
Programs have demonstrated that delinquents can
gain one grade in skill levels every 2 months
through individualized education.[32] Youth needing
remedial and GED education benefit from a
combination of individual instruction and
instructional computer programs that allow them to
go at their own pace. Although they need to
strengthen their compensatory skills through
instruction in reading and listening more
effectively, many delinquents learn best by doing.
An effective juvenile facility educational program
cannot rely primarily on auditory or visual
instruction.[33]
 
Law-related education (LRE) for delinquents is an
example of instruction that can provide an avenue
for success for youth who have failed in
school.[34] Teaching the simple concepts of how to
purchase cars, obtain insurance, and rent
apartments helps youth understand the practical
applications of the law. By discussing these
real-life examples, an LRE class engages youth by
capitalizing on their verbal skills. 

Many youth who have failed in school have trouble
asking questions. By not telling students what to
think and by helping them inquire into what is
behind a problem, LRE encourages them to question,
to express their own ideas, and to draw their own
conclusions. Critical-thinking and decisionmaking
skills are developed in the process as young people
recognize their own intelligence and how they can
apply it to problem solving and future success.

Catalina Mountain in Tucson, Arizona, is an example
of a State-run juvenile facility with an
educational program designed to meet individual
needs. The facility has been accredited by an
independent association. Lookout Mountain in
Golden, Colorado, is a State-run juvenile facility
that recently contracted with a local university,
Metropolitan State College in Denver, to operate
its educational program. The program uses certified
teachers and student teachers receiving supervision
by and conducting research with faculty from the
university's education department. In Los Angeles,
the county board of education's approach to
providing educational services to delinquent youth
is unusual because, through its Courts and
Community Schools branch, it operates the schools
in juvenile facilities as well as a day treatment
program for delinquents living in the community. At
the Florida Environmental Institute, a remote
program for serious juvenile offenders in Venus,
Florida, more than half of its youth pass their
high school equivalency exams and the remainder
make at least a three-grade increase in reading and
math skills during their stay. The Associated
Marine Institutes operate the facility. 

Contacts:

Steve Bates
Lookout Mountain
2901 Ford Street
Golden, CO 80401
303-273-2605

Maggie Valdez
Florida Environmental Institute
122 Ranch Road
Venus, FL 33960
813-887-3300

Donald Ingwerson
Los Angeles County Board of Education
9300 Imperial Avenue
Downey, CA 90242
310-922-6111

Tom Turos
Catalina Mountain School
P.O. Box 8988 CRB
Tucson, AZ 85738
602-628-5351

Education Through Vocational Instruction

Educational services can address the hopelessness
among delinquents described in the mental health
section. Delinquents often have no image of future
success for themselves other than criminality.
Hustling is familiar -- they do not have to leave
their families, neighborhood, or culture to work.
Most incarcerated youth do not have the life
experience needed to seek employment and they need
preparation if, when released, they are to find
legal jobs that build on their personal strengths
and interests.

Vocational educational must build on delinquents'
interests and how they fit into the job market.
Youth are cynical about "make work" in the
facility's kitchen or maintenance services because
it is not tied to skills promising employability in
the future.

Youth with entrepreneurial interests can learn how
to set up their own businesses. For example, a
youth-run enterprise such as making T-shirts could
include not only developing the needed artistic
skills, but also teaching product development, loan
and grant applications, marketing, and accounting.
A vocational program in fitting staff and youth
customers with eyeglasses and then making those
glasses at cost could be offered in facilities to
develop youth's skills for the job market.

YouthBuild U.S.A. is an example of
educational/vocational services originally
developed for school dropouts that would be
applicable in a juvenile correctional facility. For
12 to 18 months, youth in this program are trained
in construction skills that they use to
rehabilitate abandoned buildings or construct new
housing for homeless or low-income families. For
half of their instruction time, they attend
academic classes to prepare for the high school
equivalency diploma. Leadership training is an
important element of the program. Trainees are
included in apprenticeships so they can gain entry
into construction unions.

