September 11, 2001

#422

Joint Legislative Committee on PerformanceEvaluation and Expenditure Review (PEER)

Report tothe Mississippi Legislature

A Review of the Brookhaven JuvenileRehabilitation Facility

PEER reviewed the management and operation of the Brookhaven Juvenile RehabilitationFacility's start-up and operational costs and whether the facility's programs are meeting theneeds of the intended client population: mentally retarded juvenile offenders ordered by YouthCourt to enter the facility.

The Brookhaven Juvenile Rehabilitation Facility (BJRF), which began accepting clients inJuly 1999, was designed, constructed, and equipped appropriately to provide a "secure andtherapeutic environment" for its special needs clients. However, the Department of MentalHealth exceeded its statutory construction authorization of $5.5 million when building BJRF. Awarehouse and director's residence not in the original plan added $1 million to constructioncosts, for a total of $9.2 million.

Admission practices at BJRF are not in keeping with statutory requirements, since thirtypercent of the clients are transferred to this specialized facility from other Department ofMental Health facilities without a Youth Court order. This reduces the number of bedsavailable for the special needs juveniles for whom the facility was created. Moreover, BJRF hasnot yet admitted any females, thereby denying this resource to a significant portion of eligiblejuvenile offenders.

The Department of Mental Health has, in effect, discouraged treatment of violentoffenders at BJRF. Although the staff was not completely prepared to deal with aggressivebehavior of clients during the first two years of operation, current staff and staff training areadequate for the current clients. Security is adequate, but needs re-thinking for the intendedclientele. Program implementation problems center on a failure to carry out the positivereinforcement behavior modification treatments in a uniform manner and disagreements overthe proper role and form of discipline in client behavior change.

PEER: The Mississippi Legislature's Oversight Agency

The Mississippi Legislature created the Joint Legislative Committee onPerformance Evaluation and Expenditure Review (PEER Committee) by statute in1973. A flowing joint committee, the PEER Committee is composed of fivemembers of the House of Representatives appointed by the Speaker and fivemembers of the Senate appointed by the Lieutenant Governor. Appointments aremade for four-year terms with one Senator and one Representative appointedfrom each of the U. S. Congressional Districts. Committee officers are elected bythe membership with officers alternating annually between the two houses. AllCommittee actions by statute require a majority vote of three Representativesand three Senators voting in the affirmative.

Mississippi's constitution gives the Legislature broad power to conductexaminations and investigations. PEER is authorized by law to review any publicentity, including contractors supported in whole or in part by public funds, andto address any issues that may require legislative action. PEER has statutoryaccess to all state and local records and has subpoena power to compeltestimony or the production of documents.

PEER provides a variety of services to the Legislature, including programevaluations, economy and efficiency reviews, financial audits, limited scopeevaluations, fiscal notes, special investigations, briefings to individual legislators,testimony, and other governmental research and assistance. The Committeeidentifies inefficiency or ineffectiveness or a failure to accomplish legislativeobjectives, and makes recommendations for redefinition, redirection,redistribution and/or restructuring of Mississippi government. As directed byand subject to the prior approval of the PEER Committee, the Committee'sprofessional staff executes audit and evaluation projects obtaining informationand developing options for consideration by the Committee. The PEERCommittee releases reports to the Legislature, Governor, Lieutenant Governor,and the agency examined.

The Committee assigns top priority to written requests from individuallegislators and legislative committees. The Committee also considers PEER staffproposals and written requests from state officials and others.

PEER CommitteePost Office Box 1204Jackson, MS 39215-1204

(Tel.) 601-359-1226(Fax) 601-359-1420(Website) http://www.peer.state.ms.us

PEER Report #422 i

The Mississippi Legislature

Joint Committee on Performance Evaluation and Expenditure Review

PEER Committee

SENATORSWILLIAM CANON

Vice-ChairmanHOB BRYAN

BOB M. DEARINGSecretary

WILLIAM G. (BILLY) HEWES IIIJOHNNIE E. WALLS, JR.

TELEPHONE:(601) 359-1226

FAX:(601) 359-1420

Post Office Box 1204Jackson, Mississippi 39215-1204

Max K. Arinder, Ph. D.Executive Director

REPRESENTATIVESHERB FRIERSON

ChairmanMARY ANN STEVENS

WILLIAM E. (BILLY) BOWLESALYCE G. CLARKE

TOMMY HORNE

OFFICES:Woolfolk Building, Suite 301-A

501 North West StreetJackson, Mississippi 39201

September 11, 2001

Honorable Ronnie Musgrove, GovernorHonorable Amy Tuck, Lieutenant GovernorHonorable Tim Ford, Speaker of the HouseMembers of the Mississippi State Legislature

On September 11, 2001, the PEER Committee authorized release of thereport entitled A Review of the Brookhaven Juvenile RehabilitationFacility.

Representative Herb Frierson, Chairman

This report does not recommend increased funding or additional staff.

PEER Report #422 iii

Table of Contents

Letter of Transmittal ................................................................................................................................. i

List of Exhibits ................................................................................................................................ v

Executive Summary .............................................................................................................................. vii

Introduction ................................................................................................................................1

Authority ................................................................................................................................1Scope and Purpose ............................................................................................................................1Method ................................................................................................................................2

Establishment of Special Needs Facilities for Juvenile Offenders .......................................................3

Documentation of Need for Special Facilities for Juvenile Offenders ......................................3Legislative Authorization of Special Needs Facilities for Juvenile Offenders..........................5Roles of the Department of Mental Health's Youth Offender Facilities, Other DMH Facilities, and the Department of Youth Services' Correctional Facilities....................................................................................................................7

Brookhaven Juvenile Rehabilitation Facility Design and Construction ............................................10

Facility Design and Equipment......................................................................................................10Construction Cost ...........................................................................................................................12

Departure of the Brookhaven Facility from Its Statutory Mission toTreat Juvenile Offenders..........................................................................................................................15

Brookhaven Juvenile Rehabilitation Facility Client Admission and Discharge Practices......................................................................................................................15Success of the Department of Mental Health in Fulfilling its Legal Mandate for BJRF ...............................................................................................................20

Brookhaven Juvenile Rehabilitation Facility's Staffing, Training, and Security...............................24

DMH's Adoption of Standards for the Special Needs Facility ..................................................24Staffing of the Brookhaven Juvenile Rehabilitation Facility .....................................................27Staff Training at the Brookhaven Juvenile Rehabilitation Facility ...........................................32Security at the Brookhaven Juvenile Rehabilitation Facility .....................................................34

iv PEER Report #422

Table of Contents (continued)

Assessment of Program Quality at the BrookhavenJuvenile Rehabilitation Facility ...............................................................................................................37

The General Program......................................................................................................................37Problems with Program Implementation.....................................................................................38Lack of Measures of Program Success .........................................................................................40

Recommendations ..............................................................................................................................42

Appendix A: Definition of Mentally Ill and Mentally RetardedContained in MISS. CODE ANN. Section 41-21-61.........................................45

Appendix B: Brookhaven Juvenile Rehabilitation FacilityConstruction Revenue and Expenditure Summary.......................................46

Agency Response ..............................................................................................................................47

PEER Report #422 v

List of Exhibits

1. Summary of Construction and Equipment Expenditures for BJRF.............................13

2. Program and Security Staff Turnover by Type of Position (FY 1999-FY 2001).........29

3. Comparison of Actual BJRF Direct Care Staff vs. Minimum Staff Requiredfor the Number of BJRF Residents (July 1999 through June 2001)............................31

4. Brookhaven Facility Employees Completing Orientation Training by Type(FY 1999 through FY 2001)...............................................................................................33

PEER Report #422 vii

A Review of the BrookhavenJuvenile Rehabilitation Facility

Executive Summary

The PEER Committee reviewed the management andoperation of the Brookhaven Juvenile RehabilitationFacility (BJRF) in response to concerns about start-up andoperation costs and whether BJRF and its programs aremeeting the needs of its clients.

Establishment of Special Needs Facilities for Juvenile Offenders

To meet needs identified by a 1994 Senate Juvenile JusticeStudy Committee, in 1995 the Legislature authorized andfunded the construction and equipping of two fifty-bedspecial needs facilities, one for mentally retardedadolescent offenders (the Brookhaven facility, which beganaccepting clients in July 1999) and one for mentally illadolescent offenders (the Harrison County facility,scheduled to begin accepting clients in November 2001).These facilities were intended to be separate from existingmental health and juvenile justice facilities.

The enabling statute, MISS. CODE ANN. Section 41-21-109,defines the purpose of these special needs facilities:

[These two facilities] would be specifically designedto serve adolescents who have come into contactwith the judicial system after committing a crimeand who are mentally ill or mentally retarded to theextent that it is not acceptable to house them withnon-handicapped inmates. . . .These facilities shallbe self-contained and offer a secure but therapeuticenvironment allowing persons to be habilitatedapart from persons who are more vulnerable andwho have disabilities that are more disabling.

Facility Design and Construction Costs

The BJRF is designed and equipped appropriate to itscharge of providing a "secure and therapeuticenvironment" for treating mentally retarded adolescentscommitted by youth or chancery court.

viii PEER Report #422

Concerning construction costs, the Department of MentalHealth (DMH) expended a total of $9.2 million to constructand equip the Brookhaven Juvenile Rehabilitation Facility.The department used approximately $8 million of the $11million in bonds authorized (the amount intended forconstructing and equipping both the Brookhaven andHarrison County facilities), as well as $1.2 million inoperating funds. Construction of a warehouse anddirector's residence not contemplated in the initialauthority or planning for the facility added over $1 millionto the cost of the facility.

Departure of the Facility from Its Statutory Mission

Current admission practices at the Brookhaven JuvenileRehabilitation Facility are not in keeping with statutoryrequirements and have resulted in a move away fromaddressing the special need for which the facility wascreated. In addition to commitment by court order, whichis the only admission method contemplated in state law,BJRF admits juveniles through transfers from other mentalhealth facilities.

The Department of Mental Health and BJRF staffdeveloped the transfer methods of admission to BJRF fromexisting departmental policy and a statute addressingtransfers between mental health facilities not specific tothis special needs facility. PEER takes the position that thespecific requirement found in MISS. CODE ANN. Section41-21-109 (that the purpose of the facility is to acceptmentally ill or retarded persons committed by a court)should control admissions to BJRF.

Because its admission practices limit treatment services toa segment of the intended population and extend servicesto unqualified juveniles, the Department of Mental Healthhas only partially fulfilled its legal mandate for BJRF. Thedepartment has not admitted any females to theBrookhaven facility, thus denying this important resourceto a significant population of eligible juvenile offenders.Since its opening in 1998, nearly thirty percent of BJRF'sclients have been transferred from other mental healthinstitutions, rather than having been committed by courtorder. These transfers take bed space that could be usedby members of the targeted population. In effect, theDepartment of Mental Health has discouraged treatmentof violent offenders at BJRF.

PEER Report #422 ix

Staffing, Training, and Security

During the first two years of BJRF's existence, some of thestaff was not completely prepared for the aggressivebehavior of clients. There was also significant staffturnover during this time. BJRF now has adequatenumbers of direct care and education staff, and providessufficient staff orientation training, but because theDepartment of Mental Health has changed BJRF's clientelefrom what is legally mandated, PEER cannot assess thefacility's readiness to provide services to its intendedtarget population.

Although BJRF's method of providing security appearsadequate to protect the clients and staff within thepopulation currently being served, changing thepopulation to the intended target group could compromisethe adequacy of the facility's security.

