Residential Care: Some High-Risk Youth Benefit, But More Study Needed
(Letter Report, 01/28/94, GAO/HEHS-94-56).
A recent study has estimated that more than 10 percent of the nation's
youth are engaging in behaviors that seriously jeopardize their futures,
including poor academic performance, substance abuse, delinquency, and
unprotected sex. One approach for dealing with at-risk
youth--residential care--removes them from where they normally live and
places them in settings ranging from tents in the woods to suburban
homes, where they are taught skills and prepared to return to their
communities and become contributing members of society. GAO found that
although few rigorous evaluations of residential programs have been
done, the studies issued so far suggest that residential care can
successfully treat some high-risk youths. Thorough evaluations are
needed to determine which treatments are most effective and what the
long-term effects of the treatment are for youths so that policymakers
can make sound decisions on the most effective mix of programs and the
best role for residential care. Program officials and other experts
agree that some key elements enhance the programs' ability to alter
high-risk behavior, such as close ties with the youths' families and
continuing support after the youths have left the residential setting
and returned to their neighborhoods.
--------------------------- Indexing Terms -----------------------------
REPORTNUM: HEHS-94-56
TITLE: Residential Care: Some High-Risk Youth Benefit, But More
Study Needed
DATE: 01/28/94
SUBJECT: State-administered programs
Disadvantaged persons
Public assistance programs
Local governments
Minors
Program evaluation
Juvenile offender rehabilitation
Juvenile correctional facilities
Juvenile delinquency
Rehabilitation programs
IDENTIFIER: Starr Commonwealth, Cedar Village Program (Albion, MI)
Boys Town Home Campus Program (Boys Town, NE)
Paint Creek Youth Center Program (Bainbridge, OH)
Piney Woods Country Life School Program (Piney Woods, MS)
Hyde School Program (Bath, ME)
Oasis Center Program (Nashville, TN)
Salesmanship Club Youth Camp Program (Hawkins, TX)
Harbor Schools and Family Services, Haverhill Program
(Haverhill, MA)
Boysville Program (Clinton, MI)
Children's Village Program (Dobbs Ferry, NY)
Bridge Over Troubled Waters Transitional Living Program
(Boston, MA)
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Cover
================================================================ COVER
Report to the Chairman, Subcommittee on Oversight of Government
Management, Committee on Governmental Affairs, U.S. Senate
January 1994
RESIDENTIAL CARE - SOME HIGH-RISK
YOUTH BENEFIT, BUT MORE STUDY
NEEDED
GAO/HEHS-94-56
Residential Care
Abbreviations
=============================================================== ABBREV
AIDS - acquired immunodeficiency syndrome
GED - general educational development
Letter
=============================================================== LETTER
B-249960
January 28, 1994
The Honorable Carl M. Levin
Chairman, Subcommittee on Oversight of
Government Management
Committee on Governmental Affairs
United States Senate
Dear Mr. Chairman:
The nation faces daunting challenges in deciding how best to approach
the problem of youth whose behavior places them at risk of not
becoming self-sufficient members of society. One study has estimated
that more than 10 percent of the nation's youth aged 10 to 17 engage
in three or more of the four behaviors most commonly associated with
this risk: poor performance in school, substance abuse, delinquency,
and early unprotected sexual activity.\1
One approach for dealing with at-risk youth--residential
care--removes youths from where they normally live and places them in
settings ranging from tents in the wilderness to family-like
residences in the suburbs. In these settings, youths are taught
skills and provided treatment designed to prepare them to return to
their communities and become contributing members of society.
Because the Subcommittee is interested in the role of the federal
government in providing education, health, and social services to
children living in precarious environments, you asked us to study
residential programs that provide comprehensive long-term help for
youths who are exhibiting multiple high-risk behaviors. Our study
objectives were to determine
what is known about the effectiveness of such programs in preparing
youths to lead self-sufficient, productive lives and
what can be learned about key program characteristics important for
mitigating risky behaviors of young people.
--------------------
\1 Joy G. Dryfoos, Adolescents at Risk: Prevalence and Prevention
(New York: Oxford University Press, 1990).
BACKGROUND
------------------------------------------------------------ Letter :1
Studies indicate that the consequences associated with high-risk
behaviors are costly not only in terms of individual suffering and
diminished quality of life, but also in terms of long-term social
costs and lost productivity. Some examples follow:
On average, each male who drops out of high school will earn
$260,000 less and pay $78,000 less in taxes during his lifetime
than those who graduate from high school. Similar estimates for
a female dropout were $200,000 and $60,000, respectively.
Over 500,000 youths entered detention centers in 1988, and the
average cost to hold one youth in custody for a year was nearly
$30,000.
Early unprotected sexual activity costs taxpayers an estimated $19
billion annually for income support, health care, and nutrition
for families begun by adolescents. It also increases the
incidence of sexually transmitted diseases, including acquired
immunodeficiency syndrome (AIDS).
Experts recognize that problems of youths who exhibit multiple
high-risk behaviors are best addressed simultaneously and intensively
over an extended period, in part because problem behaviors are often
interrelated. For example, some high-risk youths experience problems
in school, become abusers of drugs and alcohol, and become involved
in delinquent activity.
One way to serve high-risk youth is through comprehensive, long-term
residential programs that remove young people from their homes,
generally for 6 to 18 months. The programs provide education,
health, and social services to address the youths' multiple problems
in-house or through arrangements with local providers. Other ways of
addressing youths' problems include nonresidential community-based
programs that serve youths at home or at school or other community
locations.
The severity of problem behaviors exhibited by youths served in
residential programs varies considerably. Some youths engage in
high-risk activities, such as drug peddling or prostitution, or
suffer from severe psychological and social problems. They may be
referred to residential programs by juvenile justice, child welfare,
or mental health organizations. Other youths are truant from school
or run away from home. Some who live in crime-ridden neighborhoods
or who come from hostile families need protection. Parents or social
agencies may refer these youths to residential care programs,
including boarding schools, which provide an opportunity for the
youths to be educated and receive guidance in a safe and stable
environment.