Contact:

Dorothy Stoneman
Youthbuild U.S.A. National Office
58 Day Street
Somerville, MA 02144
617-623-9900

Conclusion

The problems of providing high-quality services to
delinquents are well known. Adequate medical,
mental health, and educational services in a
juvenile correctional facility must be defined by
the needs of its residents. A facility's medical
services must meet the acute and chronic health
needs of youth in its custody; its mental health
services must meet the needs of a few severely
depressed, suicidal, or psychotic youth, as well as
the larger number of angry and hopeless residents.
Educational services must be designed to interest
youth who have failed in school and must include:
(1) eligibility determination, IEP development, and
special education services for the 40 percent of
incarcerated youth with disabilities; (2) remedial
and GED preparation for nondisabled youth; and (3)
vocational instruction that builds on the youth's
interests, and preparation for the job market.
Rather than simply replicating model programs,
States are challenged to design services based on
the individual needs of youth incarcerated in a
target facility.

------------------------------

Additional Resources

Programs

Alaska Youth Initiative, Department of Health and
Human Services, P.O. Box 110602, Juneau, AK 99811-
0620; Robert Gamble; 907-465-3370.

Boysville of Michigan, Clinton, MI 49236; Joseph
Tillman; 517-781-2780.

DeWitt Nelson Training Center, 7650 South Newcastle
Road, Stockton, CA 95213-9003; Celia Cruz-Reed;
209-944-6168.

Dozier School for Boys, 4111 South Street, Mariana,
FL 32448; William Baxter; 904-526-4135.

East Baltimore Mental Health Partnership, 1235 East
Monument Street, Baltimore, MD 21202; Dr. Raymond
Crowel; 410-614-4050.

Hennepin County Home School, Sex Offender Program,
14300 County Road 62, Minnetonka, MN 55345; Paul
Gerber; 612-949-4500.

Los Angeles County Court and Community School,
16703 South Clark Avenue, Bellflower, CA 90706,
Bellflower Annex; Sharon Roberts; 310-867-1783.

Los Angeles County Juvenile Court Health Services,
1925 Daly Street, First Floor, Los Angeles, CA
90031-3399; Charles Baker, M.D., Medical Director;
213-226-8723.

Medical Services for the Circuit Court for
Baltimore City, Room 126, Clarence Mitchell
Courthouse, 100 North Calvert Street, Baltimore, MD
21202; Nicholas Conti; 410-396-5078.

Orange County Court and Alternative Schools
Program, 200 Kalmus Drive, Costa Mesa, CA 92628;
Mary Lou Vachet; 714-966-4485.

Ventura School, 3100 Wright Road, Camarillo, CA
93010; Gary Collins; 805-485-7951.

Young Women's Transition Project, Children's
Services Project, 2630 North Pacific Highway,
Woodburn, OR 97071; Jonnie Zimmermann; 503-986-
4478.

Organizations

Abraxis Erie Mental Health, RFT, 429 West Sixth
Street, Erie, PA 16507; David Tamilin; 814-459-
0618.

American Bar Association, Criminal Justice Section,
Juvenile Justice Center, 1800 M Street NW.,
Washington, DC 20036; Patricia Puritz, 202-662-
1515; Fax 202-331-2226.

Juvenile Justice Clearinghouse, P.O. Box 6000,
Rockville, MD 20849-6000; 800-638-8736.

Juvenile Law Center, 801 Arch Street, Sixth Floor,
Suite 610, Philadelphia, PA 19107; 215-625-0551.

National Center for Education in Maternal and Child
Health, 2000 Fifteenth Street North, Suite 701,
Arlington, VA 22201-2617; 703-524-7802.

National Center for Youth Law, 114 Sansome Street,
Suite 900, San Francisco, CA 94104; 415-543-3307.

National Commission on Correctional Health Care,
2105 North Southport, Chicago, IL 60614-4017; 312-
528-0818.

National Maternal and Child Health Clearinghouse
(NMCHC), 8201 Greensboro Drive, Suite 600, McLean,
VA 22102; 703-821-8955, ext. 254.