Program Quality

It is too early in the life of the Brookhaven JuvenileRehabilitation Facility program to make definitivestatements about program quality and success. However,PEER noted problems with the staff not uniformlyimplementing the positive reinforcement behaviormodification plan and internal disagreements on theproper role and form of discipline for the facility. Also,BJRF has not developed measures of program success.Particularly, there are no indicators of the potential long-term impact the Brookhaven Juvenile RehabilitationFacility program may have on the lives and adaptivesuccesses of its clients upon discharge to the communityand how such successes might be measured and tracked.

Recommendations

Facility Construction

1. For future construction projects, DMH shouldutilize the planning process to identify andaccurately quantify all project costs, set budgets,and monitor progress to minimize expendituresbeyond those funds authorized. DMH shouldfollow the intent expressed in legislative grants ofauthority for project funding, by disallowingexpenditure of funds for expansion of facilities

x PEER Report #422

(e.g., the addition of staff housing or a warehouse),thereby causing project cost overruns.

Admissions

2. DMH should conform its admissions decisions tocomply with statutory criteria as set forth in MISS.CODE ANN. Section 41-21-109, which limitsadmissions to mentally ill or mentally retardedjuvenile offenders who have been committed fortreatment by a court of competent jurisdiction.

3. DMH should promptly inform all youth and chancery court judges in the state that it will fully comply with the admission intent expressed in MISS. CODE ANN. Section 41-21-109.

4. DMH should clearly define the relationshipbetween the Brookhaven facility and the HarrisonCounty facility regarding the placement of "dualdiagnosis" juvenile offenders and disseminate thisinformation to the state's youth and chancery courtjudges for their use in making commitmentdecisions.

Staffing

5. After achieving compliance with statutory admission requirements, DMH should assess its direct care staffing needs to establish the appropriate levels of direct care staff needed for treatment of the intended population of mentally ill or mentally retarded juvenile offenders.

6. Management and education staff should continueefforts to qualify for and obtain State Departmentof Education accreditation by adhering tostandards for classroom staffing--i.e., maintainingthe required level of teaching personnel.

Policies and Procedures

7. Recognizing the statutory required purpose ofBJRF, and that ICF/MR (intermediate care facilitiesfor the mentally retarded) standards are limited intheir application to treating this special needspopulation, BJRF management and DMH staffshould continue to develop policies and proceduresspecific to the BJRF program.

8. In keeping with the statutory mandate, BJRFmanagement and appropriate staff should developand offer training consistent with the role of

PEER Report #422 xi

providing treatment to the state's mentally ill andmentally retarded juvenile population.

Performance Measurement

9. DMH and facility management should develop anddefine an accurate set of outcome measures, installa system to capture relevant data, and annuallyassess and report performance for the BJRFprogram.

For More Information or Clarification, Contact:

PEER CommitteeP.O. Box 1204

Jackson, MS 39215-1204(601) 359-1226

http://www.peer.state.ms.us

Representative Herb Frierson, ChairmanPoplarville, MS 601-795-6285

Senator Bill Canon, Vice ChairmanColumbus, MS 662-328-3018

Senator Bob Dearing, SecretaryNatchez, MS 601-442-0486

PEER Report #422 1

A Review of the BrookhavenJuvenile Rehabilitation Facility

Introduction

Authority

In response to citizen concerns, the Committee authorizeda management and expenditure review of the BrookhavenJuvenile Rehabilitation Facility (BJRF).

PEER conducted this review pursuant to the authoritygranted by MISS. CODE ANN. § 5-3-57 et seq. (1972).

Scope and Purpose

The PEER Committee reviewed the management andoperation of BJRF in response to concerns about start-upand operation costs, and whether BJRF and its programsare meeting the needs of its clients. PEER sought todetermine:

• whether the agency's use of resources inconstructing and equipping the facility was relevant,justified, and timely;

• whether the physical facility, when opened, wasdesigned and equipped to meet the needs of theclient population;

• whether facility admission practices have compliedwith statutorily defined criteria;

• whether facility staffing, training practices, andprogram efforts comply with mental health facilityand other applicable standards for providing securityand client treatment; and,

• whether security procedures and practices aresufficient to protect facility staff and clients.

2 PEER Report #422

Method

In conducting this study, PEER reviewed financial,program, and other documentation of the Department ofMental Health. PEER further reviewed laws and policies,procedures, and applicable standards from other state andfederal agencies (e.g., Bureau of Building, state Departmentof Education and Department of Health, and U.S. HealthCare Finance Administration). PEER interviewedDepartment of Mental Health (DMH), State Department ofHealth, Mississippi Department of Education (MDE),Department of Human Services (DHS), Brookhaven JuvenileRehabilitation Facility, and Mississippi Association ofYouth Court Judges officials.

PEER Report #422 3

Establishment of Special Needs Facilities forJuvenile Offenders

To meet needs identified by a 1994 Senate Juvenile Justice Study Committee, theLegislature, in 1995, authorized and funded the construction and equipping of twofifty-bed special needs facilities, one for mentally retarded and one for mentally illjuvenile offenders.

Documentation of Need for Special Facilities for Juvenile Offenders

In 1994, after hearing testimony from youth court judges and other juvenileand social service professionals, a Senate Ad Hoc Committee on JuvenileJustice and School Violence reached agreement on the need for specializedtreatment facilities for potentially violent mentally retarded/mentally illjuvenile offenders separate from existing mental health facilities.

In Mississippi, there was no systematic needs assessmentto establish benchmarks and to quantify the magnitude ofthe problem prior to the facilities' authorization. The needfor such facilities as the Brookhaven JuvenileRehabilitation Facility (a facility for mentally retardedadolescent offenders) and the Harrison County Facility (formentally ill adolescent offenders) has been generallyestablished both nationally and in Mississippi.1 Recentresearch in juvenile justice has found, through surveys ofyouth confined in juvenile justice institutions, that fargreater proportions of these individuals suffer frommental health problems than youth in the generalpopulation. Youth with learning disabilities or anemotional disturbance are arrested at a higher rate thantheir non-disabled peers, and studies of incarcerated youthshow that as many as 70 percent suffer from learningdisability or educationally disabling conditions.

During the summer and fall of 1994, a Senate Ad HocCommittee on Juvenile Justice and School Violenceconducted hearings and received testimony from youthcourt judges, representatives from the Attorney General'sOffice, youth service agencies, the Department of MentalHealth, and interested groups regarding the need to createadditional facilities to accommodate emotionallydisturbed, mentally retarded, violent juvenile offenders.

1 Throughout this report, the use of the terms “juvenile,” “youth,” and “adolescent” refer tochildren between the ages of thirteen and twenty.

Studies of incarceratedyouth show that up to70 percent suffer fromlearning disability oreducationally disablingconditions.

4 PEER Report #422

Needs Voiced by Youth Court Judges

During the hearings conducted in 1994, youth court judges cited aspecial need for appropriate placement institutions for "dual diagnosis"youth--those diagnosed as both mentally retarded and mentally ill.

During the course of the study committee hearings, youthcourt judges testified to the need for appropriateplacement institutions for "dual diagnosis" youth, thosewith both mental retardation and mental illness. Severaljudges testified to the lack of such facilities, and with theonly alternative for sentencing mentally retarded juvenileoffenders prior to BJRF's existence being to the custody ofDMH, which then sent the youth to Ellisville State Schoolor to private agencies. Judges cited limited adolescentunits and beds at the State Hospital at Whitfield (30 beds)and East Mississippi State Hospital in Meridian (100 beds),which provide adolescent acute psychiatric anddrug/alcohol treatment.

A Harrison County youth court judge cited as an exampleof few hospitals having secure detention facilities foremotionally disturbed, violent juvenile offenders, a thirty-month waiting period for the South MississippiRetardation Center for admitting a retarded, violent child.This judge's testimony also suggested "an existing annualneed [to house offenders who may be behaviorally violent,suicidal, dual-diagnosed (mentally ill and retarded), orchildren in need of supervision] for approximately 150beds in the coastal counties, 200 beds in Hinds County,and 10 beds for other rural counties." He also suggested "aneed for 1,000 additional beds for such violent/retardedoffenders."

This testimony was the most specific statement of needmade to the Legislature. The 1995 Youth Court AnnualReport (DHS, Division of Youth Services) showedadditional indirect evidence of need. That annual reportshowed, in describing the "Grade Placement Reported inYouth Court Referrals During 1995," that, of 22,685 casedispositions in that year, 3.8%, or 862, were specialeducation students with limited mental functioningabilities.

Prior to BJRF'sexistence, the onlyalternative forsentencing mentallyretarded juvenileoffenders was custodyof DMH, which thensent the youth toEllisville State Schoolor to private agencies.

PEER Report #422 5

Study Committee Recommendations

In 1994, after reviewing the evidence and testimony provided, the SenateAd Hoc Committee on Juvenile Justice and School Violence found "a lackof mental health facilities for emotionally disturbed/retarded/violentchildren."

The Ad Hoc Committee recommended construction of tworesidential facilities for mentally handicapped juvenileoffenders. The committee report stated that:

. . .the Department of Mental Health has recommendedconstruction and equipping of two separate facilitiesthat could serve up to fifty children and adolescents,each of which will be located away from the existingprograms of the Department of Mental Health thatwould be specifically designed to serve children andadolescents who have come into contact with judicialsystem after committing a crime and who are mentallyretarded to the extent that it is not acceptable to housethem with non-handicapped inmates. These facilitiesshall be self contained and offer a secure buttherapeutic environment allowing persons to berehabilitated apart from persons who are morevulnerable and who have disabilities that are moredisabling.

The Ad Hoc Committee estimated a total cost of$8,100,000 to fund the construction and equipping of thetwo recommended facilities. Although the studycommittee estimated $8.1 million, subsequent legislativeaction during the 1995 Regular Session increased theamount to $11 million.

Legislative Authorization of Special Needs Facilities for Juvenile

Offenders

During the 1995 Regular Session, the Legislature authorized construction oftwo fifty-bed facilities to be administered by the Department of MentalHealth, one for mentally retarded, potentially violent juvenile offenders andone for mentally ill, potentially violent juvenile offenders, and approvedbonding authority of $11 million for the two facilities.

During the 1995 Regular Session, the MississippiLegislature passed MISS. CODE ANN. Section 41-21-109(1972) authorizing the Department of Mental Health toconstruct two special needs facilities, one for mentallyretarded juvenile offenders (the Brookhaven JuvenileRehabilitation Facility) and one for mentally ill juvenile

The Legislatureprovided $11 millionfor construction of tworesidential facilitiesfor mentallyhandicapped juvenileoffenders.

6 PEER Report #422

offenders (the Harrison County Specialized TreatmentFacility).

Purpose of a Separate Program at Brookhaven JuvenileRehabilitation Facility

The enabling statute, MISS. CODE ANN. Section 41-21-109,defines the purpose of these special needs facilities:

[These two facilities] would be specifically designed toserve adolescents who have come into contact with thejudicial system after committing a crime and who arementally ill or mentally retarded to the extent that it isnot acceptable to house them with non-handicappedinmates. . . .These facilities shall be self-contained andoffer a secure but therapeutic environment allowingpersons to be habilitated apart from persons who aremore vulnerable and who have disabilities that aremore disabling.