Many youths in these programs come from low-income homes in troubled
neighborhoods. Many have been victims of physical and sexual abuse
and have had a number of prior placements such as foster care or
correctional facilities.
SCOPE AND METHODOLOGY
------------------------------------------------------------ Letter :2
To examine what is known about the effectiveness of residential care
programs, we searched the literature and contacted experts on the
needs of at-risk adolescents to identify recent studies of program
effectiveness. We obtained and reviewed relevant studies. Because
national associations and agencies we contacted could not provide
comprehensive listings of long-term residential programs for youths
aged 10 to 17, we relied on program officials and other experts in
the field to suggest individual programs that, in their opinion, were
notable or had some documented measures of effectiveness.
In all, we judgmentally selected and contacted 29 residential
programs which, based on information we had at the time, were likely
to meet the following criteria: served youths aged 10 to 17;
provided long-term, comprehensive services that addressed each of the
four problem behaviors of poor performance in school, substance
abuse, delinquency, and early unprotected sexual activity; and had
recent outcome data on program effectiveness.
After contacting the 29 programs, we found that 17 met our criteria
and included them in our review. We also included another program,
the Piney Woods Country Life School, a boarding school that serves
youth who are not currently exhibiting the four problem behaviors,
but who come primarily from dangerous urban neighborhoods where they
may be at increased risk of adopting the behaviors. Appendix III
lists the names and addresses of these 18 programs.
We visited 9 of the 18 programs--selected to illustrate a variety of
populations (ranging from youths with relatively minor problems to
those convicted of felonies) and locations (urban, suburban, and
rural). We conducted telephone interviews with officials of the nine
programs we did not visit to obtain comparable information about
program orientation and outcomes, participant profiles, and funding.
We used the views of program officials and other experts we contacted
and the literature to develop a list of program characteristics that
appeared to be key to program success. We then asked officials from
the 18 programs to assess the importance of these key characteristics
to their programs' success.
We conducted our work between August 1992 and November 1993 in
accordance with generally accepted government auditing standards.
Appendixes I and II contain descriptions of each program included in
our study and results of evaluations and outcome measurements.
RESULTS IN BRIEF
------------------------------------------------------------ Letter :3
Residential care appears to be a viable treatment option for some
high-risk youths. Each of the 18 programs we contacted reported
benefits for some youths in such areas as maintaining attendance in
school and avoiding drug abuse and criminal behavior. However,
programs seldom conduct controlled or comparison studies to determine
how outcomes are linked to their treatment efforts, and few programs
have conducted studies to show what happened to participants more
than 12 months after they left the programs.
Not enough is known about residential care programs to provide a
clear picture of which kinds of treatment approaches work best or
about the effectiveness of the treatment over the long term.
Further, no consensus exists on which youths are best served by
residential care rather than community-based care or how residential
care should be combined with community-based care to best serve
at-risk youths over time. Many program officials and other experts
we spoke with said that further research is needed into the
effectiveness of residential care and other treatment approaches.
This could be an appropriate role for the federal government.
The programs we reviewed differed greatly from one another in such
respects as size, setting, and treatment approach. Despite these
differences, program officials considered certain characteristics to
be key for success. These 11 characteristics (see pp. 16-21)
included involving a parent or other concerned adult in the client's
care, placing a strong emphasis on building self-esteem, and planning
for the youth's return to the community after completing the program.
One of the characteristics that seemed to be particularly important
was an effective link with community-based services that continue to
support high-risk youths and their families after the youths leave
residential care.
RESIDENTIAL PROGRAMS PROVIDE
BENEFITS, BUT MORE INFORMATION
ON THEIR EFFECTIVENESS IS
NEEDED
------------------------------------------------------------ Letter :4
All programs we contacted reported positive outcomes for some youths,
such as achieving certain educational or employment goals or avoiding
illegal activity after completing the program. However, few programs
conducted rigorous evaluations to measure effectiveness or long-term
outcomes.
Program reports ranged from a one-time collection of data to a
rigorous study using a control group. Programs we reviewed typically
reported outcome data on participants for periods of 12 months or
less after discharge. None of the studies we reviewed referred to
any specific criteria that could be used to evaluate the results
reported.
The following examples depict the results reported at 12 months after
discharge:
Of 27 participants in the Eckerd Family Youth Alternatives, Inc.,
Wilderness Educational System, Camp E-How-Kee (Brooksville,
Florida), who were discharged in the 1991-92 year and for whom
data were available, 18 (67 percent) had neither dropped out of
school nor been truant.
Of 113 youths released from Boysville of Michigan, Clinton Campus,
in 1991, 17 (15 percent) were employed full- or part-time, 64
(57 percent) were unemployed, and the employment status of 32
(28 percent) was unknown.
Of the 52 participants who successfully completed the Starr
Commonwealth, Cedar Village program (Albion, Michigan) in 1991,
40 (77 percent) had no record of subsequent arrests. Twelve (23
percent) were rearrested, and 8 (15 percent) of them were
convicted.
Of the 30 participants from the KidsPeace National Centers for Kids
in Crisis, Presidential Treatment Center (Bethlehem,
Pennsylvania) contacted 12 to 24 months after their discharge in
1990, 23 (77 percent) were in school or had earned a general
educational development (GED) certificate.
Studies of 14 of 18 programs we contacted did not use control or
comparison groups. We could therefore not determine whether the
outcomes reported were due to the programs' treatments or to other
factors. However, one program we visited--Father Flanagan's Boys'
Home, Boys Town Home Campus near Omaha, Nebraska--had conducted two
longitudinal studies using a comparison group, and another--New Life
Youth Services, Paint Creek Youth Center in Bainbridge, Ohio--had
conducted a study using a control group.
