Two tiers of youth

It doesn't happen often, but sometimes a child younger than 12 gets in trouble with authorities and is referred to the juvenile office. Although children under 12 may commit a serious offense, juvenile officers and counselors who work with children say they must be treated differently from teenagers.

Juvenile officer Randy Rhodes and the social agencies he works with don't look at offenders under 12 as delinquents but as children in need of help. Some are from families already involved with the Division of Family Services, which can assist parents in getting help for the children either through private counseling or the Department of Mental Health. Often young offenders end up in juvenile custody, Rhodes said, because if the juvenile office doesn't take them they have nowhere else to go -- especially children who have mental health issues that could be causing their disruptive behavior.

For those children who are not in the state social system and who need a mental health evaluation, the situation becomes complicated. Some children are referred to the juvenile office because of the offense they have committed, but what they really need is emergency mental health treatment, Rhodes said. However, local hospitals are not equipped to handle juveniles with those issues.

"I know they have a lot to do, but it's a need that's not being met," said Danny Johnson, a counselor with New Visions Youth and Family Services, an agency that works with the juvenile office.

Both Southeast Missouri Hospital and Saint Francis Medical Center say they are aware of the need, and they're meeting it the best way they can.

"There are a lot of services we don't provide," said Barbara Thompson, vice president of marketing at Saint Francis. She said that the hospital staff adds services when there is a proven "incredible community need."

Thompson said the demand for mental health services for children does not translate into large numbers.

Saint Francis Medical Center decided in 1992 that it could not provide mental health treatment for adults or juveniles, and closed its psychiatric unit.

A year later, Southeast Missouri Hospital opened a unit for adults to pick up the slack, but found it could not afford to treat children, who cannot be housed in a ward with adults, or support a full-time pediatric psychiatrist.

"We would like to do all things there are to do," said Jim Wente, president and CEO of Southeast Missouri Hospital. "Unfortunately, we can't."

When confronted with a mental health emergency, Saint Francis tries to refer a pediatric mental health patient to another facility.

Wente said that when a troubled child is taken to Southeast's emergency room, he may be transferred for emergency treatment to any one of eight facilities as close as Kennett, Mo., or as far away as Springfield, Mo., Wente said.

"We have never experienced any problems with these facilities accepting children from our region," Wente said.

Johnson said New Visions has worked out an arrangement with hospitals in St. Louis, Springfield and Memphis to accept juveniles. So many Southeast Missouri children are coming for treatment at DePaul Health Center in St. Louis, Johnson said, that the hospital is adding another 20-bed unit.

Detention not an option

For instances that are not emergencies -- that is, cases where no one's life is threatened -- there are other options, Rhodes said, but for children 12 and under juvenile detention is not one of them because older juveniles may prey on the younger ones.

The juvenile office and New Visions work closely together to help young offenders. The first step is to look at the child's family system. Sometimes, Johnson said, children get in trouble because they're not taught any better at home. The child mimics what he sees adults doing.

"Sometimes it's poor parenting and a lack of parents knowing what to do," Johnson said. "And sometimes the family values are delinquent. It's just the way it is."

Often parents listen to so many different people when they need to get a full assessment of evaluations, including medical, he said.

"We try to put the parents back in charge of the situation," Rhodes said. "When we get one that young, we call the parents, call in an assessment person to evaluate the need for possible hospitalization."

Another aspect of treating mental health issues in children is prevention, which is what the schools try to do.

Assistant superintendent Betty Chong of the Cape Girardeau School District said the public schools work to help children before they need services from other agencies. She said the school district is seeing fewer instances of the school resource officer referring children to the juvenile office. Disciplining middle school and junior high children through in-school suspension has proven successful, Chong said. There, a specially trained teacher works with the children guiding them toward more appropriate behavior.

"We talk to them about anger management, coping skills," she said. "Counselors get involved stressing appropriate choices."

At the elementary level, Chong said, schools are modeled after Boys Town, which teaches children how to make good decisions, how to say no, how to ask for permission, the right way to make eye contact in social situations. In teaching these social skills, Chong said, teachers can also sort out those children who may have emotional problems or special learning needs that can lead to disruptive behavior and deal with them before they become problems.

What doesn't work is what some well-meaning parents have tried, Rhodes said. Rhodes said some parents have asked him if they can bring their children to the juvenile detention center in an effort to scare them into good behavior.

"I will call some counselors and set up an appointment to talk to them myself, but I'm not about to take them into the back and frighten them," he said.

lredeffer@semissourian.com

335-6611, extension 160