Of the two special need populations designated in Section41-21-109, DMH designated the Brookhaven facility toserve the special need population of mentally retardedjuvenile criminal offenders committed by the juvenilejustice system. The Brookhaven Juvenile RehabilitationFacility combines some corrections functions andeducation/training functions for mentally retarded youthcommitted to it by youth or chancery court.

Section 41-21-109 specifies a separate treatment programfor the Brookhaven facility population in two respects.First, adolescent offenders committed to BJRF shall be"mentally retarded to the extent that it is not acceptable tohouse them with non-handicapped inmates." Second, theBrookhaven facility "shall be self-contained and offer asecure but therapeutic environment allowing persons to behabilitated apart from persons who are more vulnerableand who have disabilities that are more disabling."

Thus the Brookhaven facility has two purposes: (1) providea restrictive, secure, "corrections" environment for juvenileoffenders committed to the facility by youth or chancerycourt judges, and (2) develop and carry out a habilitationand training program for educable/trainable mentallyretarded juvenile offenders.

Taken together, these two parts define the targetpopulation as the educable or trainable mentally retardedjuvenile offender. These are adolescents who need specialeducation and a treatment regimen different from "non-handicapped inmates" (who might otherwise takeadvantage of mentally retarded youth), and they are

DMH designated theBrookhaven facility toserve the special needpopulation of mentallyretarded juvenilecriminal offenderscommitted by thejuvenile justicesystem.

PEER Report #422 7

adolescents who can benefit from such a specialeducation/training regimen, unlike persons who are moreprofoundly disabled.

Admission Requires Court Commitment of a Juvenile Offender

The method of commitment to the Brookhaven facility isequally clear in the statute (Section 41-21-109). Thepurpose of this section is to provide modern and efficientrehabilitation facilities for mentally ill or mentallyretarded juvenile offenders in Mississippi:

. . .who have been committed for treatment by a courtof competent jurisdiction pursuant to Section 41-21-61et seq., Mississippi Code of 1972.

Section 41-21-61 defines a mentally ill person and amentally retarded person, among other things (seeAppendix A, page 45). Subsequent sections through 41-21-107 deal with the process of commitment by a court ofcompetent jurisdiction.

Roles of the Department of Mental Health's Youth Offender Facilities,

Other DMH Facilities, and the Department of Youth Services'

Correctional Facilities

Creation of the two DMH youth offender facilities providesan avenue for treatment of mentally retarded and mentallyill juvenile offenders apart from youth in other mentalhealth facilities and training institutions operated by theDivision of Youth Services (DYS) of the Department ofHuman Services.

Role of Brookhaven Juvenile Rehabilitation Facility

The Brookhaven Juvenile Rehabilitation Facility is differentfrom other Department of Mental Health agencies bothjurisdictionally and programmatically. BJRF does havedirect and indirect program relationships with the regionalcommunity mental health centers (CMHCs) and thecomprehensive regional facilities.

BJRF's jurisdiction is statewide. It currently receives clientscommitted to it from any of Mississippi's youth orchancery courts, or by transfer from any of thecomprehensive regional facilities. In contrast, the fifteen

State law clearlyprovides that themethod ofcommitment to BJRFshall be by court order.

8 PEER Report #422

regional CMHCs and the five comprehensive regionalfacilities serve sub-state multi-county service areas.Programmatically, the Legislature created the BrookhavenJuvenile Rehabilitation Facility to serve mentally retardedyouth that have involvement with the juvenile justicesystem in the state as an essential condition of theirassignment. In contrast to other DMH facilities, BJRF isintended for clients who have come into contact with thejuvenile justice system because they have committed acriminal offense.

The Brookhaven Juvenile Rehabilitation Facility anticipatesa close working relationship with the second facilityauthorized by Section 41-21-109, the new juvenile mentalillness facility now being completed in Harrison County.This working relationship will be particularly important indetermining the most appropriate placement of "dualdiagnosis" youth. Having both facilities available will giveyouth and chancery court judges more flexibility ofassignment. Also, the Department of Mental Healthprovides alternative living arrangements such as grouphomes, case management services, and transitionaltraining. These services are potentially important to BJRFclients as part of their support networks after release andreturn to their home communities.

Relationship to Other DMH Facilities

Other DMH mental health facilities offer treatment for thementally retarded or mentally ill juvenile non-offenderpopulation and fulfill a cooperative role by providingclient assessments upon request of the local court. Thejuvenile population is served through facilities for thementally ill and retarded and regional mental healthcenters.

Mental Illness Facilities

Mississippi State Hospital and East Mississippi StateHospital are psychiatric facilities that offer adolescentacute psychiatric care through an adolescent wing (servingabout a tenth of their annual patient loads). EastMississippi also offers inpatient alcohol and drugtreatment for adolescents. Both facilities providetransitional, community-based care for adolescents.

Regional Mental Health Centers and Facilities

The Department of Mental Health certifies and monitorsfifteen regional mental health centers, which are part of

BJRF's jurisdiction isstatewide and it servesclients who have comeinto contact with thejuvenile justice systembecause they havecommitted a criminaloffense.

PEER Report #422 9

county government, and operates community servicedivisions of Mississippi State Hospital at Whitfield andEast Mississippi State Hospital. The priority populationaddressed by these facilities is adults with serious mentalillness, although they do provide some services formentally retarded/developmentally disabled individuals.DMH also operates five comprehensive regional facilities(Boswell, Hudspeth, Ellisville, North MS, and South MS).These provide comprehensive services for the mentallyretarded and persons with developmental disabilities.

One indirect connection exists between these regionalfacilities and the Brookhaven facility. These facilities areoften the primary diagnostic and evaluation providers foradolescent offenders processed through youth andchancery courts.

Relationship to DYS Correctional Training Institutions

Correctional training for juvenile offenders with IQsgreater than 70 is provided through adolescent offenderprograms operated by the Division of Youth Services (DYS)at Columbia, Oakley, and Ironwood training schools. TheseDYS institutions offer intensive, military-type training; anaccredited education program that includes K-12, GED,Gifted Program, Special Education and vocational training;and personal development (in both individual and socialskills).

MISS. CODE ANN. Section 43-27-25 places restrictions onthe commitment of mentally retarded and mentally illjuveniles to DYS correctional facilities. This statuterequires that "No person shall be committed to aninstitution under the control of the [Department of HumanServices' Division of Youth Services] who is seriouslyhandicapped by mental illness or retardation." It providesfor transfer of such youth from DYS institutions if they aredetermined to be so handicapped. Finally, it directs theDivision of Youth Services to "establish standards withregard to the physical and mental health of persons whichit can accept for commitment."

The Division of Youth Services has established a mentalfunctioning criterion of an IQ of at least 70 to be admittedto state DYS training schools. The special educationprogram is aimed at youth with IQs between 70 and 84.BJRF defines the mental functioning dimension of mentalretardation as an IQ score of 70 or less for its admission.

Regional mental healthfacilities often serve asthe primary diagnosticand evaluationproviders foradolescent offendersprocessed throughyouth and chancerycourts.

Juvenile offenderswith IQs greater than70 are served byDivision of YouthServices trainingschools. State lawprohibits commitmentof adolescentsseriously handicappedby mental illness orretardation to a DYSinstitution.

10 PEER Report #422

Brookhaven Juvenile Rehabilitation FacilityDesign and Construction

Although the Brookhaven Juvenile Rehabilitation Facility was constructed andappropriately equipped to manage the special needs clients it was created to serve,DMH exceeded the $5.5 million initially authorized for this purpose, expending atotal of $9.2 million for construction and equipment.

The Brookhaven Juvenile Rehabilitation Facility is locatedon 43 acres of land, 17.8 of which were donated to DMHby the City of Brookhaven, and 25.6 of which werepurchased from a private owner. Construction of themajor part of the facility was completed in December1998, seven months prior to client admissions (July 1999).The campus consists of three residential living units, aneducation building, a recreation building, anadministration building, and an outdoor track and playarea enclosed by a security fence.

The facility warehouse (which includes a repair shop) anddirector's residence (about 2,543 square feet) are locatedacross a road bisecting the property from the maincampus.

Facility Design and Equipment

The BJRF is designed and equipped appropriate to its charge of providing a"secure and therapeutic environment" for treating mentally retardedadolescents committed by youth or chancery court.

Facility Design

The Brookhaven Juvenile Rehabilitation Facilityincorporates elements of both security and therapy. Assuch, some aspects of physical design depart fromtraditional mental retardation facility structure.Specifically, the security fence around the main facility,and the "sally port" (i.e., controlled entrance) area for thearrival of youth assigned by court to the facility, wereincorporated into the design to serve the juvenile offenderpopulation.

The Brookhaven Juvenile Rehabilitation Facility is designedfor full-time living, including instruction, recreation, andfunctional living, and is appropriate for the targetpopulation specified by statute.

A security fence and acontrolled entrancewere incorporated intoBJRF's design to servethe juvenile offenderpopulation.

PEER Report #422 11

Design of office space for program staff was meant toencourage close involvement with and supervision ofresidents. Program staff offices are all located in theresidential units, the education building, and therecreation facility. Although the program staff isphysically separated from the administrative staff via thesecurity entrances, the program staff members are allequipped with hand-held radios to communicate withsecurity and other staff members. The classrooms andresidential units (excluding residents' rooms) aremonitored by security staff via security cameras, andequipped with emergency telephones. Observation roomsare connected to classrooms for staff to observe studentsunobtrusively in the classroom. The education buildingcontains two "time-out" rooms for disciplining residents.

Facility Equipment

The physical plant was fully equipped when clients arrivedin July 1999. Equipment, material, and supplies storagewas a problem not completely solved until the completionof a separate building to house thestorage/maintenance/shop functions in November 2000.

The equipment is appropriate for a full-time live-in facility.Damage repair costs have not been excessive (as apercentage of the facility's annual expenditures). In FY2001, expenditures, including all items for building repairsin the two budget categories of contractual services andcommodities (e. g., including cement plaster; lumber, partsand metal for cabinet and shelf repair; paint; contractedservices), the total expended for repair was $17,936, whichwas .5 percent of the annual expenditures.

The four classrooms in the education building are eachequipped with students' desks, a teacher's desk, and achalkboard. The library of the education building has atelevision and a computer. However, it is not stocked withteacher resource and reference materials or studentsupplements. The curriculum for the residents does notrequire the use of textbooks.

BJRF program staffmembers are equippedwith hand-held radiosto communicate withsecurity and otherstaff members.

Damage repair costs atBJRF have not beenexcessive as apercentage of thefacility's annualexpenditures.

12 PEER Report #422

Construction Cost

DMH has expended a total of $9.2 million to construct and equip theBrookhaven Juvenile Rehabilitation Facility. The department usedapproximately $8 million of the $11 million in bonds authorized (the amountintended for constructing and equipping both the Brookhaven and Harrisoncounty facilities), as well as $1.2 million in operating funds.

Section 41-21-109 authorized the "construction andequipping of two (2) separate facilities each of which couldserve up to fifty (50) adolescents." The Legislatureapproved Senate Bill 2497 during the 1995 regular session,which authorized $11 million in bonding authority forconstructing and equipping these two structurallyidentical juvenile rehabilitation facilities.

Construction Costs for the Brookhaven Juvenile RehabilitationFacility Educational and Residential Components

Currently, six years after authorization, the Department ofMental Health has opened one facility (BrookhavenJuvenile Rehabilitation Facility), expending a total of $9.2million for that one facility (see Exhibit 1, page 13). The$9.2 million total includes the expenditure of operatingfunds to construct a warehouse, residential housing forthe facility director, and to equip the facility.