Boys Town Home Campus, in two separate studies, compared outcomes for
its youths to outcomes for another group of youths who were referred
to the program during the same period, and met eligibility or
admission requirements, but did not attend. One study, which looked
at educational attainment and occupational status, found Boys Town
participants outperforming the comparison group on most measures.
For example, 83 percent of participants had graduated from high
school or obtained a GED, compared to 69 percent of the comparison
group. The other study, which looked at relations with friends,
family, and supervising adults, found significantly more improvement
over time among Boys Town participants than among the comparison
group.
Paint Creek Youth Center randomly assigned youths to control and
treatment groups to evaluate its effectiveness as an alternative to a
state correctional facility. The incarceration rate for Paint Creek
participants 1 year after discharge was 23 percent compared to the
control group's 29 percent. This difference was not statistically
significant. However, study investigators commented that, despite
the lack of a statistically significant difference, the Paint Creek
study should lend support to the argument that such programs can be
run as cost effectively as training schools and without undue risk to
the public.
Information is also limited in two other important areas: treatment
effects over the long term and the place of residential care in the
continuum of treatment.
Longer term data are needed to test the endurance of treatment
effects. Our review of the literature identified a number of studies
that found that some youth leaving residential facilities have a
difficult time maintaining treatment gains. Five programs we
contacted studied program effects longer than 12 months after
discharge. One of them--Boysville--found that, for the 317 youths
discharged in 1987 from its residential programs, the cumulative
reimprisonment rate rose from 9 percent in the first year following
discharge to 15 percent in the second year and to 20 percent (a total
of 62 youths) in the third year.
Information is also limited on the appropriate place of residential
care in the service continuum--that is, which at-risk youth are best
served by residential care rather than community-based care and how
residential care should be combined with community-based care to best
serve at-risk youth over time. Boysville has been examining the
relative roles of its residential care and community-based programs
in serving at-risk youth and their families and has concluded that
changes should be made in its residential care approach. Program
officials reported that while they had always believed their program
to be superior, it did not fully meet their high expectations.
Therefore, they concluded that a radically different approach to
serving clients was needed. As a result, Boysville officials are
planning to restructure their program by shortening the time youth
spend in residential care and placing increased emphasis on
community-based care.
Program officials and other experts stated that rigorous studies of
long-term program effectiveness using control or comparison groups
are difficult to conduct. Specifically, program officials cited the
following barriers to conducting such studies:
difficulty tracking youth after they leave the program,
high cost, and
reservations about the ethics of withholding treatment from a
control group.
Without such evaluations, however, program officials have limited
data to show the specific effects their treatment has had on the
lives of the clients they have served, and policymakers lack
information on whether programs have been a worthwhile social and
economic investment. Officials from 14 of the 18 programs we
reviewed said studies are needed that (1) are longitudinal and use
control groups, (2) identify youth who would be best served by
residential treatment, and (3) determine whether some youth could be
successfully treated in less costly, less restrictive nonresidential
settings. Further, some experts suggested that an appropriate
federal role might include supporting effectiveness studies of
residential care and other treatment approaches.
Experts and program officials cited both advantages and disadvantages
to residential care. On the positive side, experts with whom we
spoke and the literature we reviewed indicated that residential care
is suited for addressing the needs of some at-risk adolescents
because
providing comprehensive services, around-the-clock contact with
clients, and services focused on individual needs can provide an
effective treatment environment;
removing clients from dangerous home and community influences can
provide a safe setting for addressing their problem behaviors;
and
establishing a routine and discipline can bring order to what may
have been fairly chaotic lives.
On the other hand, our review of the literature suggests that
residential care
is a restrictive form of care;
can disrupt youths' attachments because it removes them from family
and community, which is the setting to which treatment gains
will have to transfer if positive outcomes are to be sustained
after discharge; and
is costly. For example, 10 of the 18 residential programs we
contacted cost over $40,000 per youth for a year of treatment.
However, not enough is known about the long-term effectiveness
of residential care, or where it best fits in the continuum of
services, to determine under what circumstances it may be cost
effective compared with other types of care such as
community-based treatment.
PROGRAMS VARY IN APPROACH BUT
SHARE KEY CHARACTERISTICS
------------------------------------------------------------ Letter :5
The programs we contacted varied considerably in setting and size,
the types of troubled youth they serve, their treatment approach,
cost, and funding sources. Program types ranged from a small urban
program that served 8 homeless adolescent girls who had been actively
engaged in prostitution or at risk of doing so, to a large suburban
program on a 1,400-acre campus serving 560 young men and women with a
variety of problems. Average length of treatment ranged from 6
months to 2 years, with a median stay of 12 months. Table 1
summarizes selected aspects of the programs we visited, and table 2
shows these aspects for the programs we contacted by telephone.
The programs served youth with a wide variety of problems, ranging
from felony offenses, such as aggravated assault or burglary, to
truancy and defiance of parental authority. One program we
visited--Piney Woods Country Life School near Jackson,
Mississippi--primarily served youth who were not exhibiting specific
problem behaviors but, in many cases, came from dangerous urban
neighborhoods. Two other programs, The Hyde School in Bath, Maine,
and Oasis Center, Michael's Kids House in Nashville, Tennessee, did
not keep records of problem behaviors exhibited by their students
before they came to the program. With the exception of these three
programs, officials at all others reported that some youth in their
programs exhibited all four risky behaviors--poor performance in
school, delinquency, substance abuse, and early unprotected sexual
activity. Further, as indicated in figure 1, 10 of the programs
estimated that 50 percent or more of program youths exhibited all
four behaviors.