------------------------------

Additional Bibliography

Center for Substance Abuse Treatment. 1993. 
Guidelines for the Treatment of Alcohol- and Other
Drug-Abusing Adolescents. Washington, D.C.: U.S.
Department of Health and Human Services.

Cocozza, J.J., ed. 1992. Responding to the Mental
Health Needs of Youth in the Juvenile Justice
System. National Coalition of the Mentally Ill in
the Criminal Justice System.

Ewing, J. 1991. "Mental Health Issues In
Incarcerated Adolescent Populations." In P.M.
Sheahan, ed. Health Care of Incarcerated Youth:
Report from the 1991 Tri-Regional Workshops.
Arlington, VA: National Center for Education in
Maternal and Child Health. 

Hutchinson, J. 1991. "Challenging Perceptions of
Youth: `Bad' or `Disturbed'?" In P.M. Sheahan, ed.
Health Care of Incarcerated Youth: Report from the
1991 Tri-Regional Workshops. Arlington, VA:
National Center for Education in Maternal and Child
Health.

Hutchinson, J. 1993. "Mental Health." In L.S.
Thompson and J.A. Farrow, eds. Hard Time, Healing
Hands: Developing Primary Health Care Services for
Incarcerated Youth. Arlington, VA: National Center
for Education in Maternal and Child Health.

Murphy, D. 1986 (May/June). "The Prevalence of
Handicapping Conditions Among Juvenile
Delinquents." Remedial and Special Education
7(3):7-17.

Nelson, M.C. et al. 1987. Special Education in the
Criminal Justice System. Reston, VA: Council for
Exceptional Children.

Parent, D. et al. Conditions of Confinement:
Juvenile Detention and Corrections Facilities.
Washington, D.C.: Office of Juvenile Justice and
Delinquency Prevention, U.S. Department of Justice.

Schwartz, D.J. 1991. "The Three R's of Mental
Health Assessment of the Forgotten Child:
Reluctance, Resistance, and Rejection." In L.S.
Thompson, ed. The Forgotten Child in Health Care:
Children in the Juvenile Justice System.

Sheahan, P.M., ed. 1991. Health Care of
Incarcerated Youth: Report from the 1991
Tri-Regional Workshops. Arlington, VA: National
Center for Education in Maternal and Child Health.

Thompson, L., ed. 1991. The Forgotten Child in
Health Care: Children in the Juvenile Justice
System. Arlington, VA: National Center for
Education in Maternal and Child Health. 

Thompson, L.S., and J.A. Farrow, eds. 1993. Hard
Time, Healing Hands: Developing Primary Health Care
Services for Incarcerated Youth. National Center
for Education in Maternal and Child Health. 

Warboys, L., and C.B. Shauffer. 1986 (May/June).
"Legal Issues in Providing Special Educational
Services to Handicapped Inmates." Remedial and
Special Education 7(3):34-40.

------------------------------

Endnotes

1. Goldstein, A., R. Sprafkin, N.J. Gershaw, and P.
Klein. 1980. Skillstreaming the Adolescent.
Chicago: Research Press.

2. Beyer, M. 1992 (April). "What Do Children and
Families Need?" Children and the Law. American Bar
Association.

3. Jerry, M. 1987. Panel Report, Washington, D.C. 

4. Terry, D. 1990. Panel Report, Oklahoma. 

5. Thompson, L. S. 1993. "Health Status and Health
Care Issues," Hard Time, Healing Hands: Developing
Primary Health Care Services for Incarcerated
Youth, 21, 25. Arlington, VA: National Center for
Education in Maternal and Child Health; Farrow,
J.A. 1991. "Health Issues Among Juvenile
Delinquents," The Forgotten Child in Health Care:
Children in the Juvenile Justice System 21, 22.
Arlington, VA: National Center for Education in
Maternal and Child Health.

