37 Tex. Admin. Code § 380.8751 - Specialized Treatment
(a) Purpose. The
purpose of this rule is to establish the process by which youth committed to
the Texas Juvenile Justice Department (TJJD) are assessed and treated for
specialized treatment needs. The purpose of all provisions in this rule is to
promote successful youth reentry and reduce risk to the community by addressing
individual specialized treatment needs through programs that are designed to
reduce risk to reoffend.
(b)
Definitions. Except as indicated in this subsection, see §
380.8501 of this chapter for
definitions of terms used in this rule.
(1)
Intensive Treatment Program--a high-intensity treatment program designed to
address youth with a high need for specialized treatment. Treatment is
generally delivered in specialized groups by licensed or appropriately trained
staff.
(2) Psycho-educational
Program--a low-intensity program delivered by appropriately trained staff that
is designed to address youth with a low need for specialized
treatment.
(3) Sex Offense--a
reportable adjudication as defined in Article 62.001 of the Texas Code of
Criminal Procedure.
(4) Mental
Health Professional--see definition in §
380.9187 of this
chapter.
(5) Moderate-Intensity
Treatment Program--a program designed to address youth with a moderate need for
specialized treatment. Treatment is generally delivered in specialized groups
by licensed or appropriately trained staff.
(c) General Provisions.
(1) Youth with one or more specialized needs
will have these needs addressed while under TJJD jurisdiction. Youth may have
specialized needs addressed while in a high- or medium-restriction facility or
on parole status.
(2) If a youth
cannot be provided the type(s) of specialized program designated in this rule
for the youth's assessed need level, the youth will be provided with the most
appropriate alternate form of intervention for that treatment need.
(d) Treatment Planning.
(1) Upon admission to TJJD, comprehensive
assessments are conducted to determine if a youth has any specialized treatment
needs and to identify the type of specialized program that is best suited to
address those needs. For each youth assessed as having a specialized treatment
need, an initial plan documenting all specialized treatment needs and
recommended programs is developed as soon as possible.
(2) In addition to the initial plan, a
comprehensive plan is developed for each youth with specialized treatment
needs. The comprehensive plan must:
(A)
include individually tailored statements regarding treatment goals and
objectives;
(B) include the
tentative sequence and start dates for each specialized program;
(C) be developed with input from the youth;
and
(D) be documented in the
youth's individual case plan.
(3) The sequence and start dates for
specialized programs are based on individual youth needs, facility schedules,
and program openings, with consideration given to the youth's minimum length of
stay or minimum period of confinement.
(4) The comprehensive specialized treatment
plan is reviewed, reevaluated, and modified in accordance with rules for the
review and modification of the individual case plan, as set forth in §
380.8701 of this chapter. The plan
is also modified following each reassessment of a youth's specialized treatment
needs.
(5) Specialized treatment
needs may be reassessed at any time during a youth's stay in TJJD.
(e) Specialized Treatment Needs.
The areas of specialized treatment need are set forth in paragraphs (1) - (6)
of this subsection, with each area given priority for placement and treatment
based on urgency of need.
(1) Medical. Each
youth is provided comprehensive medical and dental examinations. Based on the
results of these examinations, each youth is assigned a need level for medical
or dental services. Non-compliance with treatment may cause any youth to be
designated as higher need than the underlying condition would typically
warrant.
(A) High Need--includes youth who
require medical, surgical, or dental services of an intense/acute nature. The
youth has a serious acute condition, experiences an exacerbation of a chronic
medical or dental condition, sustains a serious injury, and/or may require
hospitalization. The youth's condition is unstable or unpredictable, and
recovery requires 24-hour nursing care or supervision beyond the scope of
normal infirmary services. The youth's medical needs, until resolved, take
precedence over other therapeutic interventions and temporarily prevent active
participation in programming.
(B)
Moderate Need--includes youth who are diagnosed with a medical or dental
condition that is moderate to serious in severity and that may require frequent
access to clinical and/or hospital services for symptom exacerbation.
(C) Low Need--includes youth who are
diagnosed with a condition that is mild to moderate in severity and does not
require ongoing treatment or monitoring. The youth may be temporarily
restricted from an activity due to an accident, injury, or illness of mild to
moderate severity.
(D)
None--includes youth with no medical or dental diagnosis requiring ongoing
attention.
(2) Mental
Health. The mental health needs assessment is provided by mental health staff
through comprehensive psychological and/or psychiatric evaluation using the
most current edition of the Diagnostic and Statistical Manual of Mental
Disorders (DSM). Based on this assessment, each youth is assigned a need level
for mental health treatment services.