Table 1
Residential Programs GAO Visited Vary in
Setting, Size, and Cost
Salesmanship
Program Boysville Bridge Boys Town Hyde Paint Creek Piney Woods Camp Starr Threshold
----------------- ---------------- ---------------- ---------------- ---------------- ---------------- ---------------- ---------------- ---------------- ----------------
Setting Clinton, Boston, Boys Town, Bath, Maine Bainbridge, Piney Woods, Hawkins, Texas Albion, Seattle,
Michigan Massachusetts Nebraska Ohio Mississippi Michigan Washington
A 150-acre Tents on a
A 60-acre Restored living A 1,400-acre campus--the A complex of A 2,000-acre 1,250-acre Cottages on a First, a youth
treatment space on four campus former estate of barrack-like campus wilderness 350-acre campus shelter, then
complex on a floors of a in suburban shipbuilder John dormitories and in a rural campsite in rural south- apartments in
400-acre campus rectory in a Omaha S. Hyde other facilities setting central residential
residential area in a rural area Michigan areas
Percent of youth 70 20 60 Not provided 77 Not provided 29 75 75
with all four
risky behaviors\a
Average 1992 121 16 558 195 28 345 65 58 6
population
Average stay 12 months 8 months 18 months 2 years 17 months Not provided 6 months 10 months 19 months
Treatment cost\b
One year $46,508 $22,609 $49,279 $16,923 for 9- $35,188 $19,443 for 9- $25,738 $51,373 $28,927
Average stay $46,508 $15,073 $73,918 month school $51,023 month school $12,869 $42,811 $45,802
year year
Funding source
Percentage 93 72 23 - 96 - 12 96 93
public 7 28 77 100 4 100 88 4 7
Percentage
private
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\a Risky behaviors are (1) poor performance in school, (2) substance
abuse, (3) delinquency, and (4) early, unprotected sexual activity.
Percentages are based on program officials' estimates.
\b Annual treatment costs are computed by dividing total program
budget by average population. Costs vary across programs and are not
strictly comparable. All programs provide services that target each
of the four risky behaviors. However, some programs collaborate with
existing community providers to provide such services as schooling at
no cost to the program, while other programs employ their own
teachers to educate clients. Other cost variations may reflect
differences in the education level and intensity of staffing, type of
facility, or other factors.
Table 2
Residential Programs GAO Contacted by
Telephone Vary in Setting, Size, and
Cost
Children's
Program Village Eastern Nebraska Eastfield Eckerd Harbor Hillside KidsPeace Oasis Pressley
----------------- ---------------- ---------------- ---------------- ---------------- ---------------- ---------------- ---------------- ---------------- ----------------
Setting Dobbs Ferry, New Omaha, Nebraska Los Gatos, Brooksville, Haverhill, Rochester, New Bethlehem, Nashville, Ona, West
York California Florida Massachusetts York Pennsylvania Tennessee Virginia
A large group
One of 21 home in a Three cottages A wilderness A restored home Cottages in an A complex of 7 First, a group Program in
residential residential on a campus in a camp in central in a residential urban cottages on a home in a small, rural
treatment setting residential area Florida neighborhood of neighborhood suburban campus residential community
cottages on a a small town near Hillside's area; apartments
campus school later
Percent of youth 10 100 35 100 90 5 50 Not provided 50
with all four
risky behaviors\a
Average 1992 12 8 24 56 15 48 97 13 19
population
Average stay 15 months 9 months 15 months 13 months 12 months 12 months 15 months 9 mos. (group 7 months
home)
Treatment cost\b
One year $65,496 $24,740 $132,493 $41,071 $51,986 $51,746 $84,168 $24,321 $49,772
Average stay $79,141 $18,555 $165,616 $45,863 $51,986 $51,746 $105,210 Not provided $29,033
Funding source
Percentage 87 100 94 52 99 100 97 89 100
public 13 - 6 48 1 - 3 11 -
Percentage
private
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\a Risky behaviors are (1) poor performance in school, (2) substance
abuse, (3) delinquency, and (4) early, unprotected sexual activity.
Percentages are based on program officials' estimates.
\b Annual treatment costs are computed by dividing total program
budget by average population. Costs vary across programs and are not
strictly comparable. All programs provide services that target each
of the four risky behaviors. However, some programs collaborate with
existing community providers to provide such services as schooling at
no cost to the program, while other programs employ their own
teachers to educate clients. Other variations may reflect
differences in the education level and intensity of staffing, type of
facility, or other factors.
Figure 1: Youths Who Exhibit
All Four Risky Behaviors
Constitute Differing
Percentages of Program
Populations
(See figure in printed
edition.)
Notes:
Programs are listed by increasing percentage of youths (left to
right) who exhibited the following four risky behaviors: (1) poor
performance in school, (2) delinquency, (3) substance abuse, and (4)
early, unprotected sexual activity.
Two of the eighteen programs were unable to provide data on problem
behavior.
The annual cost of serving one youth ranged from about $20,000 to
about $132,000, with a median cost of about $44,000. The most costly
programs did not necessarily serve youth with the highest percentage
of risky behaviors. (See fig. 2.)
Figure 2: Annual Treatment
Costs Do Not Appear to Be
Linked to the Percentage of
Youths With Four Risky
Behaviors
(See figure in printed
edition.)
Notes:
Programs are listed by increasing percentage (left to right) of youth
who exhibited all four risky behaviors.
Annual treatment costs are computed by dividing total program budget
by average population.
Two programs could not provide data on the percentage of youth with
all four risky behaviors. The annual cost per youth at these
programs are (1) Hyde School, $20,073 and (2) Oasis Center, Michael's
Kids House, $24,321.
While most programs depended largely on public funding, funding
sources varied considerably. Fourteen of the 18 programs in our
study received over half of their funding from public sources, and 10
received 90 percent or more. While most public funds were from state
governments, some of this money included federal funds for foster
care and other purposes that were passed on to the programs by the
states. Few program officials we interviewed could provide us with
complete information about the portion of public funds for their
programs that originated at the federal level.
Although programs we studied varied with respect to the severity of
the participants' problems, we found several similarities among
participants' backgrounds. Twelve of the programs reported that most
youth were from low-income families; seven said most of their
participants came from dangerous or crime-ridden neighborhoods.