6. Brown, R. 1991. "The Overall Health Status of
Incarcerated Youth," Health Care of Incarcerated
Youth: Report from the 1991 Tri-Regional Workshops,
35, 36. Arlington, VA: National Center for
Education in Maternal and Child Health.

7. Farrow, supra, at 22.

8. Thompson, supra, at 25.

9. Farrow, supra, at 22.

10. Brown, supra, at 36.

11. Parent, D. et al. 1992. Conditions of
Confinement: Juvenile Detention and Corrections
Facilities, 11. Washington, D.C.: Office of
Juvenile Justice and Delinquency Prevention, U.S.
Department of Justice.

12. Ibid.

13. Ibid.

14. Otto, R.K. et al. 1992. "Prevalence of Mental
Disorders Among Youth in the Juvenile Justice
System," Cocozza, J.J., ed. Responding to the
Mental Health Needs of Youth in the Juvenile
Justice System, 7, 21.

15. Otto, supra, at 17-20; Hutchinson, J. 1993.
"Mental Health," Hard Times, Healing Hands:
Developing Primary Health Care Services for
Incarcerated Youth, 121, 123-125. Arlington, VA:
National Center for Education in Maternal and Child
Health; Hutchinson, J. 1991. "Challenging
Perceptions of Youth: `Bad' or `Disturbed'?" Health
of Incarcerated Youth: Report from the 1991
Tri-Regional Workshops, 98, 100. Arlington, VA:
National Center for Education in Maternal and Child
Health.

16. Otto, supra, at 21.

17. Otto, supra, at 18; "Mental Health," supra, at
125.

18. Otto, supra, at 21.

19. Otto, supra, at 20; "Challenging Perceptions of
Youth: `Bad' or `Disturbed'?" supra, at 101-102.

20. "Mental Health," supra, at 127; "Challenging
Perceptions of Youth: `Bad' or `Disturbed'?" supra,
at 101-102.

21. "Mental Health," supra, at 125-26.

22. "Mental Health," supra, at 128.

23. Parent, supra, at 10.

24. Provenzaano, F. 1993. Clinical Outcome Review
and Needs Assessment. Unpublished manuscript about
delinquents in the South Carolina Division of Youth
Services, Columbia.

25. Beyer, M. 1988 (October). "Born Dead," Children
and the Law. American Bar Association.

26. Leone, P., T. Price, and R.K. Vitow. 1986.
"Appropriate Education for Incarcerated Youth,"
Remedial and Special Education, 7, 9-14.

27. Ibid.

28. Warboys, L., and C.B. Shauffer. 1986
(May/June). "Legal Issues in Providing Special
Educational Services to Handicapped Inmates,"
Remedial and Special Education 7(3): 34, 34-35
[hereinafter Warboys]; Warboys, L. et al. 1994.
California Juvenile Court Special Education Manual
109. Youth Law Center [hereinafter California].

29. Warboys, supra, at 38; California, supra, at
111-12.

30. Warboys, supra, at 38.

31. Warboys, supra, at 39; California, supra, at
19-20.

32. Associated Marine Institutes, Tampa, Florida.

33. Beyer, M., N. Opalack, and P. Puritz. 1988
(Spring). "Treating the Educational Problems of
Delinquent and Neglected Children," Children's
Legal Rights Journal.

34. National Street Law Institute, Washington,
D.C.; Juvenile Justice Center, American Bar
Association, Washington, D.C. 

------------------------------

Appendix: Standards for the Administration of
Juvenile Justice

National Advisory Committee for Juvenile Justice
and Delinquency Prevention

4.213 Services

At a minimum, juveniles placed in training schools
should have access to the services described in
Standards 4.214-4.218. When location and security
permit, arrangements should be made for appropriate
residents to receive these services in the
community.

4.214 Development and Implementation of an
Individual Program Plan

Within 15 days of a juvenile's admission to a
training school, a comprehensive assessment report
should be completed. This report should provide an
evaluation of the juvenile's specific problems,
deficiencies, and resources, and contain the
individual's program plan.