(A) High
Need - Level 1.
(i) This level of treatment
need includes youth who:
(I) are diagnosed
with a mental disorder. As a result of the disorder, there is disorganized,
bizarre, and/or grossly inappropriate behavior in one or more of the following
areas: social or interpersonal interactions, educational or vocational
participation, or the ability to manage daily living requirements;
(II) have an assessment of adaptive
functioning that is consistent with the level of impairment noted;
(III) cannot meaningfully participate in
programming until the underlying disorder is stabilized; and/or
(IV) are an imminent danger to themselves or
others as a result of the mental disorder.
(ii) This level of impairment is not the
result of a conduct disorder, oppositional defiant disorder, or similar impulse
control/behavioral disorders and is not the result of intoxication or
withdrawal from drugs.
(iii) Youth
with this level of impairment require a protective environment during this
phase of the disorder and are treated at an agency-operated crisis
stabilization unit or a psychiatric hospital with psychiatric care as the
highest priority.
(B)
High Need - Level 2.
(i) This level of
treatment need includes youth who:
(I) are
diagnosed with a mental disorder. As a result of the disorder, there is
moderate to severe impairment in one or more of the following areas: social or
interpersonal interaction, educational or vocational participation, or the
ability to manage daily living requirements despite receiving psychiatric care
and clinical support services;
(II)
have an assessment of adaptive functioning that is consistent with the level of
impairment noted; and/or
(III) are
having a difficult time maintaining stability and program participation despite
receiving psychiatric services and local clinical support.
(ii) This level of impairment is not the
result of a conduct disorder, oppositional defiant disorder, or similar impulse
control/behavioral disorders and is not the result of intoxication or
withdrawal from drugs.
(iii) Youth
with this level of treatment need are placed in an intensive mental health
treatment program with structured interventions and enhanced clinical support
services in addition to regular psychiatric services.
(C) Moderate Need.
(i) This level of treatment need includes
youth who:
(I) are diagnosed with a mental
disorder. As a result of the disorder, behavior is mildly impaired by signs and
symptoms of the mental disorder in one or more of the following areas: social
or interpersonal interaction, educational or vocational participation, or
ability to manage daily living requirements with regular psychiatric care
and/or psychological intervention;
(II) have an assessment of adaptive
functioning that is consistent with the level of impairment noted;
and/or
(III) display symptoms or
difficulties with adaptive behavior as a result of abuse or trauma.
(ii) This level of treatment need
is not the result of a conduct disorder, oppositional defiant disorder, or
similar impulse control/behavioral disorders and is not the result of
intoxication or withdrawal from drugs.
(iii) Youth with this level of treatment need
are placed in an agency facility offering the necessary clinical and/or
psychiatric support. Youth identified with a history of abuse or trauma are
offered interventions specific to the trauma to help maintain their ability to
function and participate in programming.
(D) Low Need--includes youth who require only
periodic mental health services, regardless of whether the youth have a mental
health diagnosis, or regular psychiatric services. For youth with a psychiatric
diagnosis, the assessment of adaptive functioning is consistent with the level
of impairment noted.
(E)
None--includes youth who do not require follow-up services from mental health
or psychiatric providers, regardless of whether the youth have a mental health
diagnosis.
(3)
Intellectual Disability. The diagnosis of intellectual disability is made by
mental health staff based on the results of a culturally validated assessment
of cognitive functioning, mental abilities, reasoning, problem solving,
abstract thinking, and adaptive behavior as defined in the latest edition of
the DSM. Based on this diagnosis, each youth is assigned a need level for
intellectual disability services. Youth are assigned to the placement that is
best suited to meet the youth's individual treatment needs.
(A) High Need--includes youth diagnosed with
moderate or severe intellectual disability who have corresponding deficits in
intellectual and adaptive functioning.
(B) Moderate--includes youth diagnosed with
mild intellectual disability who have a co-occurring mental health treatment
need of moderate or low.
(C) Low
Need--includes youth diagnosed with mild intellectual disability who have no
co-occurring mental health treatment needs.
(D) None--includes youth who have no
diagnosis of intellectual disability.
(4) Sexual Behavior. The sexual behavior
treatment need assessment is provided by a psychologist, mental health
professional, or licensed sex offender treatment provider through a clinical
interview and an agency-approved juvenile sexual offender assessment
instrument. The assessment is provided for youth who have been adjudicated for
a sex offense or who have a documented history of sexually inappropriate
behavior. Based on this assessment, each youth is assigned a need level for
sexual behavior treatment services.
