• ABA via insurance

    How to Get ABA and Other Services Funded Via Insurance for Those on the Autism Spectrum

    (Editor’s Note: If you live in Indiana, trying to get a school to pay for Applied Behavior Analysis Therapy for a child with autism is extremely difficult. It’s routinely offered to children outside the state because it’s the only scientifically proven method to help teach children with autism. We still have a lot to learn here. Therefore, many folks turn to insurance companies to fund this therapy that helps children with autism learn to learn. Below is some practical advice from an Indiana parent of a child with autism on how she got ABA therapy for her child taken care of through insurance. She gave us permission to share her experiences with you. She is not an attorney, and the information below is for educational purposes, not to offer legal advice.)

    By Beverly Chase

    If you have an insurance company that is fully funded and is governed by Indiana state laws, there is a mandate (IC-27-8-14.2) that is almost 3 years old that you can use if your child has a diagnosis on the autism spectrum. I am pasting a copy of the mandate below. If your insurer does not fall under Indiana state law it is possible that the state by which they are governed has a mandate similar to ours. I know Georgia and CA. have them but I don't know about the other states. I would suggest contacting the department of insurance in the state that governs your insurer and asking if there is a mandate for PDD-NOS, autism, or aspergers.

    If you have a child on the spectrum, I highly suggest you educate yourself on this mandate. Even if you do not want ABA therapy, you can use it to get other services such as speech, OT and PT. The language in this mandate is very broad and was made that way intentionally. The Legislature wanted to make sure that insurers did not use a one-size-fits-all approach because our kids all need different things. Basically the mandate states that if your child is on the spectrum, whatever is on the treating physician's treatment plan (or plan of care) MUST be covered. For example, if Johnny's treatment plan says he needs SLP up to 3 hours a week, then the mandate says this is what the insurers must provide.

    I also want to ask that parents and physicians be reasonable. The insurers have cried, and continue to cry, that parents are or will ask for the sun, the moon, the stars. 99.9 percent of us would never ask for more than what is truly needed and reasonable. I do not suggest listing things such as vitamins, supplements and diet related expenses. And by all means do not come up with a family trip to Hawaii... it has happened (or so I was told)... While we all need and deserve a trip/vacation, we do not want to give the Legislature any reason to agree with the insurers that we are being unreasonable.

    The insurance companies are not just laying down and saying, “Oh, OK. We will do whatever the mandate says.” They are making most of us (me included) fight for it. But, parents ARE getting their ABA programs (and SLP, OT, PT, etc) funded. So, it is definitely worth it to fight. After 13 months of appeals and assistance from IDOI, we were able to get our home and now, center-based ABA program funded. It was a LONG fight but in the end well worth it. I am so glad I stuck it out as my son is making wonderful progress. The following is a step-by-step “how-to” manual. Most of what is in here I have learned out of experience and from another a parent who is a true pioneer in fighting insurers to comply with this mandate. This is my attempt to pay forward. Please feel free to pass this on to whomever you like. I think it is critical that we use/fight for this mandate. Otherwise Legislators will have fought to give us this mandate for no reason. And I for one refuse to let the insurers win.

    Steps to get insurance funding for ABA (SLP, OT, etc)

    Step 1: Call the HR dept of employer. Ask the following questions.

    1. Is my insurance plan fully funded or self-funded?

    If insurer is self-funded then they are exempt from the Indiana Insurance Mandate IC-27-8-14.2 (see copy of it below). However, I would still follow same procedure listed below. Self-funded plans can cover anything they choose, so in that regard has flexibility. I have heard of one self-funded plan, and 1 out of state plan (Eli Lilly & Blue Cross Blue Shield) that covered ABA despite not being required to. So, it is worth a shot!

    2. If plan is fully insured, ask HR which state regulates that plan.

    If the answer is Indiana, then as an Indiana resident, you are protected under the mandate. And even if the answer is not Indiana, you might be covered under a mandate. For example, California and Georgia are two other states that have similar mandates. The following is a copy of Indiana's autism mandate.

    IC 27-8-14.2

    Chapter 14.2. Insurance Coverage for Pervasive Developmental Disorders IC 27-8-14.2-1

    "Accident and sickness insurance policy" defined

    Sec. 1. (a) As used in this chapter, "accident and sickness insurance policy" means an insurance policy that provides one (1) or more of the types of insurance described in IC 27-1-5-1, classes 1 (b) and 2(a).

    (b) The term does not include the following:

    (1) Accident-only, credit, dental, vision, Medicare supplement, long term care, or disability income insurance.

    (2) Coverage issued as a supplement to liability insurance.

    (3) Worker's compensation or similar insurance.

    (4) Automobile medical payment insurance.

    (5) A specified disease policy issued as an individual policy.

    (6) A limited benefit health insurance policy issued as an individual policy.

    (7) A short term insurance plan that:

    (A) may not be renewed; and

    (B) has a duration of not more than six (6) months.

    (8) A policy that provides a stipulated daily, weekly, or monthly payment to an insured during hospital confinement, without regard to the actual expense of the confinement.

    As added by P.L.148-2001, SEC.2.

    IC 27-8-14.2-2

    "Insured" defined

    Sec. 2. As used in this chapter, "insured" means an individual who is entitled to coverage under a policy of accident and sickness insurance. As added by P.L.148-2001, SEC.2.

    IC 27-8-14.2-3

    "Pervasive developmental disorder" defined

    Sec. 3. As used in this chapter, "pervasive developmental disorder" means a neurological condition, including Asperger's syndrome and autism, as defined in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association.

    As added by P.L.148-2001, SEC.2.

    IC 27-8-14.2-4

    Group coverage required

    Sec. 4. (a) An accident and sickness insurance policy that is issued on a group basis must provide coverage for the treatment of a pervasive developmental disorder of an insured. Coverage provided under this section is limited to treatment that is prescribed by the insured's treating physician in accordance with a treatment plan. An insurer may not deny or refuse to issue coverage on, refuse to contract with, or refuse to renew, refuse to reissue, or otherwise terminate or restrict coverage on an individual under an insurance policy solely because the individual is diagnosed with a pervasive developmental disorder.

    (b) The coverage required under this section may not be subject to dollar limits, deductibles, or coinsurance provisions that are less favorable to an insured than the dollar limits, deductibles, or coinsurance provisions that apply to physical illness generally under the accident and sickness insurance policy. As added by P.L.148-2001, SEC.2.

    IC 27-8-14.2-5

    Individual coverage required

    Sec. 5. (a) An insurer that issues an accident and sickness insurance policy on an individual basis must offer to provide coverage for the treatment of a pervasive developmental disorder of an insured. Coverage provided under this section is limited to treatment that is prescribed by the insured's treating physician in accordance with a treatment plan. An insurer may not deny or refuse to issue coverage on, refuse to contract with, or refuse to renew, refuse to reissue, or otherwise terminate or restrict coverage on an individual under an insurance policy solely because the individual is diagnosed with a pervasive developmental disorder.

    (b) The coverage that must be offered under this section may not be subject to dollar limits, deductibles, or coinsurance provisions that are less favorable to an insured than the dollar limits, deductibles, or coinsurance provisions that apply to physical illness generally under the accident and sickness insurance policy.

    As added by P.L.148-2001, SEC.2.

    Step 2: Use the template of the treatment plan letter below if the PCP or other professional is unfamiliar with writing one specific to the mandate/autism.

    Take it to, fax it to, mail it to child's PCP, or other professional such as developmental pediatrician, neurologist, psychologist, etc. Send it to any treating physician whom you think would be willing to help. Ask the doctor(s) to use the language in the letter since it encompasses the language listed in the mandate. Be sure they type it on their letterhead and sign it. Ask them to send it to you, not the insurance company. You want to be the one to send the letter *certified* mail. Make sure to make copies.

    Sample:

    To Whom It May Concern: I am the _____________ (PCP, Dev. Ped, etc) for _________ (child's name). _________ (child's first name) has autism (or PDD-NOS or Aspergers), which is a neurological condition. I have been part of _______ (child's name) treatment team since _______ (date). As part of _______ (child's name) treatment plan, I find the following services to be medically necessary:

    1)__________ (type of therapy), up to ______ hours per week

    2)___________ (type of therapy), up to _____ hours per week

    3)___________ (type of therapy), up to ____ hours per week

    Sincerely,

    (doctor's signature)

    Step 3: While you are waiting on treatment plan letter(s), call your insurance company and request that a case manager be assigned to your child.

    If you get the runaround, I would first speak to a supervisor and if needed follow up request in writing. The reason this is important is you will have just one person to deal with. When you call the 800# and speak to customer service representatives you are likely to get incorrect and inconsistent information. Plus it is easier to track information. The reason you state to them verbally and/or in writing that you need a case manager is that your child has a chronic neurological disorder, which will require multiple specialists and treatments. This step is not critical, but will hopefully make life easier.

    Step 4: (This can be done in conjunction with, or exclusive of step 3.)

    If you have not started an ABA program or other therapies yet, call insurer and notify them that you have a child on the autism spectrum and their treating physician has prescribed ABA, or other therapy for your child. Ask them what you need to do. If you already receive and pay for services, ask insurer what you need to do to get funding. Insurers ask for different things, but you want to make sure you ask if there is a process or procedure they would like you to follow. Chances are they will tell you ABA is not a covered service. That they do not provide services for developmental delays, autism, etc… If you have M-Plan, Aetna or CIGNA, you *might* get someone who tells you a procedure. But most likely you will be told we don't cover it.

    Another possibility if asking for ABA therapy, is they will assign you to the mental health division. This is what CIGNA did to us. I suggest trying to keep it out of the mental health division since benefits are less favorable there and the mandate clearly states benefits cannot be less favorable than those under the accident and sickness policy. BUT... if you do end up under a mental health umbrella, don't fret. In addition to the autism mandate there are federal and state mental health mandates. The mental health mandate for Indiana is IC 27-8-5-15.6. Let me know if you need a copy of this, or more support due to placement under mental health umbrella. Regardless of where you end up, if they tell you ABA or autism is not a covered service tell them you have a copy of a mandate (IC-27- 8-14.2) which says they are required to cover what is prescribed on the treating physician's treatment plan. Offer to fax or mail them a copy of both.

    Step 5: Fax or mail a copy of the mandate and the treatment plan(s). Remember to request a return response promptly and in writing. If insurer requests copy via USPS, send it via certified mail. Now you wait for a response. If you have given them a full business week after faxing, and 2 business weeks, after mailing, and have not heard anything, I would call them and/or follow up in writing. You want to verify they received everything and ask what happens next.

    Step 6: This is where it gets gray and difficult to advise since each case is different.

    But, here are some of the things I have either had happen or heard of happening. They tell you they are working on locating providers who are licensed. This is when you inform them there is no license for ABA in Indiana. Another helpful hint is try to steer away from the term "therapist" since it conjures up the need for a license in the minds of insurers. I would use terms such as, line staff, direct one on one ABA instructors, or instructional assistants. Also, steer away from using terms like school, education, educators, teachers, etc. I remember my insurer had a fit over the term "verbal" when I said he was receiving VBA. They tried to say it was speech therapy. From that point on I used the term Applied Behavior Analysis/ABA.

    Your insurer might tell you that they will reimburse for ABA up to 60 sessions a year, or a random number of calendar days. Because IC-27-8-14.2 is not a parity law the insurer cannot place these types of limitations based on what is in their policy, the autism mandate and treatment plan supercedes their policy limitations. This means that insurer cannot say they will only provide coverages and limitations that are up to or equal to other members. For example CIGNA tried to say that once licensed professionals were found they would fund up to 60 sessions a year since this is our plan benefit under the mental health plan. They can't do this for 2 reasons 1) they are applying benefits that are less favorable than those provided under the accident and sickness policy and 2) nowhere in the mandate does it say words such as up to, not to exceed, parity law, etc. It says whatever is in the treatment plan.

    Step 7: Either turn in claims of ABA services provided if already begun, or appeal decision to not fund ABA.

    The appeals procedure is outlined in your benefits handbook, or GSA (Group Service Agreement). If turning in claims expect they will deny them and then you appeal their decision. A helpful hint… Your insurer will deduct co-pays from reimbursements. So be aware that you will not get anything (or very little) back if you have instructor "A" come for 2 hours and then have instructor "B" come in for 2 hours. For example, if both therapists make $10 an hour, that means each one made $20.00 that day. If your co-pay is $10 per provider then you are paying 50/50 match w/insurer. If your insurer decides to charge you a $20 co-pay per provider, per day as mine does, then you will get zero, zilch, nada reimbursed from insurer. I have learned the hard way that it is best to have instructors come for 4 hours or more. If you have a wee one, split the day up but w/the same therapist. Do a rotation of instructor "A" on M, W, F and instructor "B" on T & TH. I wish I would have figured this out back in August!!! CIGNA did finally reimburse, but we got little back since we were doing split days with 2 therapists. Just something to keep in mind when hiring and scheduling staff.

    Step 8: At the same time you are appealing with insurer, file a complaint with the Indiana Department of Insurance.

    The forms can be completed online or you can mail it to them. For more information contact IDOI's consumer complaint division. The reason this is important is if your complaint is not resolved and is determined valid, IDOI will send it to their enforcement division where an attorney will be assigned. The attorney will investigate and follow through with any regulatory or procedural violations. To be frank, I don't think my insurer would have ever complied with the mandate had IDOI not been involved. Also, it is VERY expensive, but know that you can also consult private attorneys. We checked into this but it was too expensive for us. Be sure the attorney specializes in insurance law, this is critical!

    Now for a few reminders…

    1. ALWAYS document every conversation you have with anyone during this process. Write down the person's name and/or employee ID#, the date, the time and a detailed summary of the conversation. If you communicate via e-mail, print and save each one. Create a file folder or binder (my choice) for this topic and keep it tidy and organized.

    2. As hard as it is, try to remain calm. Stick to the facts. The law is on your side.

    3. Know and expect that this might be a long, stressful process that is sure to make you more than angry many times. Even the people you think are trying to help you will let you down. Just try to remember that most everyone is doing their job the best they can, or as they are being instructed to do. Be direct, persistent, but respectful. Just try to find the humor in it and move on.

    4. Most importantly, KEEP GOING!!! The insurance companies do not like having to fund anything they don't have to. They are banking that people will not A) know about the mandate B) have the energy or knowledge to fight them on it C) that when they drag their feet long enough that you will finally give up. Unless your sanity or otherwise is at stake, do not give up. This battle is also for everyone else that comes behind you. I am writing this to help you, just as I was helped by someone else. KEEP GOING!!!