DMH expended approximately $8 million of the $11million in bonds to construct the first of the two juvenilefacilities, the one at Brookhaven. Initial plans for theconstruction of the identical facilities estimated the cost ofconstruction to be $5.5 million for each.

Although initial plansfor the two identicalfacilities estimated theconstruction cost ofeach to be $5.5 million,DMH expendedapproximately $8million of the $11million in bonds toconstruct BJRF.

PEER Report #422 13

Exhibit 1: Summary of Construction and Equipment Expenditures forBrookhaven Juvenile Rehabilitation Facility

Initial Funds Authorized (SB 2497) [2 Facilities] $11,000,000

REVENUE AVAILABLE FOR ONE FACILITY $5,500,000

CONSTRUCTION & EQUIPMENT EXPENSES (Incl. Campus, Warehouse, & Residence)

Expenditures - Construction

SB 2497 $8,004,671

SB 3214 664,047

Expenditures - Equipment

Operating Funds 553,442

Total Construction & Equipment Expenditures $9,222,160

CONSTRUCTION COSTS (OUTSIDE INITIAL PLAN)

Professional & Other Fees $ 85,585

Land Acquisition 126,750

Warehouse 764,600

Director's Residence 219,678

Total Expenditures (Outside Initial Plan) $1,196,613

SOURCE: Bureau of Building, Grounds, and Real Property Management and FY 2000 andFY 2001 budget requests.

Construction of the Brookhaven facility was completed inDecember 1998. The director's residence and thewarehouse were completed in November 2000. DMHexpended a portion of facility's operating budget tocomplete the house and warehouse ($537,297) and toequip the facility ($553,442). The Department of MentalHealth used the remaining $2.8 million from DMH's $11million capital improvement bond toward construction ofthe Harrison County JRF. This facility was funded withadditional bond proceeds of $7.5 million authorized by SB3119 in 1999. The Harrison County facility, for mentallyill juvenile offenders, is nearing completion and isscheduled to open and accept its first clients in late 2001.

Appendix B, page 46, summarizes revenues andconstruction costs for the BJRF.

DMH expended aportion of BJRF'soperating budget tocomplete thewarehouse anddirector's house and toequip the facility.

14 PEER Report #422

Unplanned Construction of a Warehouse and Director'sResidence Added Over $1 Million in Construction Costs

Construction of a warehouse and director's residence not contemplated inthe initial authority or planning for the facility added over $1 million to thefacility's cost.

In September 1998, prior to completing construction ofthe Brookhaven facility's main campus, DMH entered intoan architectural contract to design a 4,000-square-footwarehouse and a 2,543-square-foot director's residence.Neither was contemplated in SB 2497, which authorizedfunding for the facility, nor were they included during theproject planning phase. Subsequently, DMH accepted abid of $984,600 for construction of these two structures.Warehouse construction costs amounted to $764,600,while the director's residence cost $219,678. DMHacquired 25.6 acres from a private landowner at a cost of$126,750 for placement of the structures and to providefor future growth.

The director's residence was constructed pursuant to aDepartment of Mental Health policy that all directors liveon campus. According to the assistant director of theBureau of Building, this house design is typical of otherbureau house projects, and the bid for the structure iscomparable to like projects.

No state funds were used to furnish the BJRF director'shouse (other than built-in items such as major appliances).In addition to construction costs, DMH pays utilities andmaintenance costs for the director's residence.

The Department ofMental Health'spractice of providinghousing for facilitydirectors addedconstruction costs of$219,678 to theBrookhaven facility.

PEER Report #422 15

Departure of the Brookhaven Facility From ItsStatutory Mission to Treat Juvenile Offenders

Current admission practices at the Brookhaven Juvenile Rehabilitation Facility arenot in keeping with statutory requirements and have resulted in a move away fromaddressing the special need for which the facility was created.

Brookhaven Juvenile Rehabilitation Facility Client Admission and

Discharge Practices

Two of the three current policies used by the Department of Mental Healthto determine admission to the Brookhaven Juvenile Rehabilitation Facilityare not in keeping with statutory requirements set forth for this specialneed facility.

Brookhaven Juvenile Rehabilitation Facility's Admission Criteria

In addition to commitment by court order, BJRF admits juveniles throughtransfers from other mental health facilities.

Currently, a juvenile may be admitted to BJRF in one ofthree ways, as represented in literature and brochures ofthe facility and discussed in its Policies and ProceduresManual:

• The client may be committed by the youth or chancerycourt, in which case the judge of the court would signan order sending the youth to BJRF; or,

• The client may be transferred from one of theDepartment of Mental Health's comprehensive regionalfacilities by a transfer order signed by the director ofthe facility; or,

• A family can request BJRF to admit a mentally retardedadolescent. The youth must be evaluated by a DMHregional facility first and obtain a transfer assignmentfrom a comprehensive regional facility.

The third method is really a variation on the secondmethod, but the originating request comes from a familyrather than a DMH facility director. Still, the admission isthen technically a transfer.

16 PEER Report #422

Statutory Admission Method Specific to Brookhaven JuvenileRehabilitation Facility

Commitment to BJRF by court order is the only method contemplated instate law.

Only one of these methods of admission to BJRF wascontemplated in the statute establishing the BrookhavenJuvenile Rehabilitation Facility. MISS. CODE ANN. Section41-21-109 says the two facilities (Brookhaven and HarrisonCounty) "would be specifically designed to serveadolescents who have come into contact with the judicialsystem after committing a crime and who are mentally illor mentally retarded to the extent that it is not acceptableto house them with non-handicapped inmates and whomeet commitment criteria as defined by Section 41-21-61,Mississippi Code of 1972" (see Appendix A, page 45).

The BJRF Policies and Procedures Manual, at Appendix I tothe Admissions section ("Criteria for Admission toDepartment of Mental Health Adolescent RehabilitationFacilities"), says:

Only a person who has attained the age of thirteen (13)years but less than twenty-one (21) years, who has comein contact with the judicial system after committing acrime, is mentally ill or mentally retarded, withbehavior which renders him/her inappropriate to behoused with the population of other Department ofMental Health treatment facilities for adolescents, andwho has been committed pursuant to Sections 41-21-61,et seq., shall be appropriate for admission. No personshall be admitted with unresolved criminal charges.

This statement of procedure is wholly in keeping with theplain meaning of Section 41-21-109.

Description of DMH's Admission Practices for BJRF

The Department of Mental Health and BJRF staff developed the transfermethods of admission to BJRF from existing departmental policy and astatute addressing transfers between mental health facilities not specificto this special needs facility.

Through adoption of departmental and BJRF policygoverning transfers, the department has enumerated itscriteria for admission to BJRF. In the Department ofMental Health's Policies and Procedures Manual under"Regulations Governing Admission to Mental RetardationFacilities Operated By the Department of Mental Health,"Section VII, "Transfer," states:

PEER Report #422 17

Individuals may be transferred when such a transfer isnecessary for the welfare of that or other patients.

In BJRF'S policy manual, Appendix I continues, includinganother method of admission labeled "Transfers:"

Adolescents from other Department of Mental Healthfacilities who meet the criteria for civil commitmentmay be transferred to an adolescent rehabilitationfacility.

Persons who have been committed directly to anadolescent rehabilitation facility may be transferred toother Department of Mental Health facilities as deemedappropriate for proper treatment. The department hasoffered the following sections as supporting its authorityto transfer and admit to the Brookhaven facility withoutcourt order. Section 41-4-7(g) authorizes the departmentto establish policies for the admission of clients todepartmental facilities. Specifically, it provides that oneof the Department of Mental health's powers and duties is:

(g) To establish and promulgate reasonable minimumstandards for the construction and operation of stateand all Department of Mental Health certified facilities,including reasonable minimum standards for theadmission, diagnosis, care, treatment, transfer ofpatients and their records, and also includingreasonable minimum standards for providing day care,outpatient care, emergency care, inpatient care andfollow-up care, when such care is provided for personswith mental or emotional illness, mental retardation,alcoholism, drug misuse and developmental disabilities.

Additionally, the department cites Section 41-21-87 asauthority to transfer clients between mental healthfacilities. This section provides:

The director may transfer any civilly committed patientfrom one facility operated directly by the department ofmental health to another as necessary for the welfare ofthat or other patients. Upon receiving the director'scertificate of transfer, the court shall enter an orderaccordingly.

BJRF staff, taking this latter statute and departmentalpolicy together, developed the second and third methodsof admission to BJRF.

18 PEER Report #422

Department of Mental Health's Interpretation of Statutes inSetting Admission Policies

Because other provisions of law authorize the Department of MentalHealth to transfer clients between facilities, the department believesSection 41-21-109 must be read so as to authorize the department totransfer into BJRF clients from other facilities, regardless of whether theyhave been committed by court order.

The department argues in support of a broad constructionof Section 41-21-109 allowing transfers and admissionswithout court order. According to the department, allstatutes addressing the issue of commitment of clients tothe care of the department must be read together, withsubsequently enacted or re-enacted provisions controllingin cases where textual conflict exists between provisions.Because other provisions of general law authorize thedepartment to transfer clients between facilities and thesewere reenacted subsequent to the enactment of Section 41-21-109, the department believes Section 41-21-109 mustbe read so as to authorize the department to transfer intothe Brookhaven facility clients from other facilitiesregardless of whether they have been committed to thefacility by order of the court. The department believesthat to only require the department to house clients placedby the youth court would result in beds remaining empty.

PEER's Interpretation of Authorized Admission Method (ReadingTogether of Provisions Dealing with the Department of MentalHealth and Its Authority)

PEER takes the position that the specific requirement found in Section 41-21-109 (that the purpose of the facility is to accept mentally ill orretarded persons committed by a court) should control admissions toBJRF.

The Department of Mental Health has argued that itsgeneral authority to establish admission criteria underSection 41-4-7 and its authority to transfer personsbetween facilities established in Section 41-21-87authorize the department to admit or transfer into thefacility persons other than those court committed. PEERhas determined that in the face of conflict betweenprovisions of law dealing with admission, the morespecific provision of law, dealing specifically with theBrookhaven facility, should govern admissions to thatfacility.

The department's position as to its authority is in directcontravention to the plain meaning of Section 41-21-109, a

The Department ofMental Health believesMISS. CODE ANN.Section 41-21-109must be read so as toauthorize thedepartment to transferinto BJRF clients fromother facilities,regardless of whetherthey have beencommitted to thefacility by court order.

In the face of conflictbetween provisions oflaw dealing withadmission, the morespecific provision oflaw, dealingspecifically with theBrookhaven facility,should governadmissions to thefacility.

PEER Report #422 19

position that the PEER Committee rejects. In concludingthat admissions are limited to those judicially mandated,PEER agrees that general sections of law which deal withthe same subject matter should be read together (in parimateria) and to the extent possible each section of theCODE must be given effect as that the legislative intent canbe determined. (See Mississippi Public Service Commissionv. Municipal Energy Agency of Mississippi, 463 So 2d. 1056[Miss, 1985].) In determining what the Legislatureintended, the plain words of the statute are the bestevidence of intent. (See Mississippi Gaming Commission v.Imperial Palace of Mississippi, Inc., 751 So 2d. 1025 [Miss,1999].) Further, such doctrines as repeal by implicationor amendment by implication are only acceptable if it isclear from subsequently enacted legislation that theLegislature meant to repeal or amend a provision of law.(See State v. Wood, 187 So 2d. 820 [Miss, 1966].) Finally, ifthere is insolvable conflict between provisions of law, andone section is general while another is specific, the specificprovisions prevail. (See Imperial Palace, supra, Mauney v.State, 707 So 2d. 1093 [Miss, 1998], Benoit v. UnitedCompanies Mortgages of Mississippi, Inc., 504 So 2d. 196[Miss, 1987].)

