Section 380.8751 - Specialized Treatment(a) Purpose. The purpose of this rule is to establish the process by which youth committed to the Texas Juvenile Justice Department (TJJD) are assessed and treated for specialized treatment needs. The purpose of all provisions in this rule is to promote successful youth reentry and reduce risk to the community by addressing individual specialized treatment needs through programs that are designed to reduce risk to reoffend.(b) Definitions. Except as indicated in this subsection, see § 380.8501 of this chapter for definitions of terms used in this rule.(1) Intensive Treatment Program--a high-intensity treatment program designed to address youth with a high need for specialized treatment. Treatment is generally delivered in specialized groups by licensed or appropriately trained staff.(2) Psycho-educational Program--a low-intensity program delivered by appropriately trained staff that is designed to address youth with a low need for specialized treatment.(3) Sex Offense--a reportable adjudication as defined in Article 62.001 of the Texas Code of Criminal Procedure.(4) Mental Health Professional--see definition in § 380.9187 of this chapter.(5) Moderate-Intensity Treatment Program--a program designed to address youth with a moderate need for specialized treatment. Treatment is generally delivered in specialized groups by licensed or appropriately trained staff.(c) General Provisions. (1) Youth with one or more specialized needs will have these needs addressed while under TJJD jurisdiction. Youth may have specialized needs addressed while in a high- or medium-restriction facility or on parole status.(2) If a youth cannot be provided the type(s) of specialized program designated in this rule for the youth's assessed need level, the youth will be provided with the most appropriate alternate form of intervention for that treatment need.(d) Treatment Planning. (1) Upon admission to TJJD, comprehensive assessments are conducted to determine if a youth has any specialized treatment needs and to identify the type of specialized program that is best suited to address those needs. For each youth assessed as having a specialized treatment need, an initial plan documenting all specialized treatment needs and recommended programs is developed as soon as possible.(2) In addition to the initial plan, a comprehensive plan is developed for each youth with specialized treatment needs. The comprehensive plan must:(A) include individually tailored statements regarding treatment goals and objectives;(B) include the tentative sequence and start dates for each specialized program;(C) be developed with input from the youth; and(D) be documented in the youth's individual case plan.(3) The sequence and start dates for specialized programs are based on individual youth needs, facility schedules, and program openings, with consideration given to the youth's minimum length of stay or minimum period of confinement.(4) The comprehensive specialized treatment plan is reviewed, reevaluated, and modified in accordance with rules for the review and modification of the individual case plan, as set forth in § 380.8701 of this chapter. The plan is also modified following each reassessment of a youth's specialized treatment needs.(5) Specialized treatment needs may be reassessed at any time during a youth's stay in TJJD.(e) Specialized Treatment Needs. The areas of specialized treatment need are set forth in paragraphs (1) - (6) of this subsection, with each area given priority for placement and treatment based on urgency of need.(1) Medical. Each youth is provided comprehensive medical and dental examinations. Based on the results of these examinations, each youth is assigned a need level for medical or dental services. Non-compliance with treatment may cause any youth to be designated as higher need than the underlying condition would typically warrant.(A) High Need--includes youth who require medical, surgical, or dental services of an intense/acute nature. The youth has a serious acute condition, experiences an exacerbation of a chronic medical or dental condition, sustains a serious injury, and/or may require hospitalization. The youth's condition is unstable or unpredictable, and recovery requires 24-hour nursing care or supervision beyond the scope of normal infirmary services. The youth's medical needs, until resolved, take precedence over other therapeutic interventions and temporarily prevent active participation in programming.(B) Moderate Need--includes youth who are diagnosed with a medical or dental condition that is moderate to serious in severity and that may require frequent access to clinical and/or hospital services for symptom exacerbation.(C) Low Need--includes youth who are diagnosed with a condition that is mild to moderate in severity and does not require ongoing treatment or monitoring. The youth may be temporarily restricted from an activity due to an accident, injury, or illness of mild to moderate severity.(D) None--includes youth with no medical or dental diagnosis requiring ongoing attention.(2) Mental Health. The mental health needs assessment is provided by mental health staff through comprehensive psychological and/or psychiatric evaluation using the most current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Based on this assessment, each youth is assigned a need level for mental health treatment services.(A) High Need - Level 1.