    Please feel free to e-mail me with any questions. I may not know the answer but I will do my best to help you find it. My e-mail address is love4jake@sbcglobal.net.

    ***** Disclaimer ***** I am just a mom and have no legal training or background in the insurance industry. My statements and advice are not intended to replace your own research and examination.

    In Wheeler v. Aetna Life Ins. Co., No C6064 (N.D. Ill. 07-21-03), the court found Aetna acted arbitrarily and capriciously in denying coverage of autism-related speech, integrated sensory and occupational therapies for a plan participant’s son with autism.

    When dealing with a situation in which insurance coverage is being denied for ABA therapy, the first place to start is to look at the insurance contract carefully. If it specifically excludes autism as a covered condition, you are fighting an uphill battle. It’s not necessarily a losing battle, but it’s certainly a tough one. Another issue is who is paying for the insurance? If it's the child's parents’ employer, ERISA may pre-empt any "insurance bad-faith claim” against the insurance company.

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  • Charter Schools

    In determining whether a charter school is subject to the IDEA and Section 504, it is important to find out whether the charter school is a public school of the local education agency (LEA) or not. If the charter school is a public school of the LEA, then the responsibility to ensure that FAPE is provided to kids with disabilities is the responsibility of the LEA. If the charter school is NOT a public school of the LEA, then the responsibility is the state educational agency's unless the state assigns it to another entity. You can usually find out if the charter school is a public school of the LEA or not by asking the charter school for its memorandum between either the state or the local school district.

    If the answer is “yes” that the charter school is a public school, and most are, then all the same requirements under the IDEA and Section 504 would apply.

    Sadly, many parents describe that charter school officials tell them things like, “We’re a charter school, and therefore, we don’t do 504 plans or IEPs.” This is contrary to law.

    More details about charter school obligations to students with disabilities are available in the publication from the U.S. Department of Education Office for Civil Rights online at http://www.uscharterschools.org/pdf/fr/civil_rights.pdf

    What is a charter school’s obligation to make sure that student applicants with disabilities are treated in a nondiscriminatory manner in regard to admissions?

    Under Section 504 (of the Vocational Rehabilitation Act) and Title II (of the Americans with Disabilities Act), a charter school may not categorically deny admission to students on the basis of disability. For example, it many not deny admission to a student with a disability solely because of that student's need for special education or related aids and services. Students with disabilities must have the opportunity to meet any appropriate minimum eligibility criteria for admission, consistent with the mission of the charter school and civil rights requirements.

    Can charter schools waive their responsibilities for special education?

    No. Charter schools are public schools and, as such, cannot waive their responsibilities under federal laws. They must comply with all federal education laws including the Individuals with Disabilities Education Act (IDEA), Section 504 of the Vocational Rehabilitation Act of 1973 ("Section 504") and Title II of the Americans with Disabilities Act (ADA). A state may waive portions of its own state laws and regulations that go beyond federal requirements or the requirement to abide by school district regulations concerning special education, but no waiver is possible from federal requirements pertaining to students with disabilities enrolled in charter schools.

    It is very important that SEA officials involved with charter schools are aware of the federal laws that impact the implementation of special education in charter schools, and the important basic concepts of LEA identity and linkage between a charter school and an LEA that are covered in the Background section of this primer.

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  • COPPA

    The Council of Parent Attorneys and Advocates (COPAA) is an independent, nonprofit, tax-exempt organization of attorneys, advocates and parents established to improve the quality and quantity of legal assistance for parents of children with disabilities.

    COPAA sustains its organizational capacity through the collection of annual membership dues ranging from $50 to $1,000. Currently, COPAA has about 650 members nationwide, including 280 attorneys/firms. COPAA's main office in Virginia houses their executive director and administrative assistant. COPAA supports a website, www.copaa.org, and sponsors two listserves, one for all COPAA members and one for COPAA members who are attorneys.

    COPAA has a large group of volunteer attorneys and advocates, including the leading special education attorneys in the nation, who donate their time regularly to further the goals of COPAA as an advocacy organization.

    COPAA's board of directors meets regularly through a national call-in line and in person at their annual conference each year.

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  • First Steps

    The following is taken from a letter to the editor written by Valerie Strohl and published in the Indianapolis Star in May 2005. It is being used with permission.

    Ms. Strohl, of Zionsville, chairs the Interagency Coordinating Council for Infants and Toddlers, which advises the Family and Social Services Administration on the First Steps program.

    "I have paid close attention to comments made in The Star regarding First Steps, Indiana’s early-intervention system for infants and toddlers with disabilities, age birth to 3. Here are some facts to dispel misunderstandings about the system.

    Fact: First Steps is not Medicaid. It was the first attempt by Congress to say that families of infants with developmental delays need supports from various public sources. This system is supported through both federal and state dollars as well as private funds (co-pays and private insurance).

    Last year, First Steps had growth of only 5.5 percent, due to measures to gain control over previous years growth. The program is one of the most efficient early-intervention systems in the country, and other states have modeled their systems after ours.

    At an average cost per child per year of $2,900, First Steps is a winning solution for taxpayers. Furthermore, out of the 19,000 children served last year, we expect only 26 percent to go on to need preschool special education. Preschool has a price tag of $13,000 per child per year. With schools facing budget cuts, it is important that we serve as many children as we can within the First Steps system. It is good economics for the state.

    Many insurance companies do not cover the services needed by these children. Until two years ago, even companies that did cover First Step services refused to pay, through the law was on the books. We are now billing these companies where appropriate. Unfortunately, there is pending legislation that would make this process even more difficult for families.

    First Steps uses a development model that empowers families to care for their children to care for their children into the future. No child will make gains only by seeing a therapist once a week. The family must carry out the activities between sessions.

    Research shows that intervention in the first three years of life is the most effective time to impact a child’s development. First Steps is available to all citizens, regardless of their income level. In 2004, less than 1 percent of the children who received services were from families whose income exceeded $250,000. The significant majority of children served are middle-and lower- income families.

    Most families would relish the opportunity to not need First Steps. Unfortunately, life’s circumstances dictate otherwise. It is unfortunate that people who have limited or no knowledge of the system are now discrediting these families.

    First Steps is a wonderful, cost-effective means to ensure that our most vulnerable citizens have a chance to be productive citizens."

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  • Guardianships

    The area of guardianship law impacts families with children with disabilities because when a child turns age 18, the decision-making as to the child’s educational services, as determined by the IEP team (or case conference committee), goes to the child, rather than the parent. Obviously in some cases, this would result in harm to the child. Therefore, parents of children with disabilities will have their children sign either powers of attorney to allow the parents to continue the make the educational decisions or the parents will obtain a guardianship in court. The downside of a power of attorney is that it can be revoked fairly easily by the child, whereas revoking a guardianship requires a court decision. The downside of a guardianship is that it costs money and usually involves hiring an attorney to execute the proper documents.

    Note: The following is used with permission of the Indiana Bar Foundation.

    GUARDIANSHIPS

    When a person can no longer manage property or provide self-care, a guardianship may be appropriate. Guardianships can provide important protection to someone who is incapacitated. On the other hand, sometimes guardianships are unnecessarily imposed on persons who are capable of making their own decisions.

    Because the appointment of a guardian is more complex and serious than giving someone power of attorney, you should definitely talk to a lawyer if you think that you or someone you know might need a guardian. Planning ahead can often avoid the need for guardianship.

    DEFINITIONS

    GUARDIAN –someone appointed by a court to make decisions for an incapacitated person. In Indiana, conservator and guardian mean the same thing.

    Almost any capable adult can serve as guardian. A county Division of Family and Children, or a private charity can be a guardian. A non-resident person or corporation can serve as guardian if it is in the best interests of the person under guardianship.

    INCAPACITATED PERSON - description of someone who is incapable of either managing property or providing self care or both. Incapacity may stem from infirmity, insanity, mental illness, alcoholism, excessive use of drugs or other incapacity.

    Although these conditions may contribute to incapacity, a person who has on or more of these problems is not necessarily incapable. Old age is never a basis upon which guardianship can be granted. A person does not need a guardian just because he is old or infirm. A guardian should not be appointed for a person unless the individual cannot manage property or provide self-care.

    PROTECTED PERSON – a person for who a guardian has been appointed.

    RIGHTS OF THE PROTECTED PERSON

    The court should always look to the least restrictive alternative available to protect the interests of the incapacitated person Courts should create “limited guardianships” whenever it is appropriate in order to encourage the self-improvement in order to encourage the self-improvement, self-reliance, and independence of the protected person. In other words, if an individual is capable of making her own health care decisions, but cannot balance her checkbook, the court should create a guardianship limited to management of the checkbook.

    Even though a guardianship may help a person who is no longer capable of property management or self care, it may also mean a loss of rights for the protected person. The law is not entirely clear on what personal right the protected person has in an unlimited guardianship. The protected person may lose the right to make a gift, marry, drive a car, make decisions about health care and housing arrangements.

    The protected person does not necessarily lose the right to make a will. The protected person can make a will if she is capable of understanding what property she has and knows the “objects of her bounty,” the people who would receive the property when she dies.

    “Letter of Guardianship,” a document issued by the court, should explain exactly what powers the guardian has and whether there are any limitations on the guardianship.

    As guardianship can be a right-stripping process, the law provides a formal procedure with built in protections that must be followed before a guardian can be appointed.

    PROCEDURES FOR ESTABLISHMENT OF GUARDIANSHIP

    Any interested person may file a petition for appointment of a guardian of an incapacitated person. The person filing the petition is not necessarily the person who will be appointed guardian.

    The individual for who the guardianship is sought has the right to both notice, which includes both a notice of rights and the petition for guardianship itself, and hearing. The notice also must be given to the spouse, adult children, the attorney in fact under a power of attorney for the individual, and any person serving as guardian for or who has the care and custody of the alleged incapacitated person.

    If there are no adult children, notice must also go to the parents of the individual. If there are no parents, spouse or adult children, then at least one person most closely related by blood or marriage to the alleged incapacitated person must receive notice. The court may also direct any other person to receive notice.

    The notice must be in substantially the same form that the guardianship law provides and must advise the individual that the proceeding may substantially affect the rights of the individual. The notice should also explain the rights of the individual to attend the hearing and be represented by an attorney, or if there is no attorney, a court appointed ad litem (see below).

    The hearing provides an opportunity for alleged incapacitated person to present evidence and cross-examine witnesses, or in other words, to show the court why a guardianship should not be established.

    RIGHT TO REPRESENTATION

    The person for whom the guardianship is sought has the right to hire an attorney. In some cases, a court might be willing to appoint an attorney, although the court is not required to do so. The prospective guardian’s attorney cannot also represent the alleged incapacitated person.

    A guardian ad litem is a person appointed by the judge to help a person during a specific case. That assistance is only for that one case. The law requires the court to appoint a guardian ad litem if the alleged incapacitated person is not represented or is not adequately represented by counsel.

    The guardian ad litem represents the interests of the alleged incapacitated person. However, that does not mean that the guardian ad litem will advocate for what the alleged incapacitated person wants. So, for example, if the individual does not want a guardianship, the guardian ad litem may still determine that it is in the best interests of the individual to have one.

    IF YOU DO NOT WANT A GUARDIAN

    If you do not want a guardian and someone is trying to have one appointed for you, you should see a lawyer right away. If the court decides that you are incapacitated, ask the court appoint a limited guardian. You may also nominate the person you wish to serve as a guardian, although the court will have the final judgment on what is in your best interests.

    If you lose at the hearing, you have the right to appeal to a higher court. Be sure to consult a lawyer for the appeal.

    WHO SHOULD BE GUARDIAN

    Once a judge or jury determines that a person is incapacitated and in need of a guardian, the court must then determine who is the best qualified to serve as guardian.

    The court must give consideration for appointment to the following persons in the order in which they are listed:

    1. A person designated in the power of attorney of the incapacitated person;
    2. The spouse of the incapacitated person;
    3. An adult child of the incapacitated;
    4. A parent of the incapacitated person or a person nominated by will of a deceased parent of the incapacitated person;
    5. Any person related by blood or marriage with whom the incapacitated person has resided for more than six months prior to the filing of the petition; or
    6. A person nominated the incapacitated person who is caring for or paying for the care of the incapacitated person.

    The court may pass over a person having a priority in order to serve the best interests of the incapacitated person.

    GUARDIAN’S DUTIES

    The powers and duties of an appointed guardian may be unstated or maybe very specific, depending on the final order of the court.

    Generally, in an unlimited guardianship the guardian is responsible for the care and custody of the incapacitated person and the preservation of the “estate.”

    However, a guardian has no power with respect to property or personal health care decisions which are subject to a valid power of attorney.

    The guardian must encourage the self-reliability and independence of the incapacitated person.

    The guardian must file an accounting at least once every two years with the court which details the guardian’s administration of the incapacitated person’s estate and which describes the current condition and circumstances (including residence) of the incapacitated person.

    The guardian can pay all the expenses of the guardianship proceeding out of the incapacitated person’s estate. These expenses include reasonable medical, professional and attorney’s fees.

    The guardian is allowed to sell, mortgage, lease or exchange the property of the incapacitated person with court approval when it is in the best interests of the incapacitated person.

    Anyone who believes that a guardian is not doing his duty or is abusing his position should report the matter to the court. The court may then order an investigation. The court may remove a guardian if the guardian has not preformed properly or is unable to continue to perform his duties.

    ENDING A GUARDIANSHIP

    There are several ways that a guardianship might end:

    1. Any person, including the protected person may ask the court to end the guardianship. That person must convince the court that the protected person has regained capacity.
    2. A guardianship ends automatically when the protected person dies, but, the guardian may have limited authority to pay the protected person’s debts (relating to funeral, burial, last illness, taxes and so on), if the court approves.
    3. A guardianship limited to management of the estate may be terminated by the court it the guardianship property is reduced to $10,000 or less.
    4. A guardianship also ends when the protected person moves to another state and has a new guardian appointed there. When the guardianship ends, the guardian must take a final report to the court.

    TEMPORARY GURADIANSHIP

    In an emergency, a court can appoint a temporary guardian for a period of no more than 60 days. Temporary guardianship is used, for example, in cases in which a person cannot or will not authorize medical treatment needed to save his life. The person seeking to establish the guardianship must show not only that an emergency exists but also that the welfare of the incapacitated person requires immediate action and no other person appears to have authority to act.

    Notice must be given and hearing must be held unless the court finds that immediate and irreparable injury to the person or injury, loss, or damage to the person’s property will occur before the alleged incapacitated person can respond to the petition in a hearing.