MISS. CODE ANN. Sections 41-4-7 (g) and 41-21-87, whichconvey general authority, clearly grant the departmentbroad latitude to transfer clients between facilities and toset admissions criteria for facilities. Insofar as Section41-21-109 restricts admissions to persons who have beencommitted by a court, it contravenes general provisionsthat give the department the authority to set placementand transfer rules for departmental facilities.

To read these provisions as the department would havethem read, however, would result in a "reading out" of theprovision that would allow admission only to those clientswho have been committed to the facility by a court, aposition supported by the plain meaning of clear andunambiguous terms of the section. This would constitutean amendment by implication, a position not generallywell taken by the courts of the state.

Further, to accept the department's interpretation wouldsupport a position that the Legislature has rejected duringthe last two sessions when considering bills that wouldhave removed the requirement that clients be committedby court order. In 2000 (HB 847) and again in 2001 (HB1333), DMH has attempted to obtain an amendment toSection 41-21-109 to provide that rehabilitation facilitiesfor the mentally ill or mentally retarded juvenile offendersmay accept persons who have been transferred fromanother Department of Mental Health facility. In bothyears, the House bills failed to pass.

To accept DMH'sinterpretation wouldsupport a position thatthe Legislature hasrejected during thelast two sessions whenconsidering bills thatwould have removedthe requirement thatclients be committedby court order.

20 PEER Report #422

In light of the fact that the sections are in conflict, and aharmonious reading does not appear possible, PEER readsthe more specific provisions passed for the single purposeof regulating the operations of the Brookhaven facility ascontrolling in this matter. Such a reading preserves theclear legislative policy directive to operate a facility toaddress the needs of a special population. Consequently,PEER reads the provisions as establishing one method ofadmission, a court order. Thus the facility's second andthird admission criteria options are not in keeping withstate law. Further, absent specific authority from a court,administrative transfers would not be authorized for thisfacility, as the facility was intended for persons admittedby a court. To take a contrary position would allowadministrative transfers to fill the facility rather thanreserving this resource as law intended, for juvenileoffenders committed by a court.

The department has taken the position that limitingadmissions to only those that are court-generated wouldmean that the Legislature had authorized beds that couldnot be filled. The Department of Human Services' Divisionof Youth Services reported in 1995 over 800 juvenilescommitted to its custody in need of special education;youth court annual reports from 1995 show over 800cases annually involving special education students; andyouth court judges currently estimate an annual case loadof between 500 and 1,000 mentally handicapped juvenileoffenders, 30 to 50 of whom are "dually diagnosed." Suchindicators illustrate the continuing need for theinstitutional care for which the Brookhaven JuvenileRehabilitation Facility was created.

Success of the Department of Mental Health in Fulfilling its Legal

Mandate for BJRF

The Department of Mental Health has only partially fulfilled its legalmandate for BJRF because its admission practices limit treatment services toa segment of the intended population and extend services to unqualifiedjuveniles.

As noted previously, MISS. CODE ANN. Section 41-21-109states that the two facilities (Brookhaven and HarrisonCounty) "would be specifically designed to serveadolescents who have come into contact with the judicialsystem after committing a crime and who are mentally illor mentally retarded to the extent that it is not acceptableto house them with non-handicapped inmates and whomeet the commitment criteria as defined by Section 41-21-61, Mississippi Code of 1972."

DMH believes thatlimiting BJRF'sadmissions to onlythose court-generatedwould result in emptybeds at the facility.However, youth courtjudges currentlyestimate an annualcaseload of between500 and 1,000mentally handicappedjuvenile offenders, 30to 50 of whom are"dually diagnosed."

PEER Report #422 21

BJRF's admission practices have meant treatment at thefacility of a subset of the needy population, only partiallyaddressing the needs initially identified by the judiciaryand the intent expressed by the Legislature.

The Department of Mental Health has not admitted any females to theBrookhaven facility, thus denying this important resource to a significantpopulation of eligible juvenile offenders.

Thus far BJRF has not admitted any female clients. Failureto admit female offenders is not in accordance with MISS.CODE ANN. Section 41-21-109, which addresses juvenileoffenders, generally, and BJRF's own admissionsprocedures (quoted on page 17). Also, it is clear fromearliest meetings about BJRF construction that plansincluded the housing of females. At a 1996 meetingbetween architects and DMH and Bureau of Buildingsrepresentatives, the minutes reported: "One third of theclients are anticipated to be female, two thirds areanticipated to be male. This will lead to 3 cottages of 16beds each."

The 1995 Youth Court Annual Report (the year theLegislature authorized the Brookhaven facility'sconstruction) shows that of 22,685 juvenile cases disposedof in that year, 6,243 (27%) were committed by femaleoffenders. Applying the 3.8% number of special educationparticipants in the total cases disposed of to the numberof female offenders, PEER estimates that there were about237 female special education participants among the totalcases reported in 1995. Youth court judges have few othercommitment options for retarded female juvenileoffenders. PEER interviews with youth court judges forthis project confirmed a continuing need for placement forfemales.

BJRF staff contends that in order to designate a cottage forhousing females, that they needed to get a "critical mass"of girls. Although BJRF has designated part of the facilityfor the treatment of four autistic youth (housing themtogether in one wing of one dorm), as of June 2001, nosuch arrangement had been made for females.

Although it is clearfrom earliest meetingsabout BJRFconstruction that plansincluded the housingof females, thus farthe facility has notadmitted any femaleclients.

22 PEER Report #422

Since its opening in 1998, nearly thirty percent of BJRF's clients have beentransferred from other mental health institutions, rather than havingbeen committed by court order. These transfers take bed space thatcould be used by members of the targeted population.

Since opening BJRF, the Department of Mental Health hasaccepted eighteen clients (of sixty-five total admissions)not committed by court order. DMH contends thatallowing transfers of non-offender clients from other DMHinstitutions into BJRF is a way both to address some of thewaiting list numbers at other institutions and to try toaccelerate full occupancy at BJRF. According to BJRF staff,admitting non-offender clients gives the BJRF behaviormodification program a better chance to work andpresents less of a threat to staff and clients.

But, as one youth court judge said in an interview for thisproject, the statutory definition of mental retardationincludes (at Section 41-21-61 (f)(ii)) persons "whose recentconduct is a result of mental retardation and poses asubstantial likelihood of physical harm to himself orothers in that there has been a recent attempt or threat tophysically harm himself or others." These are the types ofadolescents that the Brookhaven facility was created toserve.

DMH holds that the four juvenile offenders who weretransferred out of BJRF for involvement in three violentincidents with staff members during the first year ofoperation were inappropriately assigned to BJRF. Whileany of those four may have had psychiatric issues, theirrecords show three of the four had IQs in the 40s, 50s, and60s. The fourth had an IQ of 75.

DMH argues that there is no difference between theseventy percent of BJRF clients assigned there by courtsand the thirty percent of clients transferred from otherDMH institutions regarding the manifestations of mentalretardationÑIQ, behavior, tendency toward violence, etc.In fact, some differences do exist. Four of the DMH-transferred clients are autistic; none of the court-orderedjuveniles are autistic. BJRF's head psychologist reported inan interview with PEER that, through transfers from otherDMH institutions, BJRF was gaining juvenile clients whoare "less street-wise, less 'thuggy'" than the earlier court-ordered clientele.

DMH contends thatallowing transfers ofnon-offender clientsaddresses waiting listsat other institutionsand accelerates fulloccupancy at BJRF.

Although BJRFcontends thatadmitting non-offenderclients gives the BJRFbehavior modificationprogram a betterchance to work andpresents less of athreat to staff andclients, mentallyretarded juvenileoffenders are theadolescents that thefacility was created toserve.

PEER Report #422 23

The Department of Mental Health has, in effect, discouraged treatment ofviolent offenders at BJRF.

Although, according to state law, BJRF was to be"specifically designed to serve adolescents who have comeinto contact with the judicial system after committing acrime and who are mentally ill or mentally retarded to theextent that it is not acceptable to house them with non-handicapped inmates," the facility's practice of acceptingclients who have not been committed by court orderreduces the number of beds available for youth courtassignment. In effect, this reduces the opportunity for thefacility to accept violent offenders. As noted above, BJRFstaff members have stated that admitting non-offenderclients gives the facility's behavior modification program abetter chance to work and presents less of a threat to staffand clients.

Also, in the first two years of BJRF's operation, after twoepisodes of injury to education staff members, BJRFtransferred the youths that engaged in those violentbehaviors to correctional or other mental health facilities.While there are times when removal from the facility maybe a legitimate option, removal should not be a primaryoption for a special needs facility targeted to potentiallyaggressive youth. Solutions must come in the form ofappropriate programs and staffing.

By reducing opportunities for commitment of violentoffenders, by removing them from the facility by transfer,and by not admitting female clients, BJRF is not reachingsegments of its intended population and resources arebeing expended on nonqualified clients.

BJRF is not reachingsegments of itsintended populationand resources arebeing expended onnonqualified clients.

24 PEER Report #422

Brookhaven Juvenile Rehabilitation Facility'sStaffing, Training, and Security

During the first two years of BJRF's existence, some of the staff was not completelyprepared for the aggressive behavior of clients. Significant staff turnover alsooccurred during this time. BJRF now has adequate numbers of direct care andeducation staff and provides sufficient staff orientation training, but because theDepartment of Mental Health has changed BJRF's clientele from what is legallymandated, PEER cannot assess the facility's readiness to provide services to itsintended target population.

Although BJRF's method of providing security appears adequate to protect theclients and staff within the population currently being served, changing thepopulation to the intended target group could compromise the adequacy of thefacility's security.

DMH's Adoption of Standards for the Special Needs Facility

Because facilities for mentally retarded juvenile offenders have nonationally recognized set of operating standards, BJRF operates under amixture of standards from the U. S. Department of Health and HumanServices, State Department of Education, and internally developed securitystandards.

PEER sought to determine whether the BrookhavenJuvenile Rehabilitation Facility's staffing, training, andsecurity complied with applicable standards for providingclient treatment and security. BJRF also operates underother function-specific standards such as professionalstandards for medical/nursing practice,state/departmental standards for finance and personnelpractices, and general mandates applicable to a class ofclients such as the Civil Rights of Institutionalized PersonsAct, but these were not within the scope of PEER's review.

The Brookhaven Juvenile Rehabilitation Facility is a newtype of special needs facility, with no comparableprograms in the state and few elsewhere. Such facilitiesfor mentally retarded juvenile offenders have neither anationally recognized set of operating standards, nor onenational association of operating professionals. Rather,these new hybrid programs have to adopt and/or adaptoperating standards from several disciplines andprofessions in developing programs for these specialneeds juveniles. The question becomes which standardsare adopted, used, modified, or developed in the processof assembling a security and treatment program for this

BJRF is a new type ofspecial needs facility,with no comparableprograms in the stateand few elsewhere.

PEER Report #422 25

special needs population, as well as how well the selectedstandards work in practice.