(i) This level of treatment need includes youth who:(I) are diagnosed with a mental disorder. As a result of the disorder, there is disorganized, bizarre, and/or grossly inappropriate behavior in one or more of the following areas: social or interpersonal interactions, educational or vocational participation, or the ability to manage daily living requirements;(II) have an assessment of adaptive functioning that is consistent with the level of impairment noted;(III) cannot meaningfully participate in programming until the underlying disorder is stabilized; and/or(IV) are an imminent danger to themselves or others as a result of the mental disorder.(ii) This level of impairment is not the result of a conduct disorder, oppositional defiant disorder, or similar impulse control/behavioral disorders and is not the result of intoxication or withdrawal from drugs.(iii) Youth with this level of impairment require a protective environment during this phase of the disorder and are treated at an agency-operated crisis stabilization unit or a psychiatric hospital with psychiatric care as the highest priority.(B) High Need - Level 2.(i) This level of treatment need includes youth who:(I) are diagnosed with a mental disorder. As a result of the disorder, there is moderate to severe impairment in one or more of the following areas: social or interpersonal interaction, educational or vocational participation, or the ability to manage daily living requirements despite receiving psychiatric care and clinical support services;(II) have an assessment of adaptive functioning that is consistent with the level of impairment noted; and/or(III) are having a difficult time maintaining stability and program participation despite receiving psychiatric services and local clinical support.(ii) This level of impairment is not the result of a conduct disorder, oppositional defiant disorder, or similar impulse control/behavioral disorders and is not the result of intoxication or withdrawal from drugs.(iii) Youth with this level of treatment need are placed in an intensive mental health treatment program with structured interventions and enhanced clinical support services in addition to regular psychiatric services.(C) Moderate Need. (i) This level of treatment need includes youth who:(I) are diagnosed with a mental disorder. As a result of the disorder, behavior is mildly impaired by signs and symptoms of the mental disorder in one or more of the following areas: social or interpersonal interaction, educational or vocational participation, or ability to manage daily living requirements with regular psychiatric care and/or psychological intervention;(II) have an assessment of adaptive functioning that is consistent with the level of impairment noted; and/or(III) display symptoms or difficulties with adaptive behavior as a result of abuse or trauma.(ii) This level of treatment need is not the result of a conduct disorder, oppositional defiant disorder, or similar impulse control/behavioral disorders and is not the result of intoxication or withdrawal from drugs.(iii) Youth with this level of treatment need are placed in an agency facility offering the necessary clinical and/or psychiatric support. Youth identified with a history of abuse or trauma are offered interventions specific to the trauma to help maintain their ability to function and participate in programming.(D) Low Need--includes youth who require only periodic mental health services, regardless of whether the youth have a mental health diagnosis, or regular psychiatric services. For youth with a psychiatric diagnosis, the assessment of adaptive functioning is consistent with the level of impairment noted.(E) None--includes youth who do not require follow-up services from mental health or psychiatric providers, regardless of whether the youth have a mental health diagnosis.(3) Intellectual Disability. The diagnosis of intellectual disability is made by mental health staff based on the results of a culturally validated assessment of cognitive functioning, mental abilities, reasoning, problem solving, abstract thinking, and adaptive behavior as defined in the latest edition of the DSM. Based on this diagnosis, each youth is assigned a need level for intellectual disability services. Youth are assigned to the placement that is best suited to meet the youth's individual treatment needs. (A) High Need--includes youth diagnosed with moderate or severe intellectual disability who have corresponding deficits in intellectual and adaptive functioning.(B) Moderate--includes youth diagnosed with mild intellectual disability who have a co-occurring mental health treatment need of moderate or low.(C) Low Need--includes youth diagnosed with mild intellectual disability who have no co-occurring mental health treatment needs.(D) None--includes youth who have no diagnosis of intellectual disability.(4) Sexual Behavior. The sexual behavior treatment need assessment is provided by a psychologist, mental health professional, or licensed sex offender treatment provider through a clinical interview and an agency-approved juvenile sexual offender assessment instrument. The assessment is provided for youth who have been adjudicated for a sex offense or who have a documented history of sexually inappropriate behavior. Based on this assessment, each youth is assigned a need level for sexual behavior treatment services.(A) High Need--includes youth who receive an assessment rating of high need for sexual behavior treatment based on the results of the clinical interview and the agency-approved juvenile sexual offender assessment instrument. Youth with this level of treatment need are assigned to participate in an intensive sexual behavior treatment program.(B) Moderate Need--includes youth who receive an assessment rating of moderate need for sexual behavior treatment based on the results of the clinical interview and the agency-approved juvenile sexual offender assessment instrument. Youth with this level of treatment need are assigned to participate in a moderate-intensity sexual behavior treatment program.