    If no notice is given and the incapacitated person petitions the court for modification or termination of the guardianship, the court must hear the petition at the earliest possible time.

    Just as in a regular guardianship, Letter of Guardianship will be issued, limiting the guardian to only that which is necessary to resolve the emergency.

    The Senior Law Project of Indiana Legal Services, Inc. has more detailed information available on guardianship.

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  • Homeschooling

    Is homeschooling legal?

    Yes, homeschooling is legal in all 50 states. However, laws and regulations vary from state to state, and interpretations can vary from school district to school district. You will need to ready the laws in your state, in addition to asking homeschooling organizations for information. The reference librarian at your local library will be able to help you find this information. You can also find a lot of good information about homeschooling on the Internet.

    Is homeschooling expensive?

    Homeschooling can be as expensive or as inexpensive as you make it. It depends on many factors, including what kinds of materials and resources you choose to use, how many children you will be homeschooling, and whether or not you will be giving up paid employment in order to homeschool your children. Parents can easily spend a small fortune on all the wonderful learning materials and books available. On the other hand, a superior education can also be accomplished using free resources found through the public library, interlibrary loan, and learning opportunities found in your community, such as museums and trips to interesting places. If you have only one child and decide to use real life experiences, the public library, garage sales and thrift stores for your resources, you may be talking about a couple hundred dollars or less for an entire year. If you decide to purchase a curriculum for five children you could be looking at several thousand dollars over that same year.

    Where can I get materials and resources?

    Many people believe that the public library is the best possible resource. Send for the catalogs that look interesting to you. They are filled with resources which you may find helpful. If you are interested in finding out more about prepackaged curriculum or correspondence schools write for their brochures and informative flyers. Homeschooling conferences and learning fairs are another place for looking at materials and getting ideas. Check with your local or state support groups for information about these.

    What about higher education?

    Hundreds of colleges and universities nationwide accept homeschooled students.

    How do I find out about homeschooling in my state?

    The American Homeschool Association maintains files with information about homeschooling for all 50 states and several foreign countries. The files are available at the AHA website.

    How do I get started with homeschooling?

    If you're thinking about homeschooling, contacting your state or local homeschooling support group is the best place to start. Often local public libraries can assist in locating them. The support groups usually have copies of the state law, information about getting started, lists of activities and resources and many offer a newsletter as well. They can offer opportunities for getting together with other families, activities for children and adults, advice and help with resource materials and even cooperative classes for children. Some have a purely social focus - others have an academic or religious focus as well.

    In addition, a list of homeschooling support groups, organizations, listserves, websites and helpful individuals can be found at the Home Education Magazine website.

    If a homeschool student needs an IEP to submit for special testing accommodations in registration to ACT testing, does the student have to enroll in public school to get an evaluation completed to finish an IEP?

    A homeschooled student is entitled to an evaluation under the child find provisions of both Section 504 and the IDEA if a disability is suspected.

    After an evaluation, a homeschooled student is then entitled to the OFFER of a fully developed IEP or a 504 plan. That offer being put into service, however, may be contingent upon the enrollment of the student into the public school system, depending on state law. That's where service plans come into play.

    Schools are NOT able to get out of conducting an evaluation simply by virtue of a student not being enrolled in the public school district.

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  • Insurance

    Access by schools to families’ private health insurance benefits:

    See OSEP Policy Letter to W. Cohen, 19 Individuals with Disabilities Education L. Rep. 278 (7/9/92). In another case, OSEP said that the district must follow certain steps as well, including obtaining parental consent and informing the parent of rights, which includes the potential loss of lifetime insurance benefits. (OSEP 1992) Letter to Spann, 20 IDELR 627.

    A parent's use of insurance is voluntary. If the parents refuse to consent to use of insurance, special education services cannot be denied.

    Case on Use of Private Insurance to Pay Costs of FAPE. See the "rather cryptic regulation" Seals v. Loftis, 614 F.Supp. 302 (E.D. Tenn. 1985), of the United States Department of Education concerning the relationship between the availability of private insurance and the requirement that a state (or, in Connecticut, a local educational authority) provide a free and appropriate public education (FAPE) under the Individuals with Disabilities Education Act (20 U.S.C. § 1400 (c)). In Raymond S. v. Ramirez, 918 F. Supp. 1280 (N.D. Iowa, 1996), Judge Mark W. Bennett summarized the issue by saying, An administrative law judge determined that the child's insurance carrier, rather than an area education authority or the school district in which the disabled child attends school, should bear the costs of an independent educational evaluation of the child, which agency regulations implementing the IDEA state must, in certain conditions, be provided "at public expense." The court therefore grapples with a question of first impression in this circuit, aided only by administrative rules and sparse judicial and administrative decisions from other circuits, as it seeks to determine what exactly "at public expense" means in this case. Id. at 1282.The case involved an independent educational evaluation performed by the University of Iowa, commissioned by the parents, most of the cost of which was paid by the parents insurance. The amount paid by insurance reduced the amount of lifetime benefits available to plaintiff to $918,068.63. The court looked to agency regulations (20 C.F.R. § 300.594 (a)(3)(ii)) which provided: (ii) "Public expense" means that the public agency either pays for the full cost of the evaluation or ensures that the evaluation is otherwise provided at no cost to the parent, consistent with § 300.301. The regulation referred to, § 300.301, provides, in part, (b) Nothing in this part relieves an insurer or similar third party from an otherwise valid obligation to provide or pay for services provided to a child with a disability. The court gave substantial deference to these regulations. The Board argued that the regulation did not require it to reimburse Plaintiff for the costs covered by insurance. The court, however, concludes that such a holding would run counter to both the sparse case law on the subject, as well as the agency's own interpretation of its regulations. Id. at 1293. The court quoted at length from the December 1980 Notice of Interpretation on Use of Parent's Insurance Proceeds, contained in 45 Fed. Reg. 86, 390 (December 30, 1980). The interpretive notice provided, in part, “The Secretary interprets the requirements that a free appropriate public education be provided "without charge" or "without cost' to mean that an agency may not compel parents to file an insurance claim when filing the claim would pose a realistic threat that the parents of handicapped children would suffer a financial loss not incurred by similarly situated parents of non-handicapped children. Financial losses include, but are not limited to, the following: (1) A decrease in available lifetime coverage of any other benefit under an insurance policy; (2) An increase in premiums or the discontinuation of the policy; or (3) An out-of-pocket expense such as the payment of a deductible amount incurred in filing a claim. The Raymond S. court looked to the Seals decision holding: “Because of [IDEA]'s emphasis upon a free appropriate public education, this Court concludes that parents of a handicapped child cannot be required to utilize their private medical insurance benefits where the utilization of those benefits would cause them to incur a financial cost. . . . Any other conclusion would be inconsistent with the concept of a free appropriate public education which underlies the [IDEA].” 614 F.Supp. at 305-306. The defendants in Seals attempted to argue that the family voluntarily filed for insurance coverage. The Raymond S. court dismissed that argument preemptively, saying that: “Situations are legion in which a person might voluntarily look to their own insurance carrier to pay benefits immediately, even though they believe another is ultimately responsible for paying for their loss.” Fn. 12 at 1295. The Raymond S. court concluded that the school district was required to reimburse parents for the insurance benefits which paid for the evaluation of their son.

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  • Medicare Waivers

    Medicare Waiver Brochure (PDF)

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  • Mental Health

    Dear Friend,

    The Indiana State Bar Association is pleased to issue this report and recommendations from the Children, Mental Health and the Law Summit, held on August 27, 2004, in Indianapolis. The Summit earned the praise of the American Bar Association which awarded the Indiana State Bar Association the Lexis Nexis Community and Educational Outreach Award to recognize the ISBA’s efforts in organizing the Summit.

    There is growing recognition that juvenile delinquency and the unmet mental health needs of children are linked. This report discusses the extent of the problem, and offers distinct suggestions for effectively improving the lives of children.

    On average it costs three times more to house a child in juvenile correctional facilities than to pay for that child to go to school. Under our current correctional system, the mental health and educational needs of juvenile offenders are minimally met, if at all. Child advocates, mental health professionals and juvenile justice officials are recognizing that earlier intervention, before children enter the juvenile justice system, and more effective intervention once children do enter the juvenile justice center, are key strategies to address this growing crisis confronting children.

    Innovative communities are proving that money can be saved, and juvenile crime can be reduced when the mental health needs of children are addressed. Screening, assessment and treatment, coupled with diversion in appropriate cases, can reduce correctional costs and reduce recidivism rates. Communities throughout Indiana, such as Fort Wayne, Kokomo, and Bartholomew County, are seeing real results in reduced public spending and lower juvenile crime rates.

    This report is a synthesis of the interdisciplinary perspectives that were shared at the invitational summit. Over 250 people, from varying disciplines, came together for a day to search for answers, and share their own expertise. These recommendations are offered to contribute to the dialogue that occurred that day, and intended to be shared with policy leaders, in an effort to help address the mental health needs of Indiana children. Summit materials can be found at http://www.inbar.org/content/commitees/standing/CROC/tableofcontents.htm

    We wish to acknowledge the many individuals who reviewed the report and made comments prior to its release: James Bell, Indiana State Bar Association Criminal Justice Section; Kristy Bredemeier, Office of Medicaid, Policy and Planning; Gary Chavers, Marion County Prosecutor’s Office; Suzanne Clifford, Indiana Mental Health and Addiction; Cathy Graham, IARCCA; Amy Cook Lurvey, Indiana Commission on Mental Health; Kurt Kumli, Santa Clara, CA; Dr. George Parker, Indiana Mental Health and Addiction; Hon. James Payne, Indiana Department of Child Services; Ellen Quigley, Indianapolis Mayor’s Office; Lordes Rosado, Philadelphia Law Center; Mary Ann Scali, National Juvenile Defender Center; Russell Skiba, Indiana University Center for Evaluation and Education Policy; and Joesph Tulman, University of District Columbia School of Law. A list of the sponsoring organizations, Summit speakers, and planning faculty is included at the end of this report. We thank the numerous individuals that contributed their time and talents toward the Summit and the eventual release of this report.

    Sincerely,
    Steven Badger, Chair
    ISBA Civil Rights of Children Committee

    JauNae Hanger, Immediate Past Chair
    ISBA Civil Rights of Children Committee

    Indiana State Bar Association Civil Rights of Children Committee

    Official Report and Recommendations Children, Mental Health and the Law Summit held August 27, 2004

    “The burden of suffering experienced by children with mental health needs and their families has created a health crisis in this country.... Too often, children who are not identified as having mental health problems and who do not receive services end up in jail. Children and families are suffering because of missed opportunities for prevention and early identification, fragmented treatment services, and low priorities for resources.” Report of the U.S. Surgeon General’s Conference on Children’s Mental Health.

    “We are not a safety net. We are the cold, hard floor that kids hit after every other safety net has failed.”

    Kurt Kumli, Supervising District Attorney, Santa Clara, Calif.2

    A number of recent studies have shown that children with unmet mental health needs are being incarcerated at an alarming rate. The juvenile justice system is ill-suited, as a matter of both sound public policy and children’s civil rights, to be the primary provider of mental health services to children. A lack of prompt identification, diagnosis and treatment of children before their mental health problems lead them into the juvenile justice system, and inadequate screening, assessment and care once they do enter the system are creating a crisis that the legal profession and others cannot ignore.

    The failure to act systematically to improve the mental health care of children leads to increased costs over time and diminishes the likelihood of successful treatment of many troubled children. Punishment without effective and appropriate treatment is not an answer. Continuing on that course, which is prevalent in varying degrees throughout Indiana counties, will cause unnecessary levels of harm, violence and recidivism among children in the juvenile justice system, and increasing rates of adult incarceration and spiraling costs in judicial administration and corrections.

    Concerns about this situation led the Indiana State Bar Association’s Civil Rights of Children Committee, in partnership with the ISBA Family and Juvenile Law Section and the ISBA Criminal Justice Section, to organize an interdisciplinary summit on August 27, 2004. This report outlines specific recommendations developed as a result of that Summit, including steps local communities, mental health officials and the juvenile justice system should consider taking to provide appropriate services to more children with mental health needs, return them safely to their communities and schools and reduce their risk of future incarceration. Indiana has made progress in these areas, but more needs to be done and can be done while at the same time improving public safety.

    I. Increasing numbers of children with unmet mental health needs

    In recent years, there has been a dramatic increase in the adjudication and incarceration of children. A congressionally mandated study in 1994 confirmed that 690,000 juveniles were admitted to juvenile correctional facilities (detention and correctional placements) nationwide in 1990.3 One million, eight hundred thousand juvenile cases were filed in U.S. courts in 1996, a 49 percent increase in juvenile cases since 1987.4 Current figures indicate two million youth under the age of 18 are arrested annually; and, on any given day, more than 100,000 youth are held in detention or correctional facilities.5 The U.S. Department of Justice has estimated that 40 percent of juvenile cases involve repeat offenders.6 Over this same period of time, an increasing number of children have been leaving schools, as zero tolerance policies have become more common, and harsher laws affecting children have been passed.7 These trends have occurred despite national statistics on juvenile crime that indicate a decline in the number and rate of youth arrested for serious offenses since 1993.8 Moreover, from 1993 through 1999, there has been a 30 percent decline in the total juvenile crime rate.9 These statistics and trends have important implications for children with mental health needs. Studies have consistently shown that juvenile justice populations experience much higher rates of mental disorders than youth in the general population, and more than half of these children have cooccurring substance abuse disorders.10

    Though increasingly popular, zero tolerance has not been shown to be an effective approach to enhancing school safety, and there is increasing evidence this approach places students at risk of future delinquency or other negative outcomes. Thus, it is troubling that, according to the most recently available data, Indiana ranks among the states with the highest rates of school expulsion and out-of-school suspension.11 Studies of school expulsion have documented that many children and youth who are expelled from school have unmet mental health needs.12 Once expelled, children with unmet mental health needs are at a greater risk of committing delinquent acts. When they are not in school, such students are typically not receiving needed treatment; when left unsupervised in the community, they have greater opportunity to socialize with other troubled youth. The National Mental Health Association (NMHA) has found that children with existing mental health and special education needs suffer the most from zero-tolerance policies and school expulsions. Consequently, the NMHA has issued a policy statement opposing such practices.13 The NMHA has expressed particular concern about how these children are often placed in environments that are highly structured and restrictive, which worsen their conditions. Similarly, the American Bar Association (ABA) has adopted a position statement that opposes, in principle, “zero tolerance,” because such school policies generally end with expulsion, or other discipline, or even juvenile court referral, “without regard to the circumstances or nature of the offense or the student’s history.” While noting that zero tolerance is theoretically directed at students who misbehave intentionally, the ABA has expressed concern that such policies are also being applied to those who misbehave as a result of emotional problems or other disabilities.14

    While public policy has shifted during the last few decades to become more punitive for children both in school and in the courts, increasingly larger numbers of children with mental health needs are entering a seriously strained community mental health system marked by chronic shortages of resources and public funding.15 Given these trends, it is not surprising that similarly large numbers of children with mental health needs are entering the juvenile justice system. Recent studies show that 50 to 75 percent of detained and incarcerated youth in the United States have mental health disorders.16 Additionally, up to two-thirds of these children have co-occurring substance abuse disorders.17 Up to 19 percent of incarcerated youth may be suicidal.18 A recent congressional study has confirmed that there are children in detention centers across the country, and in Indiana, being detained solely because their communities lack appropriate facilities to treat their mental health needs.19 On any given night, there are on average 2,000 children nationwide held in detention, waiting for community health services.20 A recent U.S. General Accounting Office report conservatively estimated that, in 2001, parents placed over 12,700 youth into the child welfare or juvenile justice systems in an effort to procure mental health services for them.21 Seventy-five percent of these placements occurred in the juvenile justice system.22

    Consequently, because of limitations and shortages in community-based care, and an increasingly more punitive approach toward the misconduct of children, the juvenile justice system has increasingly become the “de facto” mental health treatment system for children with mental health needs.