The Department of Mental Health chose to adopt the U. S.Department of Health and Human Services' standards forintermediate care facilities for the mentally retarded(ICF/MR) for BJRF's therapeutic environment. Thedepartment applied standards of the State Department ofEducation and Southern Association of Colleges andSchools for BJRF's educational program. Because thedepartment believed no suitable model existed forsecurity, BJRF developed its own standards andprocedures for security.

Standards for the Therapeutic Environment

In developing staffing and training requirements for thefacility to achieve a therapeutic environment, theDepartment of Mental Health chose to adopt standardswith which it was familiar. These standards, used at othermental retardation facilities, are the standards forintermediate care facilities for the mentally retarded(ICF/MR) promulgated by the federal Health CareFinancing Administration (HCFA) of the U. S. Departmentof Health and Human Services (HHS). Although the U. S.Department of Health later determined that theBrookhaven facility is not eligible for ICF/MR funding dueto its restrictive environment, the department's decision touse these standards has guided its development ofprograms and staffing.

DMH holds that it has no response from HCFA to itsappeal of the Mississippi Department of Health's denial ofICF/MR certification. A conference call was held March 8,2001, among staff of the Department of Health's Divisionof Health Facilities Licensure and Certification, HCFARegional Offices in Atlanta and Chicago, and the HCFACentral Office in Baltimore. That call concerned theICF/MR status of Brookhaven Juvenile RehabilitationFacility, and discussion focused on the areas in which thefacility did not meet ICF/MR certificationstandardsÑactive treatment, the security fence, thesecurity cameras. A memorandum summarizing theresults of the conference call from the Department ofHealth to PEER said that all the federal governmentrepresentatives were in agreement that BJRF does not meetcertification requirements for an ICF/MR facility. Thefederal officials said that Medicaid payments could not bemade for forensic units. A letter to this effect wasrequested from the HCFA Regional Office.

The Department ofMental Health chose toadopt the U. S.Department of Healthand Human Services'standards forintermediate carefacilities for thementally retarded(ICF/MR) for BJRF'stherapeuticenvironment.

26 PEER Report #422

Standards for the Education Program

Accreditation standards of the Mississippi Department ofEducation (MDE) and the Southern Association of Collegesand Schools (SACS) were adopted and included in theBrookhaven Juvenile Rehabilitation Facility's policies andprocedures for the education program element. Many ofthe clients eligible for commitment to the Brookhavenfacility function in the higher range of the mentallyretarded population and would benefit from accreditededucation programs.

Standards for the Security Program

In some areas, notably security, the Brookhaven facilitydeveloped its own standards and procedures. The securitydimension had to be developed from the earliest planningfor the facility. For example, several design elements of acorrections or forensic institution were included inconstruction to help control the potentially aggressivepopulation, such as a twelve-foot-high fence around theperimeter of the facility, a "sally port" as the clients' entrypoint, surveillance cameras at various common movementpoints, and telephone and other communication meansthroughout the facility to connect non-security staff withsecurity staff were provided for the facility. Security staff,most with law enforcement background or experience,were also among the personnel hired. Theseprogrammatic decisions for the Brookhaven facility wereunique among mental health facilities.

The Department ofMental Health appliesstandards of the StateDepartment ofEducation andSouthern Associationof Colleges andSchools to BJRF'seducational program.

Because theDepartment of MentalHealth believed nosuitable model existed,BJRF developed itsown standards andprocedures forsecurity.

PEER Report #422 27

Staffing of the Brookhaven Juvenile Rehabilitation Facility

Factors Affecting Staffing at BJRF

A facility for mentally retarded juvenile offenders must have appropriatestaffing for a habilitation and training program, as well as security. Duringthe first two years of BJRF's existence, some of the staff was not completelyprepared for the aggressive behavior and special needs of mentallyretarded clients. These conditions contributed to significant staff turnoverduring this period.

Special Staffing Considerations

Because the youth committed to BJRF are adjudicated delinquents, itsprogram efforts must include two equally important, appropriatelystaffed dimensions: a habilitation and training program foreducable/trainable mentally retarded juvenile offenders and a securitydimension.

As stated earlier, MISS. CODE ANN. Section 41-21-109clearly defines the appropriate clientele for theBrookhaven facility as adolescent mentally retardedcriminal offenders committed by youth or chancery courtto a secure, therapeutic environment. This is a clientelethat, as the Director of the Department of Mental Healthpublicly stated in 1994 and again in 2001, that thedepartment did not want to be responsible for treatingdue to its belief that the department lacked appropriateprograms. Because the youth committed to theBrookhaven facility are adjudicated delinquents, theprogram efforts must include two equally important,appropriately staffed dimensions: a habilitation andtraining program for educable/trainable mentally retardedjuveniles and a security dimension to reduce the danger ofharm to self or others. (See MISS. CODE ANN. Section 41-21-61.) The security component of BJRF staffing isaddressed on page 34.

Initial Staffing Problems

The initial education staff at BJRF had no special education experiencewith adolescents at the mental functioning level of BJRF clients, and theinitial group of clients included some whose aggressive behavior towardadults was not anticipated by some staff members.

The first group of clients admitted to BJRF included somewhose aggressive behavior toward adults was notanticipated by all staff. Also, none of the first educationinstructors hired had special education experience with

28 PEER Report #422

youth at the functioning level of the BJRF clientele. Apositive reinforcement behavior modification plan hadbeen installed as the primary disciplinary tool for theyouth, which all program staff (including teachers) weresupposed to administer.

These operating considerations combined in ways that ledto problems in the new program. In October 1999 andagain in February and June 2000, four different clientswere involved in three violent behavioral incidents withstaff members. These incidents led to teacher resignations.

For these and other reasons, BJRF experienced significantstaff turnover in the first operating year that madeprogram development, continuity, and adult interventionin client behaviors uncertain.

Staff Turnover

In the three years since it began operation, the Brookhaven JuvenileRehabilitation Facility has experienced 53 percent turnover for programstaff (with education and recreation staff being the highest) and 68percent turnover for security staff.

BJRF has experienced significant staff turnover since itsopening (see Exhibit 2, page 29). PEER's analysis of theentire facility's staff turnover as of June 30, 2001, showsthat one hundred four staff members in sixty-fivepositions in seventeen job categories have been hired andleft within the twenty-four months of operation withclients.

The four job categories with the highest percentage ofturnover were school administrator, 100%; security officer,68%; recreation therapist, 60%; and academic teacher, 55%.Overall, 73% of the employment terminations at theBrookhaven Juvenile Rehabilitation Facility are due toresignations, while 27% are the result of facility actions.

High turnover and difficulty in filling vacancies in theeducation staff have led to difficulty in education programplanning, lack of development of the education program inthe therapeutic regimen of the clients, and an inability topursue actively accreditation by the MississippiDepartment of Education.

In October 1999 andagain in February andJune 2000, fourdifferent BJRF clientswere involved in threeviolent behavioralincidents with staffmembers.

High turnover anddifficulty in fillingvacancies in the BJRFeducation staff haveled to difficulty ineducation programplanning, lack ofdevelopment of theeducation program inthe therapeuticregimen of the clients,and an inability topursue educationalaccreditation in anactive manner.

PEER Report #422 29

Exhibit 2: Program and Security Staff Turnover by Type of Position(For Fiscal Years 1999 through 2001)

Program Staff Turnover FY1999-FY2001

Position Overall FY1999 FY2000 FY2001

SchoolAdministrator

100%(2 OUT OF 2)

VACANT 100%(1 OUT OF 1)

100%(1 OUT OF 1)

Academic Teacher 55%(6 OUT OF 11)

0%(0 OUT OF 2)

67%(4 OUT OF 6)

29%(2 OUT OF 7)

RecreationTherapist

60%(3 OUT OF 5)

VACANT 67%(2 OUT OF 3)

25%(1 OUT OF 4)

Active TreatmentTechnician

53%(48 OUT OF 90)

23%(5 OUT OF 22)

42%(25 OUT OF 59)

25%(14 OUT OF 57)

Nurse 48%(10 OUT OF 21)

0 %(0 OUT OF 2)

47%(8 OUT OF 17)

15%(2 OUT OF 13)

AssociatePsychologist

33%(1 OUT OF 3)

VACANT 33%(1 OUT OF 3)

0%(0 OUT OF 2)

Social Worker 50%(1 OUT OF 2)

0%(0 OUT OF 2)

0%(0 OUT OF 2)

50%(1 OUT OF 2)

TOTAL PROGRAMSTAFF

53%(71 OUT OF 134)

18%(5 OUT OF 28)

45%(41 OUT OF 91)

24%(21 OUT OF 86)

Security Staff Turnover FY1999-FY2001

Position Overall FY1999 FY2000 FY2001

Security Officer 68%(15 OUT OF 22)

60%(3 OUT OF 5)

40%(4 OUT OF 10)

50%(7 OUT OF 14)

SOURCE: BJRF records.

Overview of Current Staffing

BJRF now has sufficient numbers of direct care and education staff, butbecause the Department of Mental Health has changed BJRF's clientele fromwhat is legally mandated, PEER cannot assess the facility's readiness toprovide services to its intended target population.

As of June 30, 2001, the Brookhaven JuvenileRehabilitation Facility had 110 employees serving 41residents. At maximum staffing and resident capacity, theBrookhaven facility is authorized 128 full-time positionsand can house 48 full-time residents. The facility isoperated twenty-four hours per day, seven days a week,for the entire fiscal year. The State Personnel Board checksall staff qualifications either prior to or just after hiring.The appropriate disciplines with appropriate professionalcertifications are currently present to carry out the

30 PEER Report #422

Brookhaven Juvenile Rehabilitation Facility's statutorypurposes.

Because the Department of Mental Health has expandedthe admission provisions of MISS. CODE ANN. Section 41-21-109, thus changing the actual population in residencefrom that legally mandated, PEER cannot assess BJRF'sreadiness to provide, with allocated resources, securityand therapeutic services to its intended target populationof mentally retarded juvenile offenders committed fortreatment by a court of competent jurisdiction. However,PEER provides the following observations relative tofacility staffing in comparison to applicable standards.

Direct Care Staffing

Using ICF/MR standards as a baseline, PEER found that BJRF exceedsdirect care staffing requirements.

Direct care employees at BJRF include active treatmenttechnicians who monitor the residents' behavior,implement the positive program reinforcement program,and serve as classroom aides while the residents attendschool.

In developing staffing requirements for direct careworkers, the Department of Mental Health used standardsfor intermediate care facilities for the mentally retarded(ICF/MR) promulgated by the federal Health CareFinancing Administration (HCFA) of the U.S. Department ofHealth and Human Services (HHS). The BrookhavenJuvenile Rehabilitation Facility is a special needs mentalretardation facility and should not be judged by ICF/MRstandards alone. However, the ICF/MR standards doprovide a baseline for an assessment of staffing.

Currently, ICF/MR standards require a minimum of onedirect care staff for every 3.2 residents when thepopulation consists of residents with aggressive behavior.ICF/MR standards indicate that facilities should operateabove the minimum when possible, since having additionalstaff allows for better implementation of clients'individual program plans. PEER's analysis of staffingpatterns as of June 2001 showed that the facility hadforty-one direct-care staff for forty-one residents at thattime. Exhibit 3, page 31, shows that the BrookhavenJuvenile Rehabilitation Facility has exceeded the minimumdirect-care staffing requirements since the facility beganserving clients in July 1999.

As of June 2001, BJRFhad forty-one direct-care staff for forty-oneresidents.