Reported rates of sexual abuse among youths at 15 of the programs
were high, ranging from 30 to 100 percent of the girls and 20 to 70
percent of the boys. Eleven programs said at least 80 percent of
their youth had previous out-of-home placements, including foster
care, psychiatric hospitals, group homes, and jails.
Amid the considerable variety of program approaches, program
officials and other experts said that certain key elements were
important for success. Descriptions of these 11 key elements follow.
DEVELOPING INDIVIDUAL
TREATMENT PLANS
---------------------------------------------------------- Letter :5.1
According to program officials, nearly all programs in our study
developed individual treatment plans for each youth. Plans, in some
cases, are updated at specific intervals, such as monthly. Often the
youth participate in the planning process by identifying issues they
need to address and in setting goals. At Starr Commonwealth, Cedar
Village, each youth's plan is discussed in monthly peer group
meetings. One program official from Boysville noted that if youths
can see their own treatment gains, they will begin to see themselves
as successful.
PARTICIPATION OF A CARING
ADULT
---------------------------------------------------------- Letter :5.2
Important in many youths' successful experiences in such programs,
officials said, was the presence of a caring adult, such as a
counselor or other staff member. For example, a Boys Town official
told us that his program asserts that all behavioral change can only
take place in the context of a caring relationship--youth will listen
and learn only from adults they believe care about them. A Starr
Commonwealth official said his program's expectation is that the
trust developed in an adult will extend to other adults after youths
leave the program. At Boys Town Home Campus and the Salesmanship
Club Youth Camp, staff live with the youths around the clock, 7 days
a week, and are involved in virtually all of the youths' activities.
SELF-ESTEEM BUILDING
---------------------------------------------------------- Letter :5.3
According to officials from most programs, it is important for the
programs to provide opportunities to build self-esteem so that youths
can develop a sense of success; two officials told us that the youths
in the programs are accustomed to failure. Programs build
self-esteem through such activities as sporting events, physical
education, and academics and by teaching practical skills such as
planning and budgeting for household expenditures.
PLANNING FOR POST-PROGRAM
LIFE
---------------------------------------------------------- Letter :5.4
Planning for transition from the program may begin as soon as youths
enter the program. An official from Harbor Schools and Family
Services, Haverhill Program (Haverhill, Massachusetts) said program
officials begin to talk with youths about discharge and arranging
placement even before admission. After leaving residential programs,
youths are discharged to such settings as their biological families,
foster care, or independent living. To prepare for the transition,
some programs connect the youths to services in their community and
work with the family to strengthen relationships and resolve problems
such as substance abuse. During their stay, youths are provided
assistance with career planning, vocational education, and finding a
suitable place to live.
TEACHING SOCIAL, COPING, AND
LIVING SKILLS
---------------------------------------------------------- Letter :5.5
One of the most important purposes of residential care is to prepare
youths to function in the everyday world. To this end, youths are
taught skills such as establishing good work habits, handling
confrontations, and planning and preparing nutritious meals. Some
youths have never learned how to hold a meaningful conversation
around the dinner table or have never been required to keep their
rooms tidy. Programs use group activities as well as individual
instruction to develop and enhance these skills. In some programs,
special events are used to teach practical lessons and skills.
Youths at the Salesmanship Club Youth Camp, for example, plan and
work together as a group to organize and carry out week-long camping
trips. Youths at Boys Town Home Campus share a daily family-style
dinner, which they help to prepare, with their house mates and family
teachers (surrogate parent figures who live with the youth on a
24-hour basis).
COORDINATION OF SERVICES
---------------------------------------------------------- Letter :5.6
Program officials viewed coordination of services as important,
whether the services were provided by a single caseworker or a team.
At Boysville, Clinton Campus, teams of directors, specialists,
educational coordinators, and others who work with the families track
the academic, social, and family progress of each youth under their
care and collaborate in carrying out treatment goals. At Boys Town
Home Campus, the family teachers coordinate all services provided to
the youths entrusted to their care.
INVOLVING THE FAMILY
---------------------------------------------------------- Letter :5.7
Programs acknowledge that youths' problem behaviors are often related
to family problems and dysfunction. Several programs we contacted
involve families as part of the formal treatment approach, and three
programs require such participation. The Hyde School requires
parents to agree to attend certain activities before the school
agrees to admit students. Parents are required to participate three
times a year with their children at the school in several days of
group discussions and physical challenges, including rigorous outdoor
activities. The Salesmanship Club Youth Camp requires the parents to
participate in therapy during their child's stay in camp and
encourages the parents to continue therapy for 6 months after their
child's release.
Programs that involved the family typically had social workers and
therapists work with parents individually, in parent support groups,
and with parents and children together. Some programs provided
counseling for parents as well as treatment for problems such as
substance abuse. While nearly all programs we contacted considered
family involvement to be desirable, some said it was not always
feasible. The program may be too far from a parent's residence or a
family may be unwilling to participate.
POSITIVE PEER CULTURE
---------------------------------------------------------- Letter :5.8
Peer influence is used to effect healthy behavior changes in youths.
For example, three programs that serve mostly youths who are
convicted felons use participants' influence on each other to foster
insight and growth. At all three programs, youths are assigned to
peer groups and conduct nearly all their activities in these groups.
Staff work with the peer groups to foster desirable values and
behavior patterns. At Starr Commonwealth, Cedar Village, and
Boysville, Clinton Campus, for example, daily group meetings focus on
a particular experience or problem surfaced by one of the youths from
personal experience. Youths also initiate impromptu meetings to call
one another to task for negative behaviors.
ENFORCING A STRICT CODE OF
DISCIPLINE
---------------------------------------------------------- Letter :5.9
Officials from several programs believed a strict code of discipline
for residents was of great importance. At The Hyde School, for
example, accountability is the fundamental structure on which the
school's discipline system is built. Students encourage each other
to report violations of school rules. If a student knows, but does
not report, that another student has disobeyed Hyde rules, both
students are considered equal offenders and subject to discipline.