    Once in the juvenile justice system, children continue to face fragmented mental health care and widespread deficiencies in appropriate services. Children with mental health or behavioral issues present unique challenges, and they are generally met with a juvenile justice or correctional system that is ill-prepared to handle their serious needs. A series of U.S. Department of Justice investigations has repeatedly found that children in detention and correctional facilities are generally not receiving adequate care for their mental health needs.23 Those inadequacies continue despite national estimates that approximately 70 percent of detained and incarcerated school-age youth meet eligibility criteria for special education, and up to 65 percent have mental health disorders.24

    In Indiana, a recent study of state detention facilities by the Indiana Juvenile Justice Task Force indicates that the vast majority of detained youth are not screened, assessed, or treated, and well over 50 percent have mental health and/or substance abuse problems.25 The consequences for these children can be severe. When children with disabilities go without appropriate services, they may stay incarcerated two to three years longer than other children, and their risk of recidivism increases dramatically.26 Their conditions often worsen, and their reintegration into the community can be impeded. Because of this increased risk of negative outcomes for these children generally, there is a national movement toward diverting many of them from the juvenile justice system altogether.27

    Placing children with unmet mental health needs in the juvenile justice system and failing to provide them appropriate treatment causes long-term societal costs, including increased life-long health care costs, increased reliance on public welfare support, and greater costs for the overburdened juvenile and criminal justice systems. The total savings ratio of avoided costs for an adult (including health care savings) has been estimated to be as high as $12 for every $1 invested in mental health treatment.28

    II. Indiana’s progress toward transforming children’s mental health care

    Increasingly, the Indiana mental health community is viewed as an innovative force working to transform children’s mental health care. Despite the growing demand for mental health services among children and the general population and grave shortages in supply of services and funding, Indiana has launched a number of initiatives that have gained national recognition. Considerable progress has been made in establishing systems-ofcare teams throughout Indiana counties. These teams provide a community-based, coordinated network of mental health services for children with serious emotional disturbances and their families. Just recently, Indiana was approved for the Home and Community Based Medicaid Waiver, which allows funding of community-based services for children as an alternative to psychiatric hospitalization. An early-identification-and-intervention pilot program has been established to perform screening, assessment and treatment of children who enter the child welfare system. And efforts have been made to partner with the criminal and juvenile justice systems to enhance training regarding mental illness and addiction, form diversion pilot programs and expand crisis intervention teams to assist law enforcement agencies. Additionally, Indiana has joined a growing number of states that have passed mental health and addiction insurance parity legislation. Along with these considerable statewide efforts, communities throughout Indiana have launched creative initiatives to help provide better access to mental health care for Indiana children. Some of those efforts are mentioned in this report.

    Indiana’s progress and commitment to transform children’s mental health care should be continued and supported at all levels of government. A growing body of data indicates that many programs are effective in treating children with mental illness, inside and outside of the juvenile justice system. The best research-based treatment programs can reduce recidivism and future involvement in the juvenile system by 25 to 80 percent.29 Treatment success rates for serious mental illnesses range from 60 to 80 percent for adults, when the right combination of medication and other critical services is provided.30 Likewise, experience shows that the earlier the intervention, particularly with children, the better the result.31 Thus, in the interests of healthier children and delinquency prevention, mental health care should continue to be strengthened and integrated into primary health care and educational settings, and traditional barriers to care within the juvenile justice system should be identified and eliminated. The recommendations that follow suggest that early intervention, routine screening, assessment and treatment for children entering the juvenile justice system (as well as for other at-risk populations), and diversion of children with mental health conditions into community-based care are key strategies helping children with unmet mental health needs who enter the juvenile justice system in large part because other safety nets have failed.

    III. The Summit on Children, Mental Health & the Law: An interdisciplinary dialogue

    The Indiana State Bar Association’s invitational Summit on Children, Mental Health & the Law at the Indiana Government Center, in Indianapolis, was attended by more than 250 people from across the state. It brought together many diverse organizations and individuals, underscoring the seriousness and breadth of the issues that currently confront children’s mental health care in local communities throughout Indiana. Attendees included government officials, legislators, judges, public defenders, prosecutors, probation officers, children’s advocates, medical doctors, social workers, educators, child welfare and mental health professionals. More than 60 national, state and local experts spoke on four focus areas: Screening, Assessment and Treatment; Legal Advocacy, Special Education, and Children in the Juvenile Justice System; Juvenile Competency to Stand Trial; and Funding, Building Capacity and Removing Barriers to Service. More than 30 individuals and organizational partners helped plan the Summit, and several legal and non-legal organizations participated as Summit sponsors.32 Issues were framed in advance of the gathering, and plans were made to produce this post-Summit report, with intentions to distribute it widely to policy makers, advocates and other individuals and organizations throughout the state.

    Summit attendees were asked what should happen in the next five years to guide the decision-making of those in policy positions. Several themes prevailed: Delinquency should be greatly reduced. Recidivism rates can and should be decreased significantly. Strategies involving early intervention, special education advocacy, increasing community-based mental health services and diverting low-risk youth with disabilities should be sought as alternatives to delinquency, adjudication and incarceration. For those youth who remain in the system, adequate screening, assessment and treatment should occur in juvenile justice facilities. Educators, mental health professionals, the medical community, the legal community and public officials should collaborate to make this happen. The resulting recommendations below are based on the collective thoughts and perspectives of participants from the Children, Mental Health & the Law Summit in August 2004.

    IV. Summit focus areas: Issues and recommendations

    The following recommendations are divided into four major categories that correspond to the focus areas developed at the Summit. Issues raised in breakout groups sought to answer the following: (A) Screening, Assessment and Treatment: What is the prevalence of mental health problems among youth in the juvenile justice system; how can detection and treatment be improved in an effort to bring about earlier intervention in individual cases; and how can a standard screening instrument be routinely used to identify and address unmet mental health needs? (B) Legal Advocacy, Special Education, and Children in the Juvenile Justice System: How can the legal system be more responsive to children with mental health needs through representation in juvenile justice proceedings; and how can public education and special education advocacy help children re-enter the educational system, linking them with services to address underlying mental health needs? (C ) Juvenile Competency to Stand Trial: What are the issues involved in evaluating juvenile competency to stand trial; what are the implications of the recent Indiana Supreme Court case, In re K.G., establishing that juveniles have a consti-tutional right to have competency determined before adjudication; and what should the Indiana competency model include? and (D) Funding, Building Capacity and Removing Barriers to Service: How can different funding streams at the state, federal and local levels be leveraged to provide more mental health services for more children; and what can policymakers do to eliminate barriers – statutory, regulatory, policy and budgetary – that impede access to services? The sections Part A through D below briefly discuss the above Summit focus areas, and a series of related recommendations follows each section.

    Part A

    Routine screening, assessment, treatment and diversion of children with mental health needs in delinquency proceedings

    There is a clear link between the prevalence of mental health and substance abuse problems, the economic and practical barriers to mental health services in the community-at-large and anti-social behavior that leads youth into the juvenile justice system. Untreated mental health disorders often affect a child’s behavior and have been found to play a key role in affecting delinquency and recidivism. Effective and appropriate identification of juveniles can help prevent youth from entering the juvenile justice system, decrease their involvement in the juvenile justice system and keep detained or incarcerated youth safe.

    Indiana has no systematic program or policy to screen, assess and treat children with mental health disorders in juvenile justice facilities. Yet, there has been growing recognition by mental health officials and members of the legal community that routine screening, assessment and treatment of children in the juvenile justice system should take place because of the high prevalence rates of mental health and emotional disorders among juvenile populations. Juvenile detention centers nationally and in Indiana are increasingly exploring strategies that address the mental health needs of juvenile detainees.33 An important pilot project initiated in Indiana by mental health officials with judicial support has targeted the routine screening, assessment and treatment of children who enter the child welfare system due to child abuse or neglect. This pilot project is envisioned eventually to extend to all youth involved in delinquency proceedings.

    The legal community’s commitment to extending screening, assessment and treatment of juveniles in delinquency proceedings should continue and be strengthened. A systemized screening assessment and treatment process should be used routinely starting at the point of intake into the juvenile justice system.

    An appropriate juvenile justice screening process should be brief and identify individuals with an increased risk of having problems that warrant immediate attention, intervention or more comprehensive review. The screening tool should be tailored to the age of the population and capable of administration by someone with little or no mental health training. Such an instrument is not intended to provide an accurate diagnosis, but rather is to identify those individuals who are particularly at risk and in need of further evaluation. In instances where a mental health disorder is indicated, a more comprehensive evaluation or assessment by a mental health professional should be arranged. There are a variety of screening tools that are available at little or no cost, including for example, the MAYSI-2, which has been adopted for screening youth in detention and correctional facilities in Pennsylvania, Massachusetts and other states.34

    An assessment is an evaluation process that comprehensively considers specific mental health or substance abuse problems and treatment needs of one person. While particular assessments can be performed to address specific questions about an individual, typical assessments identify psychological needs and offer recommendations for consideration by the court, treating professionals and correctional programs regarding needed interventions. All screening programs should have an assessment component, which ultimately leads to the treatment of youth. Effective screening, assessment and treatment programs can lead to opportunities for early intervention, diversion and reduced future involvement of children with mental health needs in the juvenile justice system.

    Recommendations 1–6

    Recommendation 1: A standardized, integrated, statewide program for screening, assessment and treatment of all youth as they enter the juvenile justice system should be developed and implemented. The first step to addressing the problem of juvenile offenders or detainees with mental health or substance abuse disorders is to screen systematically all youth as early as possible upon intake into the juvenile justice system. Systematic screening using a uniform screening test will help ensure that new detainees are neither a threat to themselves nor to others; it will eliminate selection biases; and it will provide a solid base of information for further study and development of public policy. The information gathered as a result of uniform screening should be aggregated into a statewide database and tracked under a system or protocol that includes measures preserving individual confidentiality and privacy. Youth who are identified with mental health or substance abuse problems should be referred for assessment and treatment, and, when appropriate, diverted out of the juvenile system into community-based care. See Recommendation 3. Individual communities and facilities should be encouraged to develop policies and procedures for screening and assessing youth and then providing appropriate treatment.

    Recommendation 2: Screening and assessment programs should safeguard a youth’s constitutional right against self-incrimination. Juveniles charged with offenses have a constitutional right against self-incrimination. Any program of screening, assess-ment and treatment of youth entering the juvenile justice system must include protections so that the information is not used to prove their guilt of juvenile delinquent acts or criminal offenses.

    Recommendation 3: A validated risk assessment instrument should be used in conjunction with screening as children enter the juvenile justice system, and low-risk children with mental health needs should be diverted to community-based treatment. An important pilot program shows that the diversion of people with mental illness from the criminal justice system, when coupled with effective treatment, works. The PAIR Diversion Program in Marion County experienced an 83 percent success rate among the 844 adults who participated in the program from October 1996 through December 2003.35 A similar pilot diversion program should be established for children in the juvenile justice system whose primary needs are for mental health services and who do not pose a threat to the safety of the community. This type of program would be particularly helpful for children with emotional disorders who enter the juvenile justice system because of minor, non-violent or status offenses. The use of a validated risk assessment instrument can help identify children who are found to pose a low risk of harming themselves or others, so they receive community mental health services in appropriate settings. The start-up of such a program could be funded by community correction funds and would eventually help enable local communities to maximize opportunities for Medicaid funding (since Medicaid is generally unavailable for youth placed in correctional institutions).36 Partnerships should be established with prosecutors in an effort to educate, provide diversion options and encourage treatment in lieu of detention or incarceration. Additionally, child welfare officials and the Indiana Department of Child Services should work with juvenile justice officials to remove traditional barriers that prevent children with unmet mental health needs who initially enter the juvenile justice system through a delinquency proceeding from being removed from that system and placed in the child welfare system to receive appropriate community-based services.

    Recommendation 4: Attorneys, judges, county and local officials should be educated concerning the mental health needs of youth in the juvenile justice system, the resources and approaches that are available to address such needs, and the benefits of prompt screening, assessment and treatment of mental health disorders. Positive outcomes ultimately depend on those at the local level who make decisions affecting youth in their communities. Often there can be resistance to change that comes from outside the local community. For these reasons, outreach should be made to educate local government officials, lawyers, judges, law enforcement and others in the juvenile justice system about mental health disorders and treatment. This should include sharing data from established screening programs that would document the incidence and severity of mental health problems in our juvenile detention facilities.

    Recommendation 5: Earlier intervention should be encouraged by promoting the use of appropriate screening and assessment methodologies to detect mental health disorders of children in CHINS (Child in Need of Services) cases. Frequently, by the time a child with a mental health disorder reaches the juvenile justice system, harm has already occurred to the child and may have occurred to others. Such harm often could be prevented or mitigated with prompt identification, assessment and treatment. Early detection of mental health disorders also maximizes the opportunities for effective and lower cost treatment. Children in the child welfare system are an important juvenile population to target for early intervention. Indiana’s pilot project to screen, assess and treat children in the child welfare system should be extended to all counties and made permanent.

