The Diagnostic Services Track (DST) provides diagnostic services and assessments for adolescents who have committed sexual offenses. These individuals have demonstrated a history of sexual acting out and other mental health or behavioral issues that require intensive levels of care, such as inpatient and residential treatment. The DST functions to determine the most efficacious inpatient programming necessary. This program takes place within a 45 day timeline, followed immediately with a Court Review.
The DST is housed within Mathom House. The facility is divided into two distinct sections operating semi-independently. One is licensed as a secure care program (East Side), the other as residential care (West Side), under DHS 3800 regulations. Residents in the DST reside on the East Side and must be adjudicated delinquent prior to entering the program. After 45 days, a recommendation will be made about future treatment.
Therapy Type and Frequency
A Clinical Therapist will act as the Diagnostic Team Leader and will oversee and coordinate diagnostic services. Each resident in the DST will receive the following therapeutic supports:
- Twice weekly individual therapy sessions
- Introductory group therapy sessions (four times per week)
- Family Therapist will meet with the family to assess family functioning and gather family history
Over a 45-day period adolescents will undergo multidisciplinary assessment including treatment, psychiatric evaluation, psychological evaluation, neuropsychological evaluation, educational assessments, medical/laboratory screenings, and a psychosexual assessment. In addition, they will receive educational services through our in-house school which provides services for mainstream and special education populations. Students receive appropriate education in coordination with the student’s home school district. If the student has an existing IEP, it will be implemented or revised as necessary. Edison Court utilizes a battery of assessment modalities that are standardized and normed on adolescent populations and which are widely accepted via empirical research as the best practice.
Examples of cases appropriate for referral to the DST include, but are not limited to, the following:
- It is sometimes necessary to admit a juvenile into the milieu to effectively ascertain if he meets medical necessity criteria for RTF treatment. Juveniles who initially present with behavioral issues are sometimes denied medical necessity authorization. In the DST, these residents may disclose traumatic histories as victims, offenders, or more often, both. These clients may therefore meet medical necessity criteria after the 45 day assessment period.
- Conversely, some juveniles may initially present mental health issues coupled with behavioral ones. It is possible that during the 45 day diagnostic period, the juvenile’s behavior concerns outweigh their ability to benefit from mental health treatment. If their behavior precludes effective treatment at the current level of care, a recommendation for a behaviorally-focused program, such as ‘State Secure’, may be made.
- The DST can be used to help clarify offending behavior. For example, a youth may be charged with a sexual offense and through the evaluation period may demonstrate that his offense was an anomaly and thus be identified as a low risk to recidivate. In such a case, a recommendation for treatment non-exclusive to sexually abusive behaviors may be appropriate.
Residents are males typically between the ages of 12 and 19 at admission. They have been adjudicated delinquent on charges related to sexual misconduct. Residents have typically committed sexual assaults against younger children known to them or against similarly aged peers. They must have histories that suggest they are capable of behaving appropriately in a milieu where physical restraint of residents is rare. In cases where preexisting assessment of intellectual functioning has taken place, a full scale IQ of 70 generally represents the minimum threshold for program amenability. In the event that no prior assessment of intellectual functioning exists, a clinical assessment of functioning above severe intellectual disability is recommended. Clients who do not currently meet medical necessity, have not yet been approved by their respective MCO and/or need a thorough battery of assessments and evaluations to meet medical necessity are appropriate referrals.
Description of Clients Served
Diagnostic treatment is available to male adolescents who are between the ages of 12 and 19 years and manifest mental health, social, emotional and/or behavioral problems that do not contra-indicate a secure setting. These juveniles are unable to remain in their own homes or other community placements without a more comprehensive assessment to determine the appropriate level of intervention and supervision. They must be adjudicated delinquent on charges related to sexual offending and require diagnostic testing to determine recommended level of care.
Relevant documentation, if applicable, may include the following, though are not necessary for admission to DST:
- Principal Axis I DSM-IV or 5 diagnosis;
- Treatment at a lower level of behavioral health care has been attempted or considered;
- Client exhibits impaired judgment, impulse control and/or cognitive and perceptual abilities;
- Client has significantly impaired interpersonal functioning;
- There is sufficient emotional, social and behavioral functioning for the client to reside in this agency’s “hands off” management milieu;
- Client has insufficient or limited resources or skills to maintain an adequate level of functioning outside of a residentially-based program;
- Client is experiencing significant family problems that prevent him/her from adequately functioning within the family setting;
- Client is medically stable and the medical needs of the resident are within the scope of the program.
Admission to DST is individually determined based on evidence that the presenting problems are those that the service is designed to address. The DST is geared for youth who may present with what often constitute exclusionary factors, e.g. fire setting, mild autism diagnosis, or deficient intellectual functioning. Those youth, who may not be appropriate for admission into the Mathom House RTF, may be admitted into the DST. After the 45 day period of evaluation, it may or may not be recommended to the Court that he remain at Mathom House to complete treatment. Residents generally not appropriate for admission include:
- Those actively psychotic, requiring a secure inpatient setting;
- Those who require 24 hour or specialized medical care;
- Those with a primary diagnosis of drug and/or alcohol abuse;
- Those who are actively suicidal, requiring a more secure inpatient setting;
- Those who are not proficient in the English language.
Review by the Administration could allow admission of a resident who would otherwise be precluded by the above criteria. Residents are referred by the Juvenile Court.