POST-PROGRAM SUPPORT
--------------------------------------------------------- Letter :5.10
Twelve of the programs we contacted continue services, such as
counseling and school placement for the youths and family counseling,
after the youths are discharged from residential care. Of those
programs that do not directly provide aftercare, four told us that
they link the youths and their families with such services in the
community.
A number of research efforts have suggested that a youth's
environment after discharge is crucial to sustaining the effects of
residential treatment. For example, a 1966 study of a group of 50
boys who were discharged from the Bellefaire Jewish Children's
Bureau's residential program in Ohio found that successful outcomes
were directly related to the quality of the family environment to
which youths returned after discharge.\2 A 1991 study of youths
discharged from the same residential setting in the mid-1980s
confirmed the importance of post-program support.\3
One program we contacted--The Children's Village in Dobbs Ferry, New
York--conducted a study of aftercare. This study, now in its ninth
year, is demonstrating the effectiveness of intensive aftercare
provided to a sample of youths (all males, mostly aged 13 when they
entered the program) discharged from the residential program. The
aftercare included counseling to help participants complete school,
secure employment, and adjust in the community. The program also
encouraged participants to save money by offering to match what they
had saved. The comparison group consisted of youths from The
Children's Village whose aftercare was limited to such contact as
bimonthly mailings on job training and education and verbal
encouragement. Among the findings from the first 6 years of this
study was a 12-percent school dropout rate among the group receiving
intensive aftercare versus a 29-percent rate for the comparison
group.
--------------------
\2 M.E. Allerhand, R. Weber, and M. Haug, Adaptation and
Adaptability: The Belle Faire Follow-up Study (New York: Child
Welfare League of America, 1966).
\3 K. Wells, E. Wyatt, S. Hobfall, "Factors Associated With Youth
Discharged From Residential Treatment," 1991, Children and Youth
Services Review, 13, 199-216.
PROVIDING A FAMILY-LIKE
ATMOSPHERE
--------------------------------------------------------- Letter :5.11
According to program officials, because many at-risk youths have not
had the opportunity to grow up in constructive family environments,
several of the programs help youths develop skills and relationships
in a healthy family-like setting. Use of this approach was
particularly important at Boys Town Home Campus, where the treatment
approach centers around a teaching family headed by a married couple
that acts as surrogate parents. Teaching parents participate in such
activities as shopping with the youths, taking them to medical
appointments, attending school functions, and helping them with their
homework. The youths have household responsibilities such as
cleaning their rooms and planning and cooking daily meals. Similar
to Boys Town, the Bridge Over Troubled Waters Transitional Living
Program in Boston, Massachusetts, operates its program much as a
household would operate, with participants scheduled to shop, cook,
and do other chores on a rotating basis.
Figure 3 shows the number of program officials citing each key
element as important to their programs' success. Although 12
programs provide post-program support and considered it to be of
great or moderate importance to their success, four others considered
it important but were unable to provide it.
Figure 3: Program Elements
That Officials Consider
Important to Success
(See figure in printed
edition.)
CONCLUSIONS
------------------------------------------------------------ Letter :6
While few rigorous evaluations of residential programs have been
done, the outcome studies conducted to date suggest that residential
care can be successful as a treatment approach for some high-risk
youths. However, limited information is available to draw
conclusions about how residential care can be best applied in the
continuum of services for high-risk youths and their families.
Additional study is needed to answer such questions as which youth
are best treated in residential settings and which would be better
treated in less restrictive and less costly community-based programs.
In particular, rigorous evaluations are needed to determine which
treatment approaches are most effective and what the long-term
effects of the treatment are for youths--in residential and other
programs--so policymakers can make sound decisions about the most
effective mix of programs and the best role for residential care.
Although conclusions cannot be drawn about the success of residential
programs, there appears to be some consensus among program officials
and other experts that certain key elements enhance the programs'
ability to alter high-risk behavior. Program officials agree that
any effective residential program for high-risk youths should include
such elements as a close alliance with the youths' families whenever
possible as well as continuing support after the youths have left the
residential setting and returned to their community.
The scarcity of rigorous outcome studies limits the ability of
policymakers to determine whether support for residential programs
constitutes the best use of limited public resources. Conducting
rigorous program evaluation is expensive and complicated. However,
without such research, questions will remain about what the most
cost-effective approaches are for treating at-risk youths.
MATTER FOR CONSIDERATION BY THE
CONGRESS
------------------------------------------------------------ Letter :7
If the Congress decides that the federal government should reexamine
its financial support for programs serving at-risk youth, it should
consider earmarking funds for rigorous evaluations of residential
care and other treatment approaches for this population to determine
what kinds of programs work best for which youths and
the appropriate place of residential treatment on the service
continuum.
---------------------------------------------------------- Letter :7.1
We are sending copies of this report to the Secretary of Health and
Human Services, the Attorney General, appropriate congressional
committees, and other interested parties. Please call me on (202)
512-7119 if you or your staff have any questions. Other major
contributors to this report are listed in appendix IV.
Sincerely yours,
Mark V. Nadel
Associate Director, National and
Public Health Issues
PROGRAMS GAO VISITED
=========================================================== Appendix I
The following descriptions of nine programs we visited contain data
obtained from interviews with program officials and written material
they provided. We did not verify the data--including program costs
and the effectiveness studies and reports. The methodologies used to
measure program outcomes and the factors they measured varied,
thereby preventing comparison among programs. Programs are listed in
alphabetical order.
BOYSVILLE OF MICHIGAN, CLINTON
CAMPUS
--------------------------------------------------------- Appendix I:1
The program seeks to meet the social, educational, economic, and
spiritual needs of its clients and staff through such means as
providing a community-oriented living and working environment and
maintaining group programs that incorporate peer influence,
individual attention, family involvement, and staff teamwork in an
open setting. Boysville expects its youth to become more responsible
and to learn to appreciate their own and others' personal worth.