    Recommendation 6: Effective treatment of the child should include efforts to determine and treat mental health needs within the family. Often a mental health disorder is affected by the circumstances or conditions in the child’s home. Children of parents with mental health and/or substance abuse problems have a heightened risk of developing mental health and substance abuse problems.37 Merely treating the child without educating and sometimes even treating other family members will not produce lasting results once the child is returned to the home environment. Parents need to be involved in the screening, assessment and treatment process and receive adjunct treatment services when appropriate.

    Part B

    Special education advocacy to help children in the juvenile justice system

    Under federal and state laws, schools have an affirmative obligation to find and identify students with disabilities (including physical, mental, emotional and learning) and determine eligibility for special education and related services.38 The U.S. Surgeon General has estimated that 5 percent of school-age children have mental disorders and extreme functional impairment.39 Many more children may have learning disabilities that co-occur with emotional or mental health issues. Yet, less than 1 percent of school age children nationally are identified as needing special education services under the Individuals with Disabilities Education Act (IDEA).40

    There are a number of reasons why children are not identified, including the family’s own hesitancy to label their children “special needs” or “mentally ill,” or their reluctance to receive assistance. It may also result from a lack of appropriate programs or sufficient training of school staff to identify these children. This failure of early identification, in which both school officials and families play a vital role, results in missed opportunities to provide prompt and cost-effective treatment and services that could keep many children with mental health and emotional problems out of the juvenile justice system altogether. The high number of detained and incarcerated children estimated to be eligible for special education evidences missed opportunities for earlier intervention in schools.

    Pursuant to the IDEA, children with disabilities are entitled to “a free appropriate public education.”41 Through a mix of mandated federal and state funding, special education and related services are available to eligible students regardless of income level. The IDEA requires educational officials to meet the unique needs of children with disabilities by offering them related services that are necessary for them to benefit from special education.42 Non-academic services may include counseling, day treatment and attendant care.43 However, the definition of related services is often quite restrictive for services administered outside of school hours or targeted to support families.44

    Coupling IDEA and Medicaid to secure comprehensive mental health services for children in schools can help fill the service gaps for many children in need. Although eligibility under Medicaid and IDEA are different, many children with mental health issues qualify for both. Medicaid operates as a low-income health insurance program, with a much broader range of services available, including, for example, home services and behavioral management. In particular, the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Medicaid provision offers low-income children a strong entitlement to behavioral health services. It requires a state to provide “necessary health care, diagnostic services, treatment, and other measures to address physical and mental illness and conditions.”45 Because of the potential for these two statutes to generate comprehensive community-based mental health systems, school officials should coordinate with other state agencies to use these statutes to provide an array of mental health services for their students through early intervention efforts offered through schools.46 State and local governments should support local efforts such as these by adopting policies consistent with a long-term, cost-effective view that favors further development of early intervention opportunities and community-based care that is integrated within schools.

    Recommendations 7–9

    Recommendation 7: Special education advocacy within the legal community should be strengthened so that it adequately advances the goal of building and supporting community-based systems of care47 and protects critical rights of children and parents. Achieving a broader, interdisciplinary understanding of the special education rights of school-age children with disabilities among the public, families, school personnel, and medical, mental health, child welfare and juvenile justice professionals is an important strategy in preventing special needs children from entering the juvenile justice system. During the last 40 years, educators, parents and advocates have made considerable progress in furthering school programs that serve children with disabilities. However, there are still important opportunities for creating a cross-disciplinary approach so that more children with mental health needs receive treatment that will help them to stay out of the juvenile justice system. Educators should ensure that reader-friendly versions of special education law48 are available to parents and families, and that local school staff receive adequate training on special education law. A broad-based understanding of special education law by the legal and medical communities should also be fostered. Attorney training programs in special education advocacy should be strengthened; and those working in the juvenile justice system, including law enforcement officers, juvenile detention center staff, probation officers, public defenders, prosecutors, judges and correctional facility staff, should be trained well enough to achieve a cross-disciplinary understanding, so that children with special needs or disabilities are ultimately placed in appropriate treatment settings and kept out of the juvenile correctional system when community-based care is appropriate. Also, efforts should be made to increase parents’ and the medical community’s awareness of and access to legal resources that can benefit children with unmet mental health needs.

    Recommendation 8: Efforts should be made to increase the availability of prevention, early intervention and special education alternatives for children with unmet mental health needs in order to reduce school expulsions and out-of-school suspensions. There is an emerging consensus that pro-active interventions focusing on prevention and early intervention are much more likely both to meet the needs of at-risk youth and reduce school violence and disruption.49 Strategies should be developed regarding how to bring services (health and mental health) into more schools, so that children having problems can be identified early, before expulsion. School programs targeting children at risk of expulsion should be developed to screen, assess and treat children with mental health needs. Increased efforts should be made to link counselors with truancy, family preservation and mental health options in the community.

    Recommendation 9: Efforts should be made to increase the use of IDEA and Medicaid entitlements to generate comprehensive community-based mental health systems that are integrated in schools to provide mental health services for school-age children through early intervention efforts. See also Recommendation 18. Major health care providers, the Indianapolis Public School System and Learning Well, a local organization whose mission is to coordinate school clinics throughout Marion County, have taken significant steps toward integrating physical and mental health care in the lives of school-age children through the operation of school-based clinics. Such clinics should be made available in other school systems throughout the state. Vermont is a good example of a state that has successfully used IDEA as an important adjunct to Medicaid in order to provide school-age children with school-based health clinics. In Vermont, the school systems paired IDEA funding to the state Medicaid match in an effort to fund 300 school-based clinicians. The state’s mental health centers participate in providing services once children are identified under IDEA.

    Part C

    Ensuring juvenile competency to stand trial

    Many juveniles facing delinquency charges are not competent to stand trial. Adolescents in the juvenile justice system are disproportionately of below-average intelligence and likewise disproportionately have serious mental illnesses. The results of the Juvenile Competence Study by the MacArthur Foundation Research Network on Adolescent Development and Juvenile Justice suggest that about one-third of 11- to 13-year-olds and one-fifth of 14- to 15-year-olds overall lack the ability to understand the charges against them, to assist in their own defense or to weigh the consequences of decisions such as waiving rights.50

    The MacArthur study shed new light on the issue of juvenile competency to stand trial. The study was focused on the legal standard for competency to stand trial: that is, whether the defendant has sufficient present ability to consult with his attorney with a reasonable degree of rational understanding and whether the defendant has a rational as well as factual understanding of the proceedings against him. Competency is not a constant or permanent condition, as it can often be modified. Nor is competency a question of criminal responsibility, culpability or blameworthiness.

    The basic research question presented in the MacArthur Study was whether adolescents differ from adults in their ability to participate as defendants in trials. Then, if they do differ, what types of children manifest significant differences from adults? If there are deficits, what kinds of deficits in their abilities are most relevant for law, policy and practice? The findings were alarming. The MacArthur study found that 20 percent of 14- to15-year-olds and 33 percent of 11- to 13-year-olds manifest deficiencies in understanding and reasoning comparable to mentally ill adults who are incompetent to stand trial. There was no significant difference between adults and adolescents ages 16 and older in these abilities, and there was a strong correlation with intelligence level and age. The risk for incompetence is especially apparent among juvenile offenders with a below-average IQ. The results were not explained by gender, ethnicity or socio-economic class.

    Indiana statutory law does not specifically address juvenile competence to stand trial. In juvenile court, there are statutes allowing for emergency psychiatric treatment, but not for determination of competency. In May of 2004, the Indiana Supreme Court addressed the issue of juvenile competency to stand trial in the case of In re K.G.51 The Court held that juveniles alleged to be delinquent have a constitutional right to have competency determined before they are subjected to delinquency proceedings. The Indiana Supreme Court’s holding applied the general “adult” standard for competence to juveniles. This standard asks “[w]hether the defendant has sufficient present ability to consult with his lawyer with a reasonable degree of rational understanding, and whether he has a rational as well as factual understanding of proceedings against him.”52 The Court also held that the adult competency statute, requiring commitment to the Department of Mental Health upon a finding of incompetency, did not apply to juveniles, thus leaving children in the juvenile justice system.

    Although the In re K.G. decision affirmed that Indiana children have a fundamental right to competency to stand trial, children who are found to be incompetent are currently left adrift in the system, with many questions left unanswered. For instance, there is no process in place to determine competency, restore juveniles to competency, or determine what to do with juveniles who cannot be restored. Further, Indiana’s response to the issue of juvenile competence to stand trial must answer some basic questions such as: How should incompetent juveniles be identified? What services ought to be provided while a juvenile is deemed incompetent? And, what do we do with those children who cannot be “restored?” There are additional juvenile justice issues implicated by the MacArthur Study results as well: raising the age threshold for transfer to criminal court; requiring competencey evaluations for youth under a certain age before transfer to adult criminal court; and referring juvenile delinquency cases involving incompetent youth as CHINS cases.53

    Recommendations 10–14

    Recommendation 10: A collaborative, interdisciplinary committee, to be appointed by the Indiana Supreme Court, should recommend processes for: (1) determining competency to stand trial in juvenile delinquency proceedings; (2) restoring children to competency; and (3) determining what to do with children who cannot be restored. The committee should include, at a minimum, representatives from the following: juvenile court judges, legislators, prosecuting attorneys, public defenders, the Indiana State Bar Association, the Indiana Division of Mental Health and Addiction (DMHA) and the Indiana Department of Child Services. The committee should submit a final report to the Indiana Supreme Court that would include points addressed in Recommendations 11-14.

    Recommendation 11: An Indiana juvenile competency model should be based on the same legal standard for competency required in criminal court, as set forth in In Re K.G. The Dusky standard constitutionally requires that a criminal defendant may not be subjected to a trial unless he has the capacity to understand the nature and object of the proceedings against him, to consult with counsel and to assist in his defense.54 The Indiana Supreme Court in In re K. G. held that due process requires “competence to understand the nature of the charge and to assist in a defense” in juvenile proceedings.55 This competency standard affords important constitutionally mandated safeguards, particularly for juveniles facing potential waiver to adult court or harsher sanctions. As Indiana develops a process for determining competency to stand trial in juvenile delinquency proceedings, the definition of competence should be the Dusky standard.

    Recommendation 12: Competency evaluations should be required, unless waived by the child’s counsel, in cases where the State is seeking waiver to adult criminal court. A child waived to adult court is an adult for all purposes, including sentencing. Given the risk of a juvenile facing the potential of an adult prison sentence, mandatory competency evaluations are a necessary safeguard to ensure these juveniles have the capacity to understand the proceedings against them, consult with counsel and assist in their defense.

    Recommendation 13: Legal counsel should be appointed in every juvenile delinquency case to help ensure that juveniles are not subjected to delinquency proceedings if they are incompetent to stand trial. Juveniles have a statutory and constitutional right to counsel in delinquency proceedings. How counsel is appointed varies from county to county, and, in practice, many juveniles proceed without representation. Many of these juveniles may not be competent to waive their constitutional right to counsel. Requiring legal counsel to be appointed in every juvenile delinquency case would help ensure that juveniles are not subjected to delinquency proceedings if they are incompetent to stand trial.

    Recommendation 14: A child found to be incompetent to stand trial, who is incompetent due to mental health issues rather than due to age and development, should be referred to the county office of the Department of Child Services to receive services as either a CHINS (Child in Need of Services) or pursuant to I.C. 31-34-1-16, which would allow for services without parents relinquishing custody of their child. The provision of necessary mental health services could then be made available in addition to restoration services. If a child is not restored to competency within a specified time period, the delinquency petition should be dismissed. Treatment for children with mental health issues should not be delayed while restoration services are provided. If the child is in need of services or treatment, this could be accomplished through a parallel CHINS process while restorative services are being provided through the pending delinquency proceeding.

    Part D

    Funding, building capacity and removing barriers to services

    A major barrier to the access of mental health care is the lack of adequate funding. Funding issues arise in part because of under-funded programs, varying eligibility requirements for programs and a lack of understanding and agreement on who should pay for services among governmental agencies at both the state and local levels. How these issues are resolved at the local level often determines which children receive services. Funding constraints also arise from the present allocation of resources. The failure to fund mental health care and special education at adequate levels sustains a system that unintentionally fosters higher costs associated with recidivism and increasing rates of juvenile, and eventually adult, incarceration.

    Strategies to enhance funding should include: pursuing cost-effective measures, such as early intervention and diversion of low-risk youth to community-based services; removing legislative and administrative barriers preventing the pooling of existing sources of federal and state money and undermining inter-agency and local-state collaborative efforts to fund services for children; leveraging state and local money with federal money to maximize available funding for children’s mental health care; and eliminating other legal and regulatory barriers that impede the ability of communities to provide adequate services at the local level. Funding programs and administrative requirements should encourage and promote prevention, early intervention, diversion of low-risk children, and use of community- and home-based services for children with mental health needs. Ultimately, such a policy would shift costs from juvenile justice, criminal justice and corrections, to community-based mental health care, and would help reduce system-wide costs through lower rates of juvenile and adult incarceration and recidivism.

    Strategies should be explored to maximize federal funding and to leverage federal match programs with state and local monies to help pay for children’s mental health needs in the juvenile justice system.56 Local counties should share in the responsibility of ensuring that cost-effective and revenue-enhancing strategies are pursued at the state and local level. County officials should understand how to appropriately maximize federal Medicaid money because local funds can serve as the state’s match under the federal Medicaid program.57 Counties should use federal, state and county monies efficiently and cooperatively, in an effort to treat children more effectively.58 School officials, mental health providers, medical professionals and officials from the Indiana Division of Mental Health and Addiction, Indiana Department of Child Services, the Office of Medicaid and the Department of Correction Community Correction program should collaborate with juvenile court judges and other juvenile justice officials to ensure that the funding of mental health needs of children in the juvenile justice system are met at the local level. This collaborative model should be carried over to the state, requiring agencies to develop joint policies, budgets and plans that provide flexibility and technical assistance on funding issues to counties.