(A) High
Need--includes youth who receive an assessment rating of high need for sexual
behavior treatment based on the results of the clinical interview and the
agency-approved juvenile sexual offender assessment instrument. Youth with this
level of treatment need are assigned to participate in an intensive sexual
behavior treatment program.
(B)
Moderate Need--includes youth who receive an assessment rating of moderate need
for sexual behavior treatment based on the results of the clinical interview
and the agency-approved juvenile sexual offender assessment instrument. Youth
with this level of treatment need are assigned to participate in a
moderate-intensity sexual behavior treatment program.
(C) Low Need--includes youth who receive an
assessment rating of low need for sexual behavior treatment based on the
results of the clinical interview and the agency-approved juvenile sexual
offender assessment instrument. Youth with this level of treatment need are
assigned to participate in a psychosexual education curriculum.
(D) None--includes youth who have no assessed
need for sexual behavior treatment.
(5) Capital and Serious Violent Offender. A
psychologist or mental health professional makes a determination of need for
capital and serious violent offender treatment for any youth who was found by a
court or a Level I due process hearing to have engaged in conduct that resulted
in the death of or serious bodily injury to a person or involved using or
exhibiting a deadly weapon and any youth referred by a mental health
professional based on a reasonable belief the youth is in need of capital and
serious violent offender treatment. The determination is based on the youth's
offense history and clinical assessment of the youth's need for specialized
treatment intervention.
(A) High Need--youth
are assigned to participate in an intensive capital and serious violent
offender program.
(B) Medium
Need--youth are assigned to participate in a moderate-intensity program
designed to address aggression and violent behavior issues.
(C) Low Need--youth are assigned to
participate in a psycho-educational anger management supplemental
curriculum.
(D) None--includes
youth who are assessed as not having a significant risk related to violent
offending or behavior.
(6) Substance Use Services. All youth are
screened to determine if they should be assessed for a need for substance use
services. Those who need further assessment are assessed and diagnosed by
mental health staff or a chemical dependency counselor using the latest edition
of the DSM. Based on a clinical interview and the results of an
agency-approved, comprehensive assessment instrument, each youth is assigned a
need level for substance use services.
(A)
High Need--includes youth with a diagnosis of substance use disorder and a
high-intensity substance-use-services treatment need based on the results of an
agency-approved assessment instrument. Youth with this level of treatment need
are assigned to participate in an intensive substance-use-services treatment
program.
(B) Moderate
Need--includes youth with a diagnosis of substance use disorder and a
moderate-intensity substance-use-services treatment need based on the results
of an agency-approved assessment instrument. Youth with this level of treatment
need are assigned to participate in a moderate-intensity substance-use-services
treatment program.
(C) Low
Need--includes youth with any identified substance use history or risk that
does not rise to the diagnostic level of substance use disorder. Youth with
this level of treatment need are assigned to participate in a
psycho-educational substance-use-services program.
(D) None--includes youth who have no history
of substance use or risk of use.
(f) Requirement to Complete Specialized
Treatment.
(1) This subsection applies only to
youth who are assessed as having a high or moderate treatment need in the
following treatment areas: sexual behavior, capital and serious violent
offender, or substance use services. This subsection does not apply to youth
assigned to complete psycho-educational supplemental curricula in these
treatment areas.
(2) For purposes
of §§
380.8545,
380.8555, and
380.8559 of this chapter,
participation in or completion of assigned specialized treatment programs
means:
(A) the youth has completed assigned
specialized treatment programs; or
(B) a designee of the executive director with
appropriate expertise determines that the youth has made sufficient progress
toward treatment goals or that the goals can be addressed in a
non-high-restriction setting.
(3) This subsection does not apply to
decisions made by the Release Review Panel under §
380.8557 of this
chapter.
(g) Individual
Exceptions.
(1) The requirement to complete
specialized treatment as described in subsection (f) of this section may be
waived if the division director over specialized treatment or designee
determines that the youth is unable to participate in the assigned specialized
treatment program due to a medical or mental health condition or due to an
intellectual disability.
(2) Each
youth's individual circumstances are considered when determining the most
appropriate type of specialized treatment intervention to assign. A youth may
be assigned or reassigned to a specialized program designated for a higher or
lower need level than the youth's assessed need level for any reason deemed
appropriate by the division director over specialized treatment or
designee.
(3) The executive
director or designee may make exceptions to provisions of this rule on a
case-by-case basis, based on a consideration of the youth's best interests and
public safety.
(4) The
justification for any individual exceptions granted under this subsection must
be documented.
(h)
Specialized Aftercare. Youth will be provided specialized aftercare as needed
and as available.
Notes
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