SETTING
----------------------------------------------------- Appendix I:1.0.1
The Clinton Campus in Clinton, Michigan, one of Boysville of
Michigan's 13 residential programs, covers 400 acres of mostly crop
land, of which 60 acres are reserved for the treatment program. The
campus includes dormitories, school and recreational facilities, a
central cafeteria, and administrative offices.
Boysville of Michigan, Inc., headquartered on the Clinton campus, is
a private, nonprofit child and family service agency serving about
900 clients a year in Michigan and Ohio through its residential,
community, and home-based programs.
NUMBER OF YOUTH SERVED IN
1992
----------------------------------------------------- Appendix I:1.0.2
The maximum capacity of the program was 125; the average population
at a given time was 121. The total population served was not
provided.
CHARACTERISTICS OF YOUTHS
SERVED
----------------------------------------------------- Appendix I:1.0.3
The program serves boys aged 12 and older, 60 percent of whom come
from the Detroit area. About half are adjudicated delinquents who
would otherwise serve their sentences in the state's training school;
the other half are wards of the state Department of Social Services
and referred because of delinquent conduct. Clinton accepts the more
severe delinquency cases--referred boys have committed crimes against
property or persons, drug-related offenses, or sexual offenses.
However, Clinton does not accept boys who are psychotic, who do not
have the mental capacity to participate in the education program, or
who have a history of unprovoked assaults.
Of the 1992 participants, about two-thirds were African-American and
one-fourth white. Nearly all of the 1992 participants had at least
one previous placement and 73 percent had single parents. Based on
disclosures during counseling sessions, staff estimate that 70 to 100
percent of the boys had been sexually abused. About 70 percent of
the youths served have exhibited all four risky behaviors: poor
performance in school, substance abuse, delinquency, and early,
unprotected sexual activity.
LENGTH OF STAY
----------------------------------------------------- Appendix I:1.0.4
The average length of stay was 1 year; stays ranged from 8 to 16
months.
COST PER YOUTH
----------------------------------------------------- Appendix I:1.0.5
For 1 year of treatment, the cost was $46,508; for an average stay of
1 year, the cost was $46,508.
FUNDING SOURCES
----------------------------------------------------- Appendix I:1.0.6
The following funding sources are for all of Boysville of Michigan,
Inc., including the Clinton Campus.
Percent
---------------------------------------------------------------------- --------
Ohio and Michigan state Departments of Social Services fees and county 64
fees, exclusive of any federal funds
Title IV-E Foster Care passed through the state 25
Donations and other private support 6
U.S. Department of Health and Human Services grants 2
U.S. Departments of Agriculture and Justice grants 2
Investment income and other 1
--------------------------------------------------------------------------------
TREATMENT APPROACH
----------------------------------------------------- Appendix I:1.0.7
Boys are assigned to a peer group of about 12, who live, eat, attend
classes, and undergo daily therapy sessions together. The sessions
are facilitated by a treatment coordinator. The sessions begin with
each member in turn stating an issue, such as anger management or
victimization, that he's working on at the time. The group then
decides to focus the meeting on one member, who receives help to talk
through and think about his issue and is offered advice when
possible. At the end of the meeting, the treatment coordinator
summarizes the discussion and comments on the group dynamics.
In addition, if at any time a group member feels that someone in the
group is acting inappropriately, he can call a "circle," meaning the
group members circle around and talk through the issue.
The treatment coordinator is a member of an interdisciplinary
treatment team responsible for formulating and implementing each
boy's treatment goals and tracking progress. Family therapy is a key
component of treatment--staff try to involve the family in counseling
sessions, which may continue for up to 6 months after discharge.
Throughout the program, Clinton staff emphasize four basic values--to
help, respect, trust in, and take responsibility for self and others.
As boys learn to control their behavior and demonstrate they are
learning the basic values, they are moved along a three-step system
leading to their release. Boys move from the first step, where they
are expected to need much guidance from their peers and staff, to the
last, where they are expected to do the right thing for the right
reason without relying on rules, staff direction, or peer opinions.
EFFECTIVENESS DATA
----------------------------------------------------- Appendix I:1.0.8
Routinely collected data. At 3 and 12 months after departure,
Boysville staff conduct telephone surveys of youths and their
families. A comparison of some 3- and 12-month outcomes for the 113
youths released from the Clinton Campus in 1991 follows:
59 percent were in a setting less restrictive than the Clinton
Campus at 3 months after discharge; at 12 months, that figure
was 52 percent. However, the drop mainly reflects an increase
in the "unknown" category.
The number of boys who were enrolled in school decreased from 53
percent 3 months after discharge to 46 percent at 12 months
after discharge. The decline is due to those who had dropped
out of school and had not obtained a high school diploma or a
general educational development certificate.
Special studies. No special studies have been conducted specifically
of the Clinton campus. However, Boysville has done several studies
of its programs' performance in general. In one study, Boysville
analyzed the imprisonment rates of youth released from its group
homes and campus-based residential facilities in 1985 and 1987.
Twenty-five percent of those who were tracked for 5 years (1985
cohort) and 20 percent of those who were tracked for 3 years (1987
cohort) were imprisoned in Michigan. The type of treatment received
(campus-based residential treatment or community-based group home)
and the legal status (child welfare case or delinquency case) were
found to be unrelated to imprisonment rates, but two other factors
were found to be significant: boys released to their homes,
relatives' homes, or independent living situations were less likely
to be imprisoned, and nonwhite boys who had multiple convictions
before coming to Boysville were more likely to be imprisoned.
Boysville also analyzed 1982-89 outcome data for its Michigan
residential programs. Analysts found declines in the percentage of
boys successfully released who were still maintaining a less
restrictive living situation 12 months after release. Successful
completion means a boy has met all or nearly all of his treatment
goals such as improving academic skills or developing appropriate and
productive relationships. Of the successful releases in 1982, 68
percent were in a less restrictive setting 12 months after release.
Of the successful releases in 1989, 54 percent were in a less
restrictive setting 12 months after release.