    Recommendations 15–21

    Recommendation 15: Inter-agency funding should be service driven at the local level, and mental health services should be easily accessible by families and children. Over a decade ago, the Indiana Division of Special Education helped lead efforts that now allow the “wrap around” service model as an option for local communities to develop community-based placements and avoid expensive out-of-state placements. Today, there are less than a handful of children who are placed in out-of-state facilities. Models of successful wrap-around programs include the Dawn Project in Indianapolis and Circle Around Families in Gary, both benefactors of Indiana’s early efforts at collaborative inter-agency funding. Over half of Indiana counties have organized wraparound systems-of-care. These efforts to use different sources of money to leverage services should be continued and should build on Indiana’s innovations in this area. Where possible, restrictive regulations prohibiting the effective use of different sources of program money should be changed to allow flexibility among different funding sources in individual cases. Successful systems found in other states have integrated funding in a common plan for families and children and coordinated the delivery of services through a single accountable entity, with various agency programs contributing resources.59 A few examples of state-level funding initiatives outside Indiana include New Jersey (innovative statewide financial management system that creates a flexible pool of funds available for children’s services), Vermont (blends funds to operate a comprehensive immediate-response system throughout the state), and Michigan (uses a wrap-around approach in 17 counties).60

    Recommendation 16: Additional revenues should be identified for children’s mental health services. While state and local officials should effectively use relevant funding sources—local, state and federal—the need to identify new sources of money should not be ignored if other revenue enhancements fall short of addressing the mental health needs of children. Redirecting existing funds from correctional to community-based care, identifying greater collaborative efficiencies at both the state and local levels, leveraging federal dollars with state and local funding, and considering different taxes or tax structures should all be pursued. Also, strategies should be developed that transition funding in juvenile justice and corrections to early intervention, diversion and treatment. There should be recognition by state policy-makers, legislators and local officials that cost-shifting will have to occur in order to fund adequately special education and mental health services. The investment that takes place in education and public health will yield considerable savings in both the short- and long-term in juvenile justice administration and corrections.

    Recommendation 17: Medicaid eligibility should be maximized by limiting placements of children with mental health needs in secured settings to those children who cannot be appropriately treated through community-based services. Whether children in the juvenile justice system are eligible for Medicaid may depend on where they are placed. Medicaid benefits are not available to children placed in detention centers, jails and correctional facilities.61 For those children, the state and local communities bear the entire cost of treatment, or their needs go unmet. In order to maximize federal funds under Medicaid, the removal of low-risk children with mental health needs from state and county correctional systems should be a priority. Savings from state and local corrections could then help fund increased community care options, and the increased availability of Medicaid dollars could help maximize the leverage of state and county funds with federal funding. Current fiscal policies and funding relationships between the county and state encourage the juvenile justice system to shift placement of children in need of services from county to state correctional facilities. Such policies should be changed to support placement decisions based on the assessed risk of a child and treatment considerations in appropriate placement settings. Also, the state should consider adopting an interpretation of Medicaid law that suspends, rather than terminates, benefits while a juvenile is placed in a detention or correctional facility, or in an adult jail, in order to minimize activation time after the child’s release from a secured facility. Additionally, to ease transitions in care, discharge planning that is currently being done in state psychiatric hospitals should be replicated by state and county correctional facilities.

    Recommendation 18: Mental health care benefits for low-income children should be maximized through Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Medicaid funding, as well as through other under-utilized federal funding programs. Indiana should maximize the use of EPSDT Medicaid funding to ensure provision of services for children with mental health needs.62 Local officials, educators, service providers, attorneys and juvenile court officials should understand how to access this funding for at-risk children or children in the juvenile justice system through the use of early intervention and juvenile diversion strategies.63 Efforts to use IDEA and Medicaid together for developing system-wide approaches to delivering services to children should be pursued. See Part B.

    Recommendation 19: Sufficient funding should be provided for building greater capacity of community-based services and for dissemination of information on evidence-based, best practices. Programs providing technical assistance regarding funding issues and the dissemination of information on best practices should be developed and supported by state and local funding. Integrating mental health services into primary health care, and employing more mental health professionals at the local level to increase access to mental health programs are important strategies for building capacity and improving service delivery to families and children.

    Recommendation 20: Local communities and counties should consider developing inter-disciplinary alternatives to encourage cross-coordination of services for youth in the juvenile justice system. Innovative models for cross-coordinating service delivery to children can be found operating in several local communities in this state, and at a national level. For example, Monroe County has facilitated an inter-disciplinary approach by developing the position of a youth placement coordinator as an alternative to the traditional probation officer. The youth placement coordinator oversees services delivered to children, brings together different perspectives, and facilitates communication among different agencies and professionals providing services. In another example, in Porter County, the juvenile court is directly involved in accessing the service system and eliminating obstacles to services through the use of a local coordinating committee, which involves families and local service providers. In Marion County, the Dawn Project, an innovative wrap-around service program, has gained national recognition as an effective program for juvenile justice youth. At a national level, Santa Clara County has developed the nation’s first juvenile mental health court. Operating since 2001, the juvenile mental health court has successfully achieved a partnership among judicial officers, prosecutors, public defenders, mental health coordinators and probation officers to provide more community-based options and humane treatment of juveniles with serious mental illness.64 In its short existence, the court has achieved a reduction in recidivism for youth who participate in the program of 7 percent, as compared to 25 percent for the general juvenile population in that county.65 Other states that have established juvenile mental health courts include Florida and Ohio. County officials and local juvenile justice officials should explore these and other innovative models and collaborate with others in their communities to provide children with cross-coordinated care.

    Recommendation 21: Policies and laws should be adopted or changed to improve collaboration, coordination and information-sharing among education, mental health, medical, juvenile justice, foster care, residential treatment programs and public/private child welfare professionals. Currently there is a lack of sufficient collaboration and information-sharing among agencies and professionals across the educational, mental health, medical, child protection and juvenile justice systems. Frequently, legal barriers—either statutory or administrative, real or perceived—impede collaboration and communication among these groups of professionals. For example, the sharing of medical records can be difficult because of actual and perceived barriers under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).66 Barriers such as these that make collaborative approaches difficult should be identified and addressed. At the same time, safeguards must be put into place to protect youth’s constitutional right against self-incrimination. See Recommendation 2.

    V. Other areas of concern and potential legislation

    The recommendations below consider additional policy areas that are implicated by the dialogue of addressing the unmet mental health needs of children. They recognize the need to provide an effective continuum of mental health care for children placed within correctional institutions and the importance of removing barriers to care that arise from shortages of private provider care at the local level. There also should be continuing juvenile jurisdiction when children with disabilities are placed within state correctional facilities, to help ensure that their needs are not overlooked. The last recommendation suggests that this interdisciplinary discourse should continue at the highest levels of government, so that the current momentum for meaningful change continues for Indiana children.

    Recommendations 22–25

    Recommendation 22: Legislation should be considered requiring timely and appropriate mental health treatment and services for juveniles and their families secured or incarcerated in the juvenile justice system. Each juvenile detention center or correctional facility should be required to provide appropriate mental health staff, through public or private providers, including child psychiatrists, proportionate to the effected population in each facility. Only skilled mental health providers or trained staff should provide mental health services to youth in the juvenile justice system. Providers should use evidence-based treatment practices; case managers should link juveniles to services in the community; families should be involved in mental health care decisions; and adjunct treatment should be provided to family members, when needed, for youth re-entering the community. Also, detention and correction facility staff should link the juvenile with appropriate after-care services in the community.

    Recommendation 23: Policies should be developed to remedy the negative impact that inadequate insurance and Medicaid reimbursement levels have on the availability of mental health services in the private sector. Medicaid regulations and reimbursement policies, and the reimbursement policies and limitations of private insurers, have had a negative impact on the profitability of private mental health service providers. Currently there are not enough mental health services to meet the immediate demands of Indiana communities. A dialogue should be held among government agencies with medical professionals, community mental health providers, universities, private hospitals and treatment facilities to identify specific measures which can be undertaken to increase the supply of mental health services throughout the state. Shortages in children’s mental health professionals, including child psychiatrists, psychologists and mental health case managers should also be addressed. State officials should increase collaboration with universities and the private health care sector, to expand the workforce.

    Recommendation 24: The jurisdiction of the juvenile court should be extended to allow monitoring of children with disabilities who are placed in state correctional facilities. With the exception of repeat truants and runaways, Indiana law provides once a child is committed to the Department of Corrections, the juvenile court no longer has jurisdiction.67 An exception for children with disabilities would allow the juvenile court periodically to review the child’s progress and would provide a means to modify the disposition if the commitment is no longer serving the child’s or society’s best interests.

    Recommendation 25: The work of the Summit should be continued. A broad-based, interdisciplinary children’s standing committee should be formed, possibly organized under the Indiana Commission on Mental Health, to advise the legislature, the Governor, agency program heads and local officials on how to strengthen, in the short- and long-term, the state’s mental health and substance abuse services for youth and their families throughout Indiana. The committee should be comprised of children, mental health and disability advocates; public and private service providers, including community mental health, substance abuse and residential treatment providers; and state and local officials in health care, mental health, education, social services and juvenile justice. It should review model or exemplary child mental health service systems in Indiana, and across the country, such as those found in Milwaukee, Philadelphia, New Jersey, Vermont, Michigan and Virginia, and make recommendations regarding potential state innovations. It should also help monitor and assess the state’s progress toward affording all Indiana children early and affordable mental health care.