PEER Report #422 31

Exhibit 3: Comparison of Actual Juvenile Rehabilitation Facility Direct-Care Staff vs. Minimum Staff Required for the Number of BrookhavenJuvenile Rehabilitation Facility Residents (For Period July 1999through June 2001)

0

5

10

15

20

25

30

35

40

45

Jul-99

Aug-99

Sep-99

Oct-99

Nov-99

Dec-99

Jan-00

Feb-00

Mar-00

Apr-00

May-00

Jun-00

Jul-00

Aug-00

Sep-00

Oct-00

Nov-00

Dec-00

Jan-01

Feb-01

Mar-01

Apr-01

May-01

Jun-01

Month

Nu

mb

er

BROOKHAVEN JRF RESIDENTS MINIMUM CRITERIA (24-HR DAY) ACTUAL JRF DIRECT-CARE STAFF

SOURCE: PEER analysis.

Education Program Staffing

Using State Department of Education standards as a baseline, PEER foundthat until recently BJRF did not meet recommended student/teacherratios.

Although BJRF's education program is not required to beaccredited by the State Department of Education, thefacility adopted the department's standards and those ofthe Southern Association of Colleges and Schools for itseducation program. PEER used these standards as abaseline and found that BJRF has been understaffed basedon the benchmark student/teacher ratios required forspecial education students in self-contained classrooms.

State special education regulations allow no more thantwelve students for each classroom with only one aide, andno more than fourteen students for each classroom withtwo aides. For classes with multiply disabled students(e.g., mentally retarded with behavior problems or withautism), the regulations allow a maximum of ten studentsper class.

From the opening ofthe facility in July 1,1999, until June 11,2001, only twoteachers served thirty-eight clients, withdirect care personnelacting as classroomaides.

32 PEER Report #422

From the opening of the facility in July 1, 1999, until June11, 2001, only two teachers served thirty-eight clients,with direct care personnel acting as classroom aides. Thusthe facility did not meet the minimum education staffingstandard set by the State Department of Education.Currently, the facility has five teachers, which should bringthe facility up to education staffing standards.

Staff Training at the Brookhaven Juvenile Rehabilitation Facility

In accordance with ICF/MR and Department of Mental Health employeetraining standards for aggressive mentally retarded juveniles, theBrookhaven facility has provided complete and timely orientation training toabout 90 percent of employees since it began operating.

In order for facility staff to implement a treatmentprogram for residents, ICF/MR standards requireorientation for all staff beginning upon the date of hire.Timely orientation training that prepares staff to interveneappropriately to control or influence client behaviorpromotes client and employee safety as well as programeffectiveness. The department has adopted thesestandards and included them in the policies andprocedures manual for the operation of the Brookhavenfacility. The content of Brookhaven Juvenile RehabilitationFacility's staff orientation program is consistent with thatrequired by ICF/MR regulations.

Facility policy requires that all new employees completefour sessions (about thirty hours) of orientation trainingon topics pertaining to client treatment and facilityoperating procedure. Staff orientation at the BrookhavenJuvenile Rehabilitation Facility includes topics on facilitypolicies and procedures, behavior management, mentalretardation, behavior observation and documentation,client rights, and the client level system. Also, employeeswho provide direct care (active treatment technicians,psychologists, nurses, and social workers) must becertified in techniques for managing aggressive behavior(TMAB) and cardiopulmonary resuscitation (CPR). Thesetwo areas require annual re-certification. Allowing staff towork with behaviorally disturbed residents prior to aproper orientation increases the potential for harm.Exhibit 4, page 33, shows the number of past and presentemployees receiving orientation.

PEER analysis of training records of employees hired sincethe facility began operating indicate that five completedno orientation, six completed only partial orientation, andthirty-one received full orientation, but some two weeks totwo months after the date of hire. The number not in

The content of BJRF'sstaff orientationprogram is consistentwith that required byICF/MR regulations.

PEER Report #422 33

compliance with policy amounts to about ten percent,while about ninety percent of the employees hired (147 of189) completed the required orientation training.

Exhibit 4: Brookhaven Facility Employees Completing OrientationTraining By Type (For Fiscal Years 1999 Through 2001)

Employee Type

FullOrientationCompleted

Timely

FullOrientation

NotCompleted

Timely

PartialOrientationCompleted

NoOrientationCompleted

Active TreatmentTechnicians,Psychologists,Nurses, & SocialWorkers

101 3 2 3

Education/Recreation

10 4 1 0

Support 24 21 1 1Security 12 3 2 1

Total 147 31 6 5

SOURCE: Brookhaven Juvenile Rehabilitation Facility

Since October 2000, the Brookhaven JuvenileRehabilitation Facility has been in compliance withdepartmental policy, which requires that all employeesreceive orientation upon the date of hire.

The department also conducts regular in-service trainingfor BJRF staff, including application of the positivereinforcement behavior management program.

34 PEER Report #422

Security at the Brookhaven Juvenile Rehabilitation Facility

The security role at BJRF is the responsibility of both guards and programstaff. In keeping with practices followed in other mental health facilities thatfollow ICF/MR standards, guards direct their primary attention to protectingthe physical facility, while program staff are primarily responsible forclients' safety-related behaviors. Although this method of providing securityappears adequate to protect the clients and staff within the populationcurrently being served, changing the population to the intended targetgroup could compromise the adequacy of the facility's security.

Potentially aggressive mentally retarded youth presentbehavioral problems that facility staff must be prepared toaddress. Behaviors that staff may encounter on a dailybasis include hitting, spitting, biting, kicking, tantrums,self-injury, aggressive language, and inappropriatetouching. These behaviors may be directed toward otheryouth or toward adults. Brookhaven JuvenileRehabilitation Facility records show that, on average, eightof these incidents daily are serious enough to require awrite-up or behavioral intervention.

Planning for the Brookhaven Juvenile RehabilitationFacility shows that the facility was to be a therapeuticenvironment with a security overlay rather than a secureenvironment with a therapeutic overlay (the latter similarto a prison or juvenile corrections facility). Securitypersonnel, in performing their duties, were to be asinvisible to the internal operations of the facility aspossible.

The security needs of the target population presented astaffing challenge to the Department of Mental Health,since it had never before been responsible for a programwith the statutory mission proscribed for the Brookhavenfacility.

PEER Report #422 35

Role of Program Staff in Facility Security

BJRF program staff (i.e., the education, recreation, nursing, psychology,social work, and residential staff) plan for and are involved in reactionsto client behaviors that need management or correction.

According to planning minutes and staff training logs,program staff of the Brookhaven Juvenile RehabilitationFacility are expected to provide security for the internalfunctioning of the facility. This means program staff planfor and are involved in reactions to client behaviors thatneed management or correction. Consequently, staffreceive training particularly related to behaviormanagement and cardiopulmonary resuscitation. Staffmembers are expected to recognize signs of escalatingclient behaviors, and apply appropriate ways to manage it.The management of aggressive behavior may include suchstaff actions as talking calmly to an upset client,redirecting the client's behavior, using time out rooms,using self-defense techniques such as blocking a client'sblow, and using physical restraints.

All program staff--the education, recreation, nursing,psychology, social work, and residential staff--are expectedto have this knowledge and play this role. Currently, stafftraining certification is offered only for TMAB and CPR. Allstaff members are required to be certified annually inthese areas, and in order to obtain certification in thesetwo areas, staff members must demonstrate their ability toperform the requisite skills. The staff is also expected todemonstrate their effectiveness in these areas on the job.

Role of Security Staff in Facility Security

BJRF's security guards' primary duties are to protect the physical facility.If BJRF restricted its admissions to those required by statute, thedepartment would need to reassess the role of BJRF security personnel inrelation to clients.

Unlike correctional facilities where security guards arehighly visible and are employed to provide protectionamong staff, the correctional population, and the physicalplant, the job assignment of security guards at theBrookhaven Juvenile Rehabilitation Facility is much lessvisible and less involved in escorting or directingresidents. The BJRF's security guards' role primarilyconcerns protection of the physical facility. Securityguards are expected to keep unwanted visitors out of thefacility, to prevent resident escape by ensuring securitymeasures are followed in the restricted environment, to

Program staff at BJRFare expected toprovide security forthe internalfunctioning of thefacility.

36 PEER Report #422

protect the inventory of the facility, and be able torespond to client behavior emergencies.

Guards are primarily accessible to staff by hand-heldradios, security telephones in common rooms, andsurveillance cameras. Although guards walk and ridearound the forty-three acres of the facility, their primaryrole is security in the abovementioned areas. The guards'roles for internal security are more reactive than theproactive role program staff are expected to carry out.Guards do, however, receive training in TMAB in case theyhave to intervene in aggressive conduct of clients.

The mental health security model appears adequate to thecurrent needs of the facility. However, if BJRF restrictedits admissions to those required by statute, thedepartment would need to reassess the role of BJRFsecurity personnel in relation to clients.

At BJRF, securityguards' roles forinternal security arereactive; program staffare expected to take aproactive role.

PEER Report #422 37

Assessment of Program Quality at theBrookhaven Juvenile Rehabilitation Facility

It is too early in the life of the Brookhaven Juvenile Rehabilitation Facility programto make definitive statements about program quality and success. However, PEERnoted problems with the staff not uniformly implementing the positivereinforcement behavior modification plan and internal disagreements on theproper role and form of discipline for the facility. Also, BJRF has not developedmeasures of program success.

The General Program

All clients are provided with timely and appropriate assessment offunctioning and individualized habilitation programs based on a positivereinforcement treatment program.

The Brookhaven facility conducts a comprehensivefunctional assessment of all clients within fourteen daysof admission. The facility staff develops an IndividualProgram Plan (IPP) for each youth based on thecomprehensive functional assessment. The IPP addressesmedical, dietary, social, psychological, behavioral,recreational, and educational needs of each client. All ofthis is fully documented in each client's records. (Therecordkeeping is extensive, thorough, and kept up to date.)An interdisciplinary team monitors and modifies (aswarranted by the client's progress) each client's IPPregularly.

The core training mechanism for the clients is a positivereinforcement behavior modification plan. The plan isthoroughly worked out with respect to rewards andwithholding of rewards for the youth for their appropriateand inappropriate behaviors. All staff who come in contactwith clients are expected to understand and administerthis plan. It is the subject of formal training in the initialgeneral orientation, and the subject of ongoing informaldiscussion and training among professional staff.

Each client has anIndividual ProgramPlan that addresses hismedical, dietary, social,psychological,behavioral,recreational, andeducational needs.

38 PEER Report #422

Problems with Program Implementation

Problems with program implementation have centered on a failure to carryout positive reinforcement programs uniformly and internal disagreementson the proper role and form of discipline in behavior change.

Uniformity in Carrying Out the Positive Reinforcement Program

Problems have existed with some of the BJRF staff fullyimplementing the behavior modification plan. Theproblems have taken two main forms. One form has beenindividual staff members making individual "bargains"with individual clients, in the form of "If you will behave insuch-and-such a way, I'll bring you so-and-so for a reward."As the head psychologist points out, such "side"arrangements cannot be applied to the entire clientpopulation and can undermine the effectiveness ofbehavior modification efforts (by misusing its veryprinciple). According to him, this problem has beenaddressed and eliminated.

Proper Role and Form of Discipline

The second, broader problem has centered in theeducation staff and has to do with the nature of"discipline" in the education program specifically. Most ofthe teaching staff (past and present) believes thatdisciplinary measures for the youth could be improved tobe appropriate for the special population served. Theassistant director for program services reported that earlyin the program, some of the teaching staff were reluctantto intervene in clients' behavioral incidents.