(C) Low Need--includes youth who receive an assessment rating of low need for sexual behavior treatment based on the results of the clinical interview and the agency-approved juvenile sexual offender assessment instrument. Youth with this level of treatment need are assigned to participate in a psychosexual education curriculum.(D) None--includes youth who have no assessed need for sexual behavior treatment.(5) Capital and Serious Violent Offender. A psychologist or mental health professional makes a determination of need for capital and serious violent offender treatment for any youth who was found by a court or a Level I due process hearing to have engaged in conduct that resulted in the death of or serious bodily injury to a person or involved using or exhibiting a deadly weapon and any youth referred by a mental health professional based on a reasonable belief the youth is in need of capital and serious violent offender treatment. The determination is based on the youth's offense history and clinical assessment of the youth's need for specialized treatment intervention.(A) High Need--youth are assigned to participate in an intensive capital and serious violent offender program.(B) Medium Need--youth are assigned to participate in a moderate-intensity program designed to address aggression and violent behavior issues.(C) Low Need--youth are assigned to participate in a psycho-educational anger management supplemental curriculum.(D) None--includes youth who are assessed as not having a significant risk related to violent offending or behavior.(6) Substance Use Services. All youth are screened to determine if they should be assessed for a need for substance use services. Those who need further assessment are assessed and diagnosed by mental health staff or a chemical dependency counselor using the latest edition of the DSM. Based on a clinical interview and the results of an agency-approved, comprehensive assessment instrument, each youth is assigned a need level for substance use services.(A) High Need--includes youth with a diagnosis of substance use disorder and a high-intensity substance-use-services treatment need based on the results of an agency-approved assessment instrument. Youth with this level of treatment need are assigned to participate in an intensive substance-use-services treatment program.(B) Moderate Need--includes youth with a diagnosis of substance use disorder and a moderate-intensity substance-use-services treatment need based on the results of an agency-approved assessment instrument. Youth with this level of treatment need are assigned to participate in a moderate-intensity substance-use-services treatment program.(C) Low Need--includes youth with any identified substance use history or risk that does not rise to the diagnostic level of substance use disorder. Youth with this level of treatment need are assigned to participate in a psycho-educational substance-use-services program.(D) None--includes youth who have no history of substance use or risk of use.(f) Requirement to Complete Specialized Treatment.(1) This subsection applies only to youth who are assessed as having a high or moderate treatment need in the following treatment areas: sexual behavior, capital and serious violent offender, or substance use services. This subsection does not apply to youth assigned to complete psycho-educational supplemental curricula in these treatment areas.(2) For purposes of §§ 380.8545, 380.8555, and 380.8559 of this chapter, participation in or completion of assigned specialized treatment programs means:(A) the youth has completed assigned specialized treatment programs; or(B) a designee of the executive director with appropriate expertise determines that the youth has made sufficient progress toward treatment goals or that the goals can be addressed in a non-high-restriction setting.(3) This subsection does not apply to decisions made by the Release Review Panel under § 380.8557 of this chapter.(g) Individual Exceptions.(1) The requirement to complete specialized treatment as described in subsection (f) of this section may be waived if the division director over specialized treatment or designee determines that the youth is unable to participate in the assigned specialized treatment program due to a medical or mental health condition or due to an intellectual disability.(2) Each youth's individual circumstances are considered when determining the most appropriate type of specialized treatment intervention to assign. A youth may be assigned or reassigned to a specialized program designated for a higher or lower need level than the youth's assessed need level for any reason deemed appropriate by the division director over specialized treatment or designee.(3) The executive director or designee may make exceptions to provisions of this rule on a case-by-case basis, based on a consideration of the youth's best interests and public safety.(4) The justification for any individual exceptions granted under this subsection must be documented.(h) Specialized Aftercare. Youth will be provided specialized aftercare as needed and as available.37 Tex. Admin. Code § 380.8751
The provisions of this §380.8751 adopted to be effective September 1, 2009, 34 TexReg 5543; amended to be effective November 1, 2011, 36 TexReg 7170; transferred effective June 4, 2012, as published in the Texas Register June 22, 2012, 37 TexReg 4639; amended by Texas Register, Volume 39, Number 47, November 21, 2014, TexReg 9259, eff. 12/1/2014; Amended by Texas Register, Volume 48, Number 06, February 10, 2023, TexReg 0712, eff. 5/19/2023