    1. U.S. Department of Health and Human Services, Report of the U.S. Surgeon General’s Conference on Children’s Mental Health, Washington, D.C. (2000 Report) (available at http://www.surgeongeneral.gov/topics/cmh/childreport.htm).
    2. Kurt Kumli, Keynote Address: Children, Mental Health and the Law Summit, Indianapolis, IN (August 27, 2004).
    3. David W. Kaplan, et al., Health Care for Children and Adolescents in the Juvenile Correctional Care System, American Academy of Pediatrics, V. 107.4, 799, April 2001 (citing Parent, D.G., Conditions of Confinement: Juvenile Detention and Corrections Facilities. Research Summary, Office of Juvenile Justice and Delinquency Prevention, U.S. Department of Justice, Washington, D.C., 1994).
    4. Id. (citing H.N. Snyder and M. Sigmund Juvenile Offenders and Victims: 1999 National Report, Office of Juvenile Justice and Delinquency Prevention, U.S. Department of Justice, Washington, D.C., 1999).
    5. Data provided by the National Center for Mental Health and Juvenile Justice (2005).
    6. Id. (citing H. N. Snyder, Juvenile Arrests, 1996, Office of Juvenile Justice and Delinquency Prevention, U.S. Department of Justice, Washington, D.C., 1999).
    7. A large percentage of public schools employ zero-tolerance policies for certain student behavior. A governmental survey in 2002 confirmed that 79 percent of the nation’s public schools have zero-tolerance polices to address violence and tobacco use; and 94 percent have such policies to deal with weapons. Definitions vary from school to school, with some more stringent than others. Jill F. Devoe et. al., Indicators of School Crime and Safety: 2002, U.S. Departments of Education and Justice, Washington, D.C., 2002. Throughout the last several decades Indiana’s adult transfer statutes have grown through statutory exclusions, including drug offenses and weapon possession. I.C. § 31-30-1-4. Also, Indiana is one of 31 states that have “once an adult, always an adult” provision. I.C. § 31-3-3-6 and § 31-30-1-2.
    8. H.N. Snyder and M. Sickmund, Juvenile Offenders and Victims, Office of Juvenile Justice and Delinquency Prevention,U.S. Department of Justice, Washington, D.C., 1999.
    9. Id.
    10. National Mental Health Association, Prevalence of Mental Disorders Among Children in the Juvenile Justice System (2001).
    11. Russell Skiba, M. Karega Rausch and Shana Ritter, Children Left Behind: School Suspensions and Expulsions in Indiana, Education Policy Briefs, Vol. l. 2, Center for Evaluation and Education Policy, Indiana University, 2004. In addition to examining national data showing a lack of evidence for the effectiveness of zero tolerance, the report presented data from the 20002001 school year from the U.S. Department of Education, Office for Civil Rights, showing that Indiana ranked first in the nation in school expulsions, and ninth in out-of-school suspensions.
    12. Gale M. Morrison et al., School Expulsion as a Process and an Event: Before and After Effects on Children At-Risk for School Discipline, Univ. of Calif., Santa Barbara, CA (2001).
    13. National Mental Health Association (NMHA) Position Statement Opposing the Blanket Application of Zero Tolerance in Schools (Adopted June 8, 2003).
    14. ABA, Report to House of Delegates, 103 B, February 2001. The ABA’s position statement on zero tolerance not only notes the disproportionate impact zero tolerance has on children with disabilities, but also on students of color, which, for both reasons, contravenes ABA anti-discrimination policies. The ABA report notes, pointing to a study conducted of ten school districts in 1999, that black students are being suspended or expelled at higher rates than their peers, and were thus suffering the most under new “zero-tolerance” policies. Moreover, such policies are at odds with the Individuals with Disabilities Education Act (IDEA), which requires “the need for individualized attention to needs and behavior of students with disabilities whose responses in certain situations may be misinterpreted as disciplinary problems.”
    15. National and state prevalence rates of mental illness support that the demand for mental health/substance abuse interventions far exceeds the current supply of services. The U.S. Surgeon General has estimated that 75-80 percent of children with mental and behavioral issues fail to receive appropriate services. U.S. Department of Health and Human Services, Mental Health: A Report of the Surgeon General, 1999. Suzanne Clifford, Director, Division of Mental Health and Addiction, presented data to the Indiana Commission on Mental Health in September 2004, indicating that the annual number of people served by the Division of Mental Health and Addiction had doubled over the last ten years, despite strained state and federal budgets; and, as a consequence, resources to treat children who are actually in the community mental health system are severely strained. For instance, in 2004, HAP (Hoosier Assurance Plan) average funding per child with serious emotional disturbance was $500, even though the cost of minimum services was estimated at $2,000 per child.
    16. Linda A. Teplin et al., Psychiatric Disorders in Youth in Juvenile Detention, Archives of General Psychiatry, 59(12): 1133-1143 (December 2002).
    17. National Mental Health Association, Mental Health Treatment for Youth in the Juvenile Justice System; A Compendium of Promising Practices, 1, 2004; see also, supra note 10.
    18. Id.
    19. Over a six-month period, 15,000 children in 49 states were held in detention centers, simply because they were waiting for mental health services. U.S. House of Representatives Committee on Government Reform-Minority Staff Special Investigations Division, Report: Incarceration of Youth Who Are Waiting for Community Health Services in the United States, prepared for Rep. Henry A. Waxman and Sen. Susan Collins (July 2004).
    20. Id.
    21. Supra note 5.
    22. Id.
    23. Id.
    24. Peter E. Leone, et al., Understanding the Over-Representation of Youths with Disabilities in Juvenile Detention.D.C.L Rev. 3(Fall), 389-401, 1995.
    25. William N. Glick & Mistie Morales, Indiana Juvenile Detention Mental Health and Substance Abuse Assessment Project (summary statistics) (2004).
    26. Joesph Tulman, University of District Columbia, David A. Clarke School of Law, Presentation Prepared for the Children, Mental Health and the Law Summit: Special Education Advocacy for Young People in the Delinquency and Criminal Systems, Indianapolis, IN (August 27, 2004) (available at http://www.inbar.org/content/news/article.asp?art=339). Children with disabilities are 200 percent more likely to be arrested than the general juvenile population due to a variety of reasons related to their disabilities, including their inability to cooperate and the failure of the system to perceive their disabilities and respond to them. Similarly, at the trial stage, children with disabilities are 220 percent more likely to be adjudicated; and at disposition, their terms of incarceration and/or probation average 2 to 3 years longer.
    27. Supra note 5.
    28. Suzanne Clifford, Director, Division of Mental Health and Addiction, FSSA, Report to the Indiana Commission on Mental Health: Mental Health and Addiction Recovery & Resilience in Indiana (September 21, 2004)(citing National Alliance for the Mentally Ill Policy Research Institute, 2004; National Institute of Health, 1999).
    29. Supra note 17.
    30. Clifford, supra note 28 (citing National Council for Community Behavioral Healthcare, 2004 Candidate Briefing, as cited by the National Mental Health Advisory Council, Healthcare Reform for Americans with Serious Mental Illness in 1993).
    31. Id. At the Dawn Project, a wrap-around program in Marion County, 70 percent of youth successfully meet their treatment goals and graduate from the program, with youth ages 8 or younger more likely to achieve success. The National Mental Health Association (NMHA) included the Dawn Project as one of 11 models nationally that have demonstrated promising results for effective intervention for youth with mental health needs in the juvenile justice system. See also, supra note 17, at 13.
    32. See Appendix for complete list of Summit sponsors, participating organizations, and speakers; a current list of ISBA Civil Rights of Children Committee Members can be found at http://www.inbar.org/content/commitees/standing/CROC/CROCroster.asp
    33. Christine Siegfried, Checking Up on Juvenile Justice Facilities, National Mental Health Association, September 1999.
    34. Thomas Grisso and Richard Barnum, Massachusetts Youth Screening Instrument: Version 2 (MAYSI-2) (2000). For overview of implementation of MAYSI-2 in Pennsylvania juvenile detention centers, see Lourdes Rosado, staff attorney, Juvenile Law Center, Philadelphia, PA, Presentation for the Children, Mental Health and the Law Summit: Screening and Assessment of Youth in the Juvenile Justice System, Indianapolis, IN (August 27, 2004) (available at http://www.inbar.org/content/news/article.asp?art=340). The effort in Pennsylvania resulted after juvenile detention center administrators in 1999 identified mental health as their most important concern; they chose the MAYSI-2 as the screening tool that best fit their needs and resources.
    35. Clifford, supra note 28.
    36. 42 C.F.R. § 436.1004(a).
    37. See Wasserman, Jensen, Ko, Cocozza, Trupin, Angold, Cauffman and Grisso, Mental Health Assessments in Juvenile Justice: Report on the Consensus Conference, J. Am. Acad. Child Adolesc. Psychiatry, 42:7, at 5 (July, 2003).
    38. Individuals with Disabilities Education Act (IDEA) 20 U.S.C. § 1401; 34 C.F.R. § 300 et seq. (2004); Indiana Administrative Code 511 I.A.C. 7-17.
    39. Office of the Surgeon General, U.S. Public Health Service, Mental Health: A Report of the Surgeon General (1999).
    40. Tammy Seltzer and Ellen Harris, The Role of Specialty Mental Health Courts in Meeting the Needs of Juvenile Offenders, Bazelon Center for Mental Health Law, Washington, D.C., 2004 (citing James M. Kauffman, Characteristics of Emotional and Behavioral Disorders of Children and Youth (7th ed.) (Prentice-Hall, 2001)).
    41. 20 U.S.C. § 1400(c).
    42. Id.
    43. Bazelon Center for Mental Health Law, Teaming Up: Using the IDEA and Medicaid to Secure Comprehensive Mental Health Services for Children and Youth, 8-13, August 2003.
    44. Id.
    45. 42 U.S.C. § 1396(r)(5).
    46. See generally, Teaming Up: Using the IDEA and Medicaid to Secure Comprehensive Mental Health Services for Children and Youth.
    47. For a publication discussing how to organize systems of care, see Shelia A. Pires, Building Systems of Care: A Primer, the Human Services Collaborative for the Georgetown University National Technical Assistance Center for Children’s Mental Health, 2002. See also Chris Koyanagi, et al., Mix and Match: Using Federal Programs to Support Interagency Systems of Care For Children with Mental Health Care Needs, Bazelon Center for Mental Health Law, Washington D.C., 2003 (lists core values and principles for a system of care for child and adolescent services developed by the Child and Adolescent Service System Program (CASSP)).
    48. There are a variety of reader-friendly booklets on special education law and learning disabilities available through the Indiana Department of Education, Division of Special Education.
    49. K. Dwyer, D. Osher and C. Warger, Violence and Youth: Psychology’s Response, American Psychological Association, Washington, D.C., 1993; U.S. Department of Education, Early Warning, Timely Response: A Guide to Safe Schools, 1998; H.M. Walker, R.H. Horner, G. Sugai; M. Bullis, J.R. Sprague, D. Bricker and M.J. Kaufman, Integrated Approaches to Preventing Antisocial Behavior Patterns Among School-Age Children and Youth, Journal of Emotional and Behavioral Disorders, 4, 194209, 1996. See also The Safe and Responsive Schools Project, www.indiana.edu/-safeschl.
    50. Thomas Grisso and Lawrence Steinberg, The MacArthur Juvenile Adjudicative Competence Study, The MacArthur Foundation Research Network (summary of results and methods, and tables available at http://www.mac-adoldevjuvjustice.org/page25.html).
    51. 808 N.E.2d 631 (Ind. 2004).
    52. Resneck v. State, 499 N.E.2d 230, 235 (Ind. 1986) (citing Mato v. State, 429 N.E.2d 945, 964 (Ind. 1982)).
    53. The Indiana Juvenile Law Commission recently approved a recommendation that legislation be drafted to provide procedures for the determination of juvenile competency to stand trial (when competency issues are raised), including the possible dispositional alternatives of juveniles found to be incompetent. It further recommended that the legislation should be informed by the work and recommendations of the Juvenile ICST (Incompetence to Stand Trial) Program, Indiana Division Mental Health and Addiction, Family and Social Services Administration (DMHA/FSSA); the “Children, Mental Health and the Law” Summit, Indiana State Bar Association; and models that have been successfully implemented in other states. The DMHA has been looking at legislation and practices used by other states in addressing the issue of juvenile competency. In particular, DMHA has compared statutes and practices from Virginia, Georgia, Texas and Florida.
    54. Dusky v. United States, 362 U.S. 402 (1960).
    55. In re K.G., 808 N.E.2d 631, 635 (Ind. 2004).
    56. See Bruce Kamradt, Funding Mental Health Services for Youth in the Juvenile Justice System: Challenges and Opportunities, National Center for Mental Health and Juvenile Justice Research and Program, December 2002. Some important federal and state funding sources include Medicaid (in particular, the Early and Periodic Screening, Diagnostic and Treatment [EPSDT] Program); the Individuals with Disabilities Education Act (IDEA) (school systems provide special education services, such as counseling, substance abuse prevention and behavioral management, to children with disabilities); State Children’s Health Insurance Program (SCHIP) (a partial funding source for lower-income families that do not qualify for Medicaid); and Title IV-E Waivers (a potential funding source to develop community-based treatment services to reduce correctional placements). Other federal funding sources include family preservation program grants, Mental Health Block Grants (have been used in Indiana to help pay for screening and assessment for youth in the juvenile justice system), Temporary Assistance to Needy Families (TANF) (pays for services for low-income families and can be used to reduce out-of-home placements), OJJDP State Challenge and Formula Grants (awarded to states that are in compliance with the Juvenile Justice and Delinquency Prevention Act), and Juvenile Accountability Incentive Block Grants (the focus is primarily on law enforcement and juvenile courts). See also Chris Koyanagi et al., Mix and Match: Using Federal Programs to Support Interagency Systems of Care For Children with Mental Health Care Needs, Bazelon Center for Mental Health Law, Washington D.C., 2003.
    57. See Jennifer Ryan, The Basics: Medicaid Financing, National Health Policy Forum, 2, September 2004 (available at http://www.nhpf.org/pdfs_basics/Basics-MedicaidFinancing.pdf)
    58. Koyanagi, supra note 55, at 10.
    59. Id., at 3.
    60. Id. at 5-6. See also Virginia’s Comprehensive Services Act. (§§ 2.2-4300-4377 (2001)) (allows innovative pooling of funds resulting in greater flexibility and inter-agency cooperation).
    61. Supra note 36.
    62. Supra note 45.
    63. For a discussion on states’ ineffective use of EPSDT to identify children who need mental health services, with recommended state policy changes, see Where to Turn-Confusion in Medicaid Policies on Screening Children for Mental Health Needs, Bazelon Center for Mental Health Law, Washington D.C., 2003. Also, for an initiative to launch juvenile diversion programs, see Rosado, supra note 34 (discussing the mental health-juvenile justice project in Pennsylvania led by the Juvenile Law Center with support from the MacArthur Foundation).
    64. David E. Arredondo, et al., Juvenile Mental Health Court: Rationale and Protocols, Juv. & Fam. Ct. J. 1 Fall, 2001. Kurt Kumli, the supervising juvenile prosecutor in Santa Clara County, and one of the nation’s leading advocates for juvenile mental health courts, provided the keynote address at the Children, Mental Health and the Law Summit.
    65. 65. Id.
    66. 45 C.F.R. §§160 and 164 (2002). The HIPAA Privacy Rule establishes the federal floor for health information privacy protection. Under the law, protected health information is defined broadly to include past, present or future physical or mental health condition, as well as information related to the provision of services.
    67. I.C. § 31-30-2-1; I.C. § 31-37-22-7.

    APPENDIX

    Acknowledgments

    The Children, Mental Health & the Law Summit was sponsored by the Indiana State Bar Association in cooperation with Indiana Bar Foundation; Indiana Council of Juvenile & Family Court Judges; Indiana Department of Education; Indiana Division of Mental Health & Addiction, Family and Social Services Administration; Indiana Criminal Justice Institute; Indiana Juvenile Task Force; Indiana Prosecuting Attorneys Council; and the Indiana Public Defender Council. Primary financial support was provided by the Indiana State Bar Association and the Indiana Bar Foundation, with additional financial assistance from the Indiana Department of Education and the Indiana Criminal Justice Institute. John E. Connor & Associates provided in-kind support transcribing the proceedings. Special thanks are due to Stephanie Sluss-Funding and David Brimm for their invaluable assistance with the Summit; and to Allison Fetter-Harrot, Jessica Garascia, Tara Gandel Hudson, Terra Martin, April Meade, Kelly Roth, Janet Rumple and James Russell for their help transcribing the proceedings.

    SPEAKERS

    Susan Boatright, Marion County Public Defender, Juvenile Division

    Rebecca Bowman, Indiana Department of Education

    Sen. Billie Breaux (D), Indiana General Assembly

    Rep. Charlie Brown (D), Indiana General Assembly

    John Browning, Southwestern Indiana Mental Health Center, Evansville

    Joyce Burrell, American Institutes for Research, Washington, D.C.

    Gary Chavers, Marion County Prosecutor’s Office, Juvenile Division

    Suzanne Clifford, Indiana Division of Mental Health & Addiction, Family and Social Services Administration (Director)

    David Collins, Monroe County Public Defender

    Sherrill Wm. Colvin, Indiana State Bar Association (President), Fort Wayne

    Katherine Cornelius, Marion County Public Defender, Appellate Division

    Representative William Crawford (D), Indiana General Assembly

    Jill Denman, Huntington County Public Defender

    Roger Duval, Former Scott County Prosecuting Attorney, current Circuit Court Judge, Scott County

    Bill Glick, Indiana Juvenile Justice Task Force, Indianapolis

    Hon. Mary Harper, Porter County Circuit Court

    James M. Hmurovich, Hmurovich & Associates

    Sue Holifield, Parent of Child in Juvenile Justice

    Dr. Bryan Hudson, Pediatric Neuropsychology Associates

    Katie Humphreys, Indiana Juvenile Law Commission (Chair)

    Dr. Michael J. Jenuwine, Indiana University School of Law, Bloomington

    Kurt Kumli, Santa Clara County District Attorney’s Office, Juvenile Delinquency Unit, San Jose, Calif.

    Sen. Connie Lawson (R), Indiana General Assembly

    Robert Marra, Indiana Department of Education

    Kevin McDowell, Indiana Department of Education

    Sen. Robert L. Meeks (R), Indiana General Assembly

    Dennis Morrison, South Central Indiana Community Mental Health Center, Bloomington

    Donald Murphy, Indiana Public Defender’s Council

    Dr. George Parker, Indiana Division of Mental Health and Addiction, Family and Social Services Administration

    Dorene Jackson Philpot, Philpot Law Offices, Indianapolis

    Gary Plaford, Bloomington

    Tom Rich, Evansville Psychiatric Children’s Center

    Lourdes Rosado, Juvenile Law Center, Philadelphia

    Marilyn Schultz, Indiana State Budget Agency (Director)

    M. Bruce Scott, Tourkow Crell Rosenblatt & Johnston, Fort Wayne; (ISBA Family and Juvenile Law Section)

    Lindsey Smith, Indiana Division of Family and Children, Family and Social Services Administration

    Erika Stallworth, Laporte County Juvenile Services Center

    Hon. Viola Taliaferro, Monroe County Circuit Court (ISBA Civil Rights of Children Committee)

    Prof. Joseph Tulman, University of District of Columbia, Washington, D.C.

    Betty Walton, Indiana Division of Mental Health and Addiction, Family and Social Services Administration

    Paul Wilson, Park Center (Community Mental Health), Fort Wayne

    Dr. Jennifer Woolard, Georgetown University, Washington, D.C.