An assessment team, composed of a caseworker, a
youth-care worker, an educational diagnostician, a
psychiatrist, and a psychologist, should perform
the assessment.

The assessment should include: family history,
developmental history, physical examinations,
psychological testing, psychiatric interviews,
community evaluation, language and educational
analyses, and information concerning the nature and
circumstances of the conduct on which the
adjudication is based. It should be the
responsibility of the family court to ensure that
any of the above material in its possession is
forwarded to the training school.

After all assessment team members have completed
their respective tasks, they should meet together
to discuss the findings and finalize their
recommendation for the juvenile's program plan. At
such meetings, and throughout the assessment
process, the juvenile should be given full
opportunity to participate in the formulation of
the program plan and to have a voice in determining
his/her program goals.

The juvenile should be given a copy of the program
plan; a copy should be maintained in the juvenile's
institutional file; and a copy should be forwarded
to the placing family court.

The plan should be reviewed monthly by appropriate
staff including members of the assessment team and
other members of the treatment staff with knowledge
of the juvenile's progress under the plan. Any
change in the plan should be noted in the
juvenile's file and notification of the significant
modifications forwarded to the placing family
court.

4.215 Individual and Group Counseling Programs

Training schools should provide a broad range of
individual and group counseling programs with
emphasis upon positive reinforcement and strict
limits on negative reinforcement.

4.2151 Group Therapy

Group therapy should be conducted in groups no
larger than 10 and should meet at least once per
week. Such therapy should be conducted by group
leaders whose experience and training are
commensurate with the type of therapy being
provided and the responsibilities that they have
for supervising the group.

4.216 Educational Services

Training school education programs should provide
for the diverse educational needs of the juveniles
placed therein, and should include academic,
vocational, and special education components.

4.2161 Academic Education

A curriculum substantially equivalent to that
required under the law of the jurisdiction for
public school students should be available to all
juveniles placed in a training school. The academic
program should meet all requirements necessary for
the transfer of earned credits to public schools
within the state and should be certified to award
academic diplomas to juveniles who meet the
requirements for the award of such diplomas during
their placement.

4.2162 Vocational Education

All juveniles should receive career counseling to
provide them with knowledge of a wide range of
career options and with sufficient information and
to choose among vocational and academic areas of
emphasis.

A vocational education curriculum should be
available to juveniles age 14 and over who choose
to participate. Participating juveniles should
receive at least 3 hours of vocational instruction
per week in addition to academic studies, and those
who at age 15.5 decide to undertake vocational
education as their major area of emphasis should
receive at least 15 hours of vocational instruction
per week. An employability plan, based on extensive
counseling regarding career options, should be
developed for each juvenile participating in their
vocational education program.

Limits should be established for "work-experience"
training consisting of institution-maintenance
activities. In no case should those activities
constitute the primary focus of a vocational
education program.

4.2163 Special Education

Special education programs should be available to
meet the needs of juveniles who are educationally
disadvantaged. Juveniles who should be provided
with special education include those who:

a) Exhibit subaverage general intellectual
functioning, possibly in conjunction with deficient
adaptive and/or physical impairments which inhibit
their ability to learn;

b) Exhibit average general intellectual
functioning, although have a visual, hearing, or
speech impairment or emotional disturbance that
significantly inhibits their ability to learn; and 

c) Despite average intelligence, adequate hearing,
vision, motor capacity, and emotional adjustment,
exhibit a substantial deficiency in learning and
conceptualizing which is frequently demonstrated by
their inability to read or clearly and consistently
understand spoken language.

In utilizing intelligence quotient and achievement
tests to determine whether a juvenile requires
special education, primary reliance should be
placed on those tests which are appropriate for the
juvenile's ethnic and cultural background.

4.217 Health and Mental Health Services

Training schools should provide programs to protect
and promote the physical and mental well-being of
juveniles placed therein, to discover those in need
of short-term and long-term medical and dental
treatment, and to contribute to their
rehabilitation by appropriate diagnosis and
treatment.