In dealing with this problem (of a teachers' perceived lackof discipline), education staff members and psychologistshave discussed at length the proper application of thebehavior modification program in specific cases. Dailybehavioral incident rates have fluctuated in the firsttwenty-four months of operation. The education staffbelieves that for some of the clients (usually the higherfunctioning ones), the positive reinforcement plan doesnot have much meaning and hence is ineffective as abehavior management tool.

The head psychologist reports that the behaviormanagement model is ineffective for twenty to twenty-fivepercent of the clients, for whom the IPP then specifies

Staff members'individualarrangements withclients cannot beapplied to the entireclient population andcould undermine theeffectiveness ofbehavior modificationefforts.

Disagreement existsamong members ofBJRF's professionalstaff about theeffectiveness of thefacility's behaviormodification program.

PEER Report #422 39

alternatives. With respect to specific disciplinary needs,there have been some significant differences betweenteachers and psychologists. Teachers employed during theearly operation of the program have wanted theadministration of medication to clients during behavioralincidents as the means of behavior management. TheBrookhaven Juvenile Rehabilitation Facility's policystrongly discourages this practice, as does the Civil Rightsof Institutionalized Persons Act.

After two episodes of injury to education staff members,the youths that engaged in those behaviors weretransferred from BJRF and recommitted to correctional orother mental health facilities. PEER would note that, whilethere are times when removal from the facility may be alegitimate option, removal should not be a primary optionfor a special needs facility targeted to potentiallyaggressive youth. Solutions must come in the form ofappropriate programs and staffing.

Since the injurious incident, and subsequent substantialturnover in teaching staff, current teachers report fewersignificant client-staff behavioral incidents. The behavioralincidents that the teachers now deal with are mostly client-to-client. There is continuing discussion, and still somedisagreement, among professional staff about the behaviormodification program. The head psychologist mentions"client non-compliance" and "staff inconsistency" as"barriers to successful programming." The "staffinconsistency" barrier takes good training and continualdiscussion about specific cases to improve the behaviormodification program, and BJRF is making these efforts.

Management team members expect program treatment tobe "long-term" for most clients. The Brookhaven JuvenileRehabilitation Facility staff's "long-term" expectations aredriven by the facility's programmatic behavioral objectives:the primary focus on developing adaptive behaviors thatyouth need for successful living after discharge. Thebehavior modification plan is an essential element of this"long-term" strategy. Whether it produces the desiredadaptive behavior, including discipline in the classroom, isessential to the success of the facility's programmaticefforts.

While there are timeswhen a client'sremoval from thefacility may be alegitimate option, thisshould not be theprimary option for aspecial needs facilitytargeted to potentiallyaggressive youth.

40 PEER Report #422

Lack of Measures of Program Success

Current Department of Mental Health program performance measures forthe Brookhaven facility do not include indicators of program success.Particularly, there are no indicators of the potential long-term impact theBrookhaven Juvenile Rehabilitation Facility's program may have on the livesand adaptive successes of its clients upon discharge to the community andhow such successes might be measured and tracked.

Every element of the individual program plan hasbehavioral objectives. The professional in each disciplineuses measures of performance on these objectives togauge the progress of each client. These are useful internalmeasures for tracking individual progress within thefacility and in each program element, but they do notaddress what happens to the youth after discharge fromBrookhaven Juvenile Rehabilitation Facility back into thecommunity.

BJRF's FY 2002 Budget Request reports the followingprogram performance indicators and measures:

• Program Outputs: total number of resident/client days

• Program Efficiencies: Operating cost perresident/client day (projected as $250/resident/day)

• Program Outcomes (targeted in FY 2002):

-- to provide habilitation, medical, and custodial care24 hours a day, 365 days a year tolicensed/certified care facility with at least 98%occupancy of total client days;

-- to obtain and maintain the facility's licensure andcertification;

-- to achieve licensure and certification by the StateDepartment of Health;

-- to meet the school accreditation requirements ofthe State Department of Education; and,

-- construction of two ICF/MR Group homes.

Except for the very beginning phase of the program (e.g.,the first year), during which staff are taking programactions that result in the allocation of resources necessaryto meet licensing/certification/accreditation standards,these are not ongoing measures of program outputs andoutcomes. Rather, once they are achieved, they are inputmeasures, illustrating the resources and activities theBrookhaven Juvenile Rehabilitation Facility and itsprograms will bring to bear on its clients. These program

BJRF's programperformance measuresinclude no indicator oflong-term impact onclients.

PEER Report #422 41

performance measures include no indicator of whatdifference BJRF's programs make to the lives of its clients,and particularly no indicator of what long-term impact theprogram might make to the lives and adaptive successesits clients might have upon discharge back into thecommunity.

Although the BJRF staff has considered recidivism (i.e., thenumber of youth who, once discharged, are returned toBJRF) as a measure, this measure is neither comprehensivenor dependable as a measure of programmatic success.

42 PEER Report #422

Recommendations

Facility Construction

1. For future construction projects, DMH shouldutilize the planning process to identify andaccurately quantify all project costs, set budgets,and monitor progress to minimize expendituresbeyond those funds authorized. DMH shouldfollow the intent expressed in legislative grants ofauthority for project funding, by disallowingexpenditure of funds for expansion of facilities(e.g., the addition of staff housing or a warehouse),thereby causing project cost overruns.

Admissions

2. DMH should conform its admissions decisions tocomply with statutory criteria as set forth in MISS.CODE ANN. Section 41-21-109, which limitsadmissions to mentally ill or mentally retardedjuvenile offenders who have been committed fortreatment by a court of competent jurisdiction.

3. DMH should promptly inform all youth and chancery court judges in the state that it will fully comply with the admission intent expressed in MISS. CODE ANN. Section 41-21-109.

4. DMH should clearly define the relationshipbetween the Brookhaven facility and the HarrisonCounty facility regarding the placement of "dualdiagnosis" juvenile offenders and disseminate thisinformation to the state's youth and chancery courtjudges for their use in making commitmentdecisions.

Staffing

5. After achieving compliance with statutory admission requirements, DMH should assess its direct care staffing needs to establish the appropriate levels of direct care staff needed for treatment of the intended population of mentally ill or mentally retarded juvenile offenders.

6. Management and education staff should continueefforts to qualify for and obtain State Departmentof Education accreditation by adhering tostandards for classroom staffing--i.e., maintainingthe required level of teaching personnel.

PEER Report #422 43

Policies and Procedures

7. Recognizing the statutory required purpose ofBJRF, and that ICF/MR standards are limited intheir application to treating this special needspopulation, BJRF management and DMH staffshould continue to develop policies and proceduresspecific to the BJRF program.

8. In keeping with the statutory mandate, BJRFmanagement and appropriate staff should developand offer training consistent with its role ofproviding treatment to the state's mentally ill andmentally retarded juvenile population.

Performance Measurement

9. DMH and facility management should develop anddefine an accurate set of outcome measures, installa system to capture relevant data, and annuallyassess and report performance for the BJRFprogram.

PEER Report #422 45

Appendix A: Definition of Mentally Ill and Mentally RetardedContained in MISS. CODE ANN. §41-21-61

Mentally Ill Person

(e) "Mentally ill person" means any person who has a substantial psychiatricdisorder of thought, mood, perception, orientation, or memory which grossly impairsjudgment, behavior, capacity to recognize reality, or to reason or understand, which (i)is manifested by instances of grossly disturbed behavior or faulty perceptions; and (ii)poses a substantial likelihood of physical harm to himself or others as demonstrated by(A) a recent attempt or threat to physically harm himself or others, or (B) a failure toprovide necessary food, clothing, shelter or medical care for himself, as a result of theimpairment.  "Mentally ill person" includes a person who, based on treatment historyand other applicable psychiatric indicia, is in need of treatment in order to preventfurther disability or deterioration which would predictably result in dangerousness tohimself or others when his current mental illness limits or negates his ability to make aninformed decision to seek or comply with recommended treatment.  "Mentally illperson" does not include a person having only one or more of the following conditions:(1) epilepsy, (2) mental retardation, (3) brief periods of intoxication caused by alcohol ordrugs, (4) dependence upon or addiction to any alcohol or drugs, or (5) senile dementia.

Mentally Retarded Person:

(f) "Mentally retarded person" means any person (i) who has been diagnosed ashaving substantial limitations in present functioning, manifested before age eighteen(18), characterized by significantly subaverage intellectual functioning, existingconcurrently with related limitations in two or more of the following applicable adaptiveskill areas: communication, self-care, home living, social skills, community use, self-direction, health and safety, functional academics, leisure and work, and (ii) whoserecent conduct is a result of mental retardation and poses a substantial likelihood ofphysical harm to himself or others in that there has been (A) a recent attempt or threatto physically harm himself or others, or (B) a failure and inability to provide necessaryfood, clothing, shelter, safety, or medical care for himself.

46 PEER Report #422

Appendix B: Brookhaven Juvenile Rehabilitation Facility ConstructionRevenue and Expenditure Summary

Facility Description Revenue / Expenditure Item

Revenue / (Expenditure)

Amount Sub-Totals Balance

REVENUES:

Proceeds from Bond Sale Authorized by SB 2497

(1995, 1996, 1999) $11,000,000

Proceeds from SB 3214 $664,047

TOTAL REVENUE $11,664,047

EXPENDITURES:

Brookhaven JRF Main Campus:

(Administration building, education building, recreation

building, three residential living buildings, and fencing)

Professional & Other Fees ($457,159)RFP Advertisement (53)

Construction Costs (7,014,894)

Total Main Campus Cost (7,472,106)

Warehouse and Directors Residence:

Professional & Other Fees (71,414)

RFP Advertisement (79)

Land Acquisition (126,750)

Construction Costs (Warehouse) (764,600)Construction Costs (Director's Residence) (219,678)

Network Communications (14,091)

Total Warehouse/Residence Cost (1,196,613)

TOTAL CONSTRUCTION EXPENDITURES (8,668,718)

Campus Equipment: Equipment Purchased Directly by Facility (553,442)

TOTAL CONSTRUCTION AND EQUIPMENT EXPENDITURES (9,222,160)

BALANCE REMAINING (SB 2497 Proceeds) $2,995,329

CONSTRUCTION, LAND AND EQUIPMENT EXPENDITURES (From Operating Funds)

Land Acquisition (126,750)

House/Warehouse Construction (537,297)

Campus Equipment (553,442)

Total Expenditures (From Operating Funds) (1,217,489)

SOURCE: Bureau of Building, Grounds, and Real Property Management and FY 2001 andFY 2002 legislative budget requests.

54 PEER Report #422

PEER Committee Staff

Max Arinder, Executive DirectorJames Barber, Deputy DirectorTed Booth, General Counsel

Evaluation Editing and RecordsSam Dawkins, Division Manager Ava Welborn, Editor and Records CoordinatorLinda Triplett, Division Manager Tracy BoboOona McKenzie Sandra HallerPamela O. CarterKim Cummins AdministrationBarbara Hamilton Mary McNeill, Accounting and Office ManagerKaren Kerr Pat LuckettJoyce McCants Jean SpellCharles H. Moore Gale TaylorDavid PrayLee Anne Robinson Data ProcessingKatherine Stark Larry Landrum, Systems AnalystLynn WatkinsSara Watson Corrections AuditCandice Whitfield Louwill Davis, Corrections AuditorLarry Whiting