Sunday, August 3, 2008

Courts and Kids: Will the CBHI make the process easier?

I seem to have spent a lot of time lately on the rituals of government, as evidenced in yesterday's screed about the legislative engrossment of our marvelous Children's Mental Health bill last week.   Last week, I was also privileged to observe the Juvenile Court in action;  usually a sobering experience- last time I was there, I watched a 13 y/o "tough" burst into tears as he was shackled and taken off into DYS custody.  Sometimes I think that the images on "Law and Order" make us forget that these are kids, and, despite the bravado and "in your face" gangsta thing, they really don't want to screw up their lives.  This week, I was struck by how difficult the task of the court was in trying to straighten out the lives of children, and how the ritual makes it, if not doable, at least palatable.  Here is what I wrote at the time, appropriately edited.

Court is ritual. The family, the judge, the attorney, the interpreter, the social worker: all elements must be in place for the ritual to occur. We waited for all to arrive, then it began. It proceeds like a ritual, with the judge at the head. He called on the Department of Children and Families, on the guardian ad litum, on mother. This was a happy story; the brother and sister were being reunited with their mother. I have no idea what sort of behavior resulted in their separation, but it was clear that their mother wanted them back and that she felt that the State had made no positive contribution to her children's welfare. Her anger was visceral; it seemed directed at this systems that cared for her children. The Judge tried to understand her anger; she had much difficulty in stating her grievances in words. After hearing her out, the judge let them go home together with stiff admonitions to the children that they should not cause their mother such problems in the future. He might as well have said, “Go and sin no more”.
LESSON: Don't expect thanks when circumstances require you to intervene on behalf of children. And, as is continually stated at our "Rosie D" forums, how does one practice "family centered" care when the family is a part of the problem?  It was interesting to watch a judge wrestle with that issue- it is hard work.

We them moved to plea bargains. Three girls at a local hight school were caught on videotape stealing from a locker and plead guilty. They all had their cases continued without finding after giving up all of their rights. The Judge carefully made sure that the facts were all in place, and impressed on the girls how close to the edge they were. He asked them about his dreams. Then he was appropriately merciful.
LESSON: Mandatory sentencing, automatic suspensions and the like do not allow for the complexity of human interactions.  Some humans do learn from experience;  I recall an 11 y/o of my acquaintance who once lit a field on fire while playing with matches, and "went straight" after a stern talking-to by the Fire Chief.  Humans make mistakes; one hopes that they continue to learn and grow from them.  And, in terms of our response, one size is unlikely to fit all.  As we build the Children's Behavioral Health Initiative, with the screening and the CANS and the ICC and the wraparound, we need to remember that:  the human experience requires a flexible response.  We need to give those working in the system enough room to provide it.

We moved on to the ritual of CHINS. Here I must be circumspect due to confidentiality:  the cases were complex, and involved petitions files by parents and by the schools.  In each case, the Judge tried to recognize that the CHINS is a culmination of a series of events, and that the history often helped him understand the future direction of the case.  His response to the child varied, depending on the nature of the case.  
LESSON:  Each case begged the question:  could a better designed and more family centered mental health system address some of these issues so that the court didn't need to be involved?

As the morning moved on (the Judge is just back from vacation, and had quite the docket).  Two cases stick in my mind:  One was a  restraining order, through which the mother of a younger girl was trying to keep her from talking to an older boy.  Violations involving the telephone and texting were alleged;  it is not clear who was calling whom.
THOUGHT:  Why don't the parents just take away their cell phones?
The other one was a CHINS case: a young man with severe psychiatric problems who is not currently getting psychiatric treatment. He is hearing voices, he tells a court ordered evaluation, but his mother doesn’t agree.  They are installing FST program, to try to get him some services-  if that doesn't work, his options are foster care, lock up or maybe an alternative school.  What can we do with this?
THOUGHT:  All of which leads me to wonder why we can’t handle these things without a court.  I guess we need the court when the family is not making the creaky and overburdened system work well for themselves.
OBSERVATION:  It is interesting that, in all of the continuance cases, the judge asks “Are you under the care of psychiatrist’”, I presume as a screen for serious mental illness. Given the shortage of child psychiatrists in the Commonwealth, I wonder if that is sufficient screen.  Also, there are lots of folks with mental illness who see psychologists and social workers, not psychiatrists.
I alway learn things sitting in the Juvenile Court, in part because that is where the kids that we haven't helped often end up.  This time, I saw the need for options, so that the Judge, in his wisdom and compassion and common sense, has something to offer the families that come to him seeking help.  We have to be able to make that work.

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