Training schools should undertake treatment of
health problems, without cost to the juvenile or
his/her family including medical care and
correction of health defects of a cosmetic nature.
Procedures should be established for assuring the
continuation and completion of treatment begun in a
facility whenever a juvenile remains subject to the
disposition of the family court following release
from the training school.

Health services available to juveniles placed in a
training school should be of equal quality to those
available in the community.

4.2171 Initial Health Examination and Assessment

Each juvenile, as part of the admittance
procedures, should be examined for apparent
injuries, and for fever or other signs of illness.
The examining officer should also note the
juvenile's level of consciousness and level of
gross motor function. Written standing orders
should define the conditions which require prompt
medical or nursing attention.

All juveniles placed in a training school should
undergo a health assessment at the first possible
opportunity after admission. Exceptions should only
be made for juveniles with a written record of a
thorough health assessment which is sufficiently
current so that no substantial change can be
reasonably expected. Health assessment should
include physical examination within 24 hours of
admission, the taking of a medical history, the
taking of a mental history if necessary, screening
for vision and hearing defects. Conditions which
might affect behavior, such as epilepsy or
diabetes, should be reported to the appropriate
assessment team in a manner compatible with medical
ethics and the rights of the patient.

4.2172 Responsibility Toward Patients

Appropriate permission should be obtained for the
performance of significant medical and dental
procedures. Permission for such procedures should
be obtained from a juvenile's parents or guardian
unless the juvenile has a legal right to receive
the medical or dental service without that consent.
All medical and dental care should be rendered with
consideration for the juvenile's dignity and
feelings. Medical procedures should be performed in
privacy and in a manner designed to encourage the
juvenile's subsequent utilization of appropriate
medical, dental, and other health services.

The use of any procedures, techniques, or
medications that have not previously passed
rigorous scientific tests which demonstrate both
their safety and their effectiveness, or that pose
an unnecessary threat to the juvenile's physical or
mental well-being, should be prohibited.

4.2173 Diet

Training schools should provide an adequate, varied
diet and well-prepared and well-served meals
supervised by a licensed dietician who should
receive special training pertaining to allergic
reaction, hyperactivity, and other mental,
emotional and physical reactions of susceptible
youth to particular food substances.

Weekly menus should be prepared and copies should
be posted and maintained centrally within the
facility. All deviations from the weekly menu
should be recorded.

To the extent possible, food ordering and
preparation should take into consideration ethnic
tastes and food preferences of the juveniles.

4.2174 Mental Health Services

Psychiatric services in training schools should
concentrate on diagnosis and training of staff who
have daily contact with juveniles. Diagnosis should
be utilized to determine whether the juvenile is
appropriate for the training school program and to
assess the juvenile's treatment needs. Staff
training and consultation should be utilized
primarily to assist childcare workers and other
staff with direct treatment responsibilities in
helping their charges through group and individual
approaches.

When therapeutic mental health services are
provided, the juvenile's family should be involved
insofar as is possible and consistent with the
needs of the juvenile. Individual therapy should
only be conducted by psychiatrists, psychologists
who have a doctoral or masters degree in
psychology, or individuals with masters degrees in
social work and counseling.

All juveniles placed in training schools should be
informed upon entry that they may request of any
training school employee a personal consultation
with either a psychiatrist or psychologist.
Consultation with either a psychiatrist or
psychologist, selected by the training school,
should be provided as quickly as possible.

4.218 Recreational Services

Training schools should provide opportunities for
exercise and constructive and entertaining
leisure-time activity. The opportunities should be
in addition to the physical education requirements
that may exist under the education laws of the
jurisdiction. Activities should be balanced between
individual-type and team-type activities of both
indoor and outdoor varieties. At least 2 hours of
recreation should be provided on school days and 3
hours on nonschool days, not including unsupervised
periods spent primarily in such activities as
watching television.

4.223 Services

Camps and ranches should offer a broad range of
services including, but not limited to, the
specific service areas described below.