    Marie Young, Monroe County Juvenile Youth Placement Coordinator

    PLANNING FACULTY

    Professor Amy G. Applegate, Indiana University School of Law, Bloomington

    Steven M. Badger, McTurnan & Turner, Indianapolis. ( ISBA Civil Rights of Children Committee)

    Hon. Taylor L. Baker, Jr., Retired Judge, Indianapolis (ISBA Civil Rights of Children Committee)

    James J. Bell, Kiefer & McGoff, Indianapolis (ISBA Criminal Justice Section)

    Jeffrey Bercovitz, Indiana Judicial Center

    Cynthia K. Booth, Child Advocates, Inc., Indianapolis

    Pamela Clark, Bartholomew County Youth Services Center

    Amy Cook Lurvey, Indiana Commission on Mental Health (Member)

    Cathy Danyluck, Indiana Department of Education

    Hon. Steven H. David, Boone County Circuit Court (Indiana Council of Juvenile and Family Court Judges; ISBA Civil Rights of Children Committee)

    Laurie Elliott, Indiana Juvenile Justice Task Force, Indianapolis (ISBA Civil Rights of Children Committee)

    Paje E. Felts, Indiana State Bar Association (Legislative Counsel)

    Cathleen Graham, IARCCA: An Association of Children and Family Services, Indianapolis

    Daryl Hall, Indiana Department of Correction

    Terry E. Hall, Baker & Daniels, Indianapolis (ISBA Civil Rights of Children Committee)

    JauNae Hanger, Waples & Hanger, Indianapolis (ISBA Civil Rights of Children Committee)

    Prof. Frances Lee Watson Hardy, Indiana University School of Law, Indianapolis

    Hon. Stephen Heimann, Bartholomew County Circuit Court (Indiana Council of Juvenile and Family Court Judges)

    Dianna Huddleston, Indiana Council of Community Mental Health Centers

    Steven J. Johnson, Indiana Prosecuting Attorneys Council

    Amy E. Karozos, Indiana Public Defender’s Office (ISBA Civil Rights of Children Committee)

    Jerome P. Kelly, Clarian Health (ISBA Civil Rights of Children Committee)

    Nikki Kincaid, Indiana Criminal Justice Institute

    Larry Landis, Indiana Public Defender Council

    Andrew Manna, Locke Reynolds LLP, Indianapolis (ISBA Civil Rights of Children Committee)

    Willard Mays, Indiana Division of Mental Health and Addiction, Family and Social Services Administration

    Hon. Andrea McCord, Lawrence County Circuit Court

    Gaylon J. Nettles, Indiana Department of Education (ISBA Civil Rights of Children Committee)

    Megan Orneilas, Indiana State Budget Agency

    Evelyn Ridley-Turner, Indiana Department of Correction (Commissioner)

    Leslie Rogers, Indiana GAL/CASA

    Carson Soule, Marion County Mental Health Association

    Derelle Watson-Duvall, Kids Voice of Indiana

    Kathy Williams, KWMS, Inc. Eric Yandt, LaPorte County Community Corrections

    Nancy Zemaitis, Indiana Department of Education; Early Identification and Intervention Policy Academy (Member)

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  • Other Resources

    The links below are to other websites that are not affiliated with Philpot Law Office LLC in any way. Philpot Law Office LLC obviously cannot warranty the accuracy, legal accuracy, usefulness or anything else about anyone else's web site materials, which can be changed on a daily basis and are under the control of others, not Philpot Law Office LLC. Thus, these links are offered for educational purposes only. They are not to be considered to be legal advice. If you need legal advice about your particular case, please consult the legal professional of your choice.

    Advocacy, Inc.
    7800 Shoal Creek Blvd. #171-E
    Austin, TX 78757-1024
    512-454-4816 (V/TDD)
    512-323-0902 (Fax)
    1-800-252-9108 (V/TDD)
    infoai@advocacyinc.org

    Family to Family Network
    13150 FM 529, Suite 106
    Houston, TX 77041
    713-466-6304


    TEAM Project

    3311 Richmond Ave., Suite 334
    Houston, TX 77098
    713-524-2147
    www.partnerstx.org/projects/team/team/htm


    Special Kids Inc. (SKI)

    Serves Houston Independent School Districts
    South, South Central and Central.
    P.O. Box 266958
    Houston, TX 77207-6958
    www.specialkidsinc.org


    Region 4 Education Service Centers

    7145 West Tidwell
    Houston, TX 7092-2096
    713-462-7708


    ABA Services Inc.

    10584 Tremont Circle
    Fishers, IN 46038
    Phone: 577-3797
    Fax: 842-5911
    Website: www.abaservicesinc.com

    Sherry Quinn
    E-mail: sherry.abaservicesinc@insightbb.com

    The Arc of Indiana
    107 N. Pennsylvania St., Suite 300
    Indianapolis, IN 46204
    Toll-Free: 800-382-9100
    Phone: 977-2375
    Fax: 977-2385

    Assistive Technology Through Awareness in Indiana
    ATTAIN PROJECT
    2346 Lynhurst Drive
    Airport Office Center, Suite 507
    Indianapolis, IN 46241
    Phone: 317-486-8808
    Toll-Free Indiana: 800-528-8246
    Toll-Free / TTY: 800-486-8809
    Fax: 317-486-8809
    Email: attain@attaininc.org
    Website: www.attaininc.org


    ATTIC Inc.
    P.O. Box 2441
    2758 B. E. Pine Hill Dr.
    Vincennes, IN 47591
    Toll-Free/TTY: 800-962-8842
    Phone/TTY: 812-886-0575
    Fax: 812-886-1128
    Email: inattic2@aol.com

    Autism Advocates Of Indiana
    Jennifer Grim, President
    Phone: 842-6441
    Website: www.autismindiana.4t.com

    Has support group on Southside of Marion County

    Autism Society of America
    Toll-Free: 1-800-3-AUTISM

    Behavioral Healthcare for Children and Families
    8945 N. Meridian St., Suite 125
    Indianapolis, IN 46260
    Randall Krupsaw
    Phone: 816-5600

    Brain Injury Association of Indiana
    9531 Valparaiso Court, Suite A
    Indianapolis, IN 46268
    Phone: 317.356-7722
    Email: info@biai.org
    Website: www.biausa.org/Indiana

    The Bridge at Cornerstone
    Phone: 718-0089
    Agency that does OT, PT and speech therapies in Danville
    Purpose – bridge school-based therapy with the individual medically-based therapy.


    Jan Bullington
    Parent advocate group member
    Phone: 317-873-9817
    Email: scbull@sbcglobal.net

    Saw my name on COPAA list and contacted me.

    CHADD, Bloomington
    Joan Hart
    Email: Joanhart12@aol.com
    Cell Phone: 812-219-4360


    Children’s Law Center
    5160 E. 65th St., Suite 109
    Indianapolis, IN 46220
    Phone: 317-558-2870.

    Connections, Inc.
    711 South East Street
    Indianapolis, Indiana USA 46225
    Phone: 317.423.1000 ext. 103
    Fax: 317.423.3425
    Website: www.connections-inc.net

    Jenifer Asher
    President/ CEO
    Email: jasher@connections-inc.net

    Behavioral health services with licensed therapists and psychologists available to offer behavior management services, individual and family counseling, as well as, psychological evaluations to individuals residing in BDDS districts 1-6. For the past seven years, Connections, Inc. has primarily served children, teens, and adults with emotional issues and/or developmental disabilities in Indianapolis and the surrounding counties. Serves children and adults with autism spectrum disorders as well as those with co-existing issues of serious mental illness and developmental disabilities, Down syndrome, addictions issues, Prader-Willi and/or very high risk behavioral choices.

    Daymar
    Chris Akers
    Program planner
    Phone: 856-5201 ext. 195


    Down Syndrome Association of Central Indiana
    10792 Downing St.
    Carmel, IN 46033-3869
    Phone/Fax: 317-574-9757

    Down Syndrome Association of NWI
    2927 Jewett Ave.
    Highland, IN 46322
    Phone: 219-838-3656
    Fax: 219-838-6959
    Email: dsa@netnitco.net

    Down Syndrome Support Association of Southern Indiana (DSSASI)
    P.O. Box 3262
    Clarksville, IN 47131
    Phone: 812-948-5182

    Education-A-Must
    Website: www.education-a-must.com

    Emerald Consulting
    40 N. Ridgeview
    Indianapolis, IN 46219
    Phone: 317-843-0850
    Darla Cohen
    Email: dcohen@child-dev.com

    Family Resource Center of Southeast Indiana
    4101 Timberview Rd.
    West Harrison, IN 47060
    Phone: 812-637-1445

    Robert W. Fechtman
    Attorney at Law
    36 S. Pennsylvania St., Suite 600
    Indianapolis, IN 46204
    Phone: 317-655-5140
    Email: rfechtman@indianaelderlaw.com

    Medical waivers, BDDS, elder law, disability law

    First Steps Early Intervention of New Horizons
    P.O. Box 98
    Batesville, IN 47006
    Phone/TTY: 812-934-4528
    Fax: 812-934-2522

    First Steps for Families
    500 8th Ave.
    Terre Haute, IN 47804
    Phone: 812-231-8419
    Phone: 812-231-8420
    Fax: 812-231-8208
    Email: famnetwork@aol.com

    Future Choices
    309 N. High St.
    Muncie, IN 47305
    Phone: 765-741-3494
    Fax: 765-741-8333


    Hear Indiana
    9041 Colgate Dr.
    Indianapolis, IN 46268-1210
    Phone: 872-3242
    Fax: 872-0795
    Email: skillion2@comcast.net


    Indiana Department of Education
    Division of Exceptional Learners
    Room 229, State House
    Indianapolis, IN 46204
    Kevin McDowell
    Phone: 232-5547
    Fax: 232-0744


    Indiana Down Syndrome Foundation
    3050 N Meridian St
    Indianapolis, IN 46208
    Phone: 317-216-6319
    Fax: 317-925-7619
    Email: idsfdirector@sbcglobal.net
    Website: www.indianadsf.org


    Indiana Parent Information Network Inc
    4755 Kingsway Dr., Suite 105
    Indianapolis, IN 46205
    Phone: 257-8683
    Toll Free: 800-964-4746
    Fax: 251-7488

    Indiana Protection and Advocacy
    4701 N. Keystone, 2nd floor
    Indianapolis, IN 46205
    Phone: 317-722-5555

    Indiana Resource Center for Autism
    Phone: 812-855-6508

    IN*SOURCE
    1703 South Ironwood Dr.
    South Bend, IN 46613
    Phone: 219-234-7101
    Phone/TTY: 219-239-7275
    Toll Free Indiana: 800-332-4433
    Fax: 219-234-7279
    Email: insource@insource.org
    Website: www.insource.org

    Olive Swenson
    5739 Spruce Knoll Court
    Indianapolis, IN 46220
    317-472-7500
    email readobs@msn.com


    Knox County Advocates
    1805 Indiana Ave.
    Vincennes, IN 47591
    Phone: 812-882-0375
    Phone: 812-886-0575
    Fax: 812-886-1128
    Email: INATTIC1@aol.com

    Learning Disabilities Association of Indiana
    Kathy Klawiter
    Email: ldaofindiana_Kathy@yahoo.com

    Michaels List
    Website: www.michaelslist.net

    Indiana resource for parents, caregivers and professionals who work with and love someone with autism spectrum disorder.

    NEO Fight
    4363 Idlewild Ln.
    Carmel, IN 46033-4716
    Phone: 317-255-5242
    Fax: 317-274-2846
    Email: kmarrs@iupi.edu
    Website: member.tripod.com/~neofight

    Riley Child Development Center
    Indiana University Hospitals
    550 N. University Blvd.
    Indianapolis, IN 46202-5250
    Dr. Angela M. Tomlin, Ph.D.
    Phone: 317-274-8167

    Santa S.J. Brink & Associates
    2131 Longleaf Drive
    Fort Wayne, IN 46104
    Phone: 260-625-5662
    Cell Phone: 260-402-9119
    Fort Wayne Learning Center
    Santa Brink
    Email: santa@santabrink.com

    Linda Snider
    Parent advocate
    2003-C Chamblee Dr.
    Valparaiso, IN 46383
    Email: parentsforparents@msn.com

    Success Coach Inc.
    Ed Burns
    Email: successcoach@earthlink.net

    Currently working with LDA-Indiana, NAMI of Indianapolis and CHADD of Central Indiana. I have a private support business called Success Coach LLC. I help families, children, adolescents and adults with issues caused by Developmental Disabilities (ADD, ADHD, ODD, OCD, Anxiety and Depression). My support consists of education and the development of successful strategies that make life more rewarding.

    Nanette Whightsel
    Email: nwhightsel@arcind.org
    Phone: 977-2375

    Parent advocate for kids w/special needs. Knows a lot about Medicaid Support Services Waiver.

    For more information about deducting the costs of services for children with disabilities on your taxes, visit http://www.centerforlearningdifferences.org/funding.php

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  • U.S. DOE Study

    The United States Department of Education did a study in April 2009 that appears to show that the special education services and programs provided to disabled kids aren’t having the desired outcome.

    The study is called: “The Post-High School Outcomes of Youth With Disabilities up to 4 Years After High School A Report From the National Longitudinal Transition Study-2 (NLTS2)Executive Summary, April 2009” and can be found at http://ies.ed.gov/ncser/pdf/20093017.pdf.

    Back to top

  • Web Resources

    The links below are to other websites that are not affiliated with Philpot Law Office LLC in any way. Philpot Law Office LLC obviously cannot warranty the accuracy, legal accuracy, usefulness or anything else about anyone else's web site materials, which can be changed on a daily basis and are under the control of others, not Philpot Law Office LLC. Thus, these links are offered for educational purposes only. They are not to be considered to be legal advice. If you need legal advice about your particular case, please consult the legal professional of your choice.

    http://www.lrp.com/

    http://www.specialedconnection.com/

    http://www.mayerslaw.com/

    http://rsaffran.tripod.com/legal.html

    Indiana Department of Education
    http://ideanet.doe.state.in.us/

    The First Steps web site is a great resource for early intervention
    http://www.state.in.us/fssa/first_step

    http://earlychildhoodmeetingplace.indiana.edu

    With this website, you can plug in a school and find out how that school is doing by test data and other measures of performance. They also have analyzed what works and what doesn't and have tips and tutorials.
    http://216.30.107.242/us/us_home.asp

    Autism websites

    This website is by special education attorney David Sherman, 2740 Van Ness Ave.,San Francisco, CA 94909. He can be reached at 415-924-1300 or Aspecialedlawyer@sbcglobal.net.
    www.aboutautismlaw.com

    http://www.featofmn.org/

    http://www.lovaas.com/links/index

    Mental retardation website:
    http://arcind.org/

    Helpful websites for Texas parents:

    http://www.texasprojectfirst.org/SEProcessStep.html

    http://www.thearcoftexas.org/

    http://www.txp2p.org/

    http://www.partnerstx.org/

    http://www.peytonwolcott.com/

    http://texasschoolwatch101.virtualnsn.com/modules/wfchannel/

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