A treatment plan should be prepared jointly by each
juvenile and his/her assessment team. Each
assessment team should be composed of a childcare
worker, a caseworker, and a teacher. The plan
should provide a structured schedule of activities,
counseling, and education, but should not involve
intensive psychotherapy because juveniles with
deep-seated emotional or psychological problems
should be treated at facilities closer to community
resources.

The primary emphasis of the treatment strategy of a
camp or ranch should be on a work-oriented program.
However, remediation resources should be available
to juveniles requiring specific academic attention
as an adjunct to their vocational training
experience.

Camps and ranches should have contractual
relationships with local physicians and hospitals
for the delivery of medical and dental needs which
cannot be fulfilled by the staff. These
arrangements should include screening and
assessment of incoming juveniles, 2-hour emergency
care procedures and routine medical care
procedures. Each camp or ranch should have a
written medical care plan detailing by name and
telephone number the person or institution to be
contacted for each category of medical care.

4.233 Services

Inhouse services at all group homes should include
shelter, food, recreation, temporary financial
assistance, and individual and/or group counseling.
Juveniles placed in group homes should have access,
as their particular needs require, to services in
the community which are not provided inhouse. Among
the community services which should be available to
such juveniles are medical, psychiatric, and dental
care; psychiatric evaluation, counseling, and
therapy; vocational training; vocational and/or
employment counseling and evaluation; employment
placement; and academic upgrading. Supplementary
services in these areas may also be provided by the
group home.

Before or upon admission to a group home, a
juvenile and, whenever possible, his/her family
should assist in the preparation of an assessment
of needs and the development of a plan establishing
goals to be achieved during the juvenile's stay. In
helping the juvenile to accomplish these goals, the
group home's role should be similar to that of a
properly functioning natural home, including the
provision of necessities; assisting juveniles to
overcome difficulties in a broad range of areas;
and serving as a place to which juveniles can turn
in time of need.

A single case record for each juvenile admitted to
a group home should be maintained.

4.252 Services

The foster home should be a family setting.
Concentration should be upon comfort and privacy in
the living arrangements, the parenting skills of
the houseparents and accessibility of the home to
schools, recreation, and special resources such as
medical clinics required by the juveniles placed
therein.

4.263 Services

Although detention centers should not be considered
as treatment facilities, detained juveniles should
be provided with educational, medical,
recreational, and other services appropriate to
their needs, and an adequate and competent staff.
Upon admission, or as soon as possible thereafter,
there should be an assessment of a juvenile's needs
including an examination by a physician within 24
hours of admission, and a determination of the
juvenile's educational level.

Contractual arrangements should be made with a
nearby hospital for all medical services which
cannot be appropriately provided within the
facility or where contractual arrangements can
result in better or a broader range of services. A
medical record should be maintained and all should
be provided for pursuant to the physician's
instructions. Each juvenile should also be afforded
reasonable access to psychiatric counseling and
crisis intervention services in accordance with
his/her needs.

The educational program provided in detention
facilities should seek to assist detained juveniles
to keep up with their studies to the greatest
extent possible. Remedial education services should
be provided for those juveniles who require it.

The recreational program should provide
opportunities for exercise and constructive
leisure-time activity. At least 2 hours of
recreation should be provided on school days, and 3
hours of recreation on nonschool days, not
including unsupervised periods spent primarily in
such activities as watching television.

4.32 Services

A broad range of services should be available to
persons subject to community supervision.
Ordinarily such services should be provided by the
community rather than directly by the supervision
agency. 

Upon placement under community supervision, the
person supervised and, whenever possible, his/her
family, should assist in the preparation of an
assessment of needs and the development of a plan
establishing the goals to be achieved during the
supervision period.

The family court should have the authority to order
supplemental services to families when such
services are necessary to enable the juvenile or
family to participate in a nonresidential program.
Among the supplemental services which should be
available are homemaker services for a juvenile's
family and cash payments directly to the juvenile
when supervised independent living is appropriate.
Whenever specific supplemental or other services
ordered by the family court are not available, an
application to review and modify the disposition
decision should be submitted pursuant to Standard
3.189.