Using 1990 data, Boysville also evaluated the cost effectiveness of
two residential programs, a foster care program, and a home-based
program. Boysville found that the residential programs cost more
than the other programs and resulted in fewer successful releases
than the home-based program--but more than the foster care program.
With regard to campus-based residential care, these special studies
led Boysville to propose shortening the time boys spend in such care
and provide longer term and more intensive community-based aftercare
for youths and their families. Boysville plans to assign
campus-based residential care a more limited role in the continuum of
services the agency offers. Campus-based residential care would be
reserved for those youths who cannot initially be safely treated in
the community (because of potential harm to themselves or others) or
who have already demonstrated an unwillingness or inability to
respond to community-based treatment. Boysville officials said that,
ideally, youths should be placed in the least restrictive setting
available, such as a nonresidential program, in the continuum of
care.
THE BRIDGE OVER TROUBLED WATERS
TRANSITIONAL LIVING PROGRAM
--------------------------------------------------------- Appendix I:2
The Bridge Transitional Living Program aims to help youth make the
transition from the streets to become fully sustaining members of
society.
SETTING
----------------------------------------------------- Appendix I:2.0.1
The Bridge Transitional Living Program occupies four floors of a
remodeled rectory in a lower-income Boston residential neighborhood.
The first floor contains a kitchen/eating area and a living area;
bedrooms are on the upper floors. Rooms are simple but light and
spacious, and decorations reflect occupants' preferences.
The program is one of a variety of services provided by Bridge Over
Troubled Waters, a nonprofit organization in Boston. Bridge's other
services include an independent living program, medical outreach van,
GED program, medical and dental care, a substance abuse counseling
program, and runaway and family counseling.
NUMBER OF YOUTHS SERVED
IN 1992
----------------------------------------------------- Appendix I:2.0.2
The maximum capacity for the program was 16; the average population
at a given time was 16. The total served was 43.
CHARACTERISTICS OF YOUTHS
SERVED
----------------------------------------------------- Appendix I:2.0.3
The program serves both men and women ranging in age from 16 through
22; in 1992, 74 percent were under age 20. The primary reason for
referral to the program is homelessness. However, about 80 percent
of these youths have been physically abused or neglected and about 40
percent, sexually abused. Forty percent are white; 40 percent,
African-American; and 20 percent, Hispanic. About 20 percent of the
youths served have exhibited all four risky behaviors: poor
performance in school, substance abuse, delinquency, and early
unprotected sexual activity.
LENGTH OF STAY
----------------------------------------------------- Appendix I:2.0.4
The average length of stay was 8 months; stays ranged from 6 to 18
months.
COST PER YOUTH
----------------------------------------------------- Appendix I:2.0.5
For 1 year of treatment, the cost was $22,609; for an average stay of
8 months, the cost was $15,073. Costs do not include education.
FUNDING SOURCES
----------------------------------------------------- Appendix I:2.0.6
Percent
---------------------------------------------------------------------- --------
HHS Transitional Living Program grant 62
HHS Runaway and Homeless Youth grant 10
Foundations and corporations 16
United Way 10
Local donations 2
--------------------------------------------------------------------------------
TREATMENT APPROACH
----------------------------------------------------- Appendix I:2.0.7
The program prepares homeless adolescents to live independently. The
program coordinator works with each youth to design a specific plan
at intake. Based on that plan, youths receive individual and group
therapy, medical services, and education at other facilities both
within and outside Bridge. However, youths return "home," i.e., to
the Bridge Transitional Living Program, each evening to a full
complement of housekeeping, cooking, and gardening jobs and time with
the peers they come to regard as a family and a support group.
The house setting, peer group, and program coordinator--who is in
charge of the house and is seen as a parent figure--are much like a
family. Program officials regard this environment as critical and
see the family setting as enabling youths, who have been largely
isolated, to open up and receive support on hurtful issues.
In addition to functioning as a parent figure, the program
coordinator also facilitates a Tuesday night meeting, with compulsory
attendance, at which youths review events of the previous week,
including the consequences of their actions on others and on the
effective functioning of the household.
The program generally does not release youths until they are involved
in a job or vocational program. Some go on to the Bridge Independent
Living program, perhaps to share an apartment based on a friendship
formed at the Bridge Transitional Living Program. Bridge recently
began a follow-up group aimed at maintaining youths' contacts with
Bridge after discharge.
EFFECTIVENESS DATA
----------------------------------------------------- Appendix I:2.0.8
Routinely collected data. For the 1993 annual report, the Bridge
compiled data on outcomes such as education, living situation, and
work status of 13 youths who were at the Bridge Transitional Living
Program for at least 6 months beginning in September 1991 and had
been out of the program between 1 and 15 months. The report shows
that
9 (69 percent) were working full time, two (15 percent) were in
college full time, and the other two were rearing children who
were being supported by the children's fathers; and
11 (85 percent) had earned a high school diploma or GED
certificate--10 since coming to the Bridge Transitional Living
Program--and the other 2 (15 percent) were still enrolled in a
GED program.
Special studies. A 1986 report summarized the results of a 2-year
study by a researcher at the University of Massachusetts who
evaluated outcomes of 2 years' participants in Bridge House, the
precursor to the Bridge Transitional Living Program. The report
examined the program's effectiveness in achieving improved
self-concept and more stable education, employment, and living status
for a group of 16- and 17-year-old youths. The study reported that
11 youths who had been out of the program an average of 5.7 months
fared significantly better than did a group of 18 youths with similar
backgrounds who were involved in programs other than Bridge's
transitional living program. For example,
10 (91 percent) of the program youths were employed, compared with
eight (44 percent) of the non-Bridge group; and
7 (64 percent) of the program youths were in school or had
graduated compared with six (33 percent) of the non-Bridge
group.
The Bridge Transitional Living Program is one of 10 study sites
included in a federally funded multiyear transitional living program
study. The study will gather information--such as living situation,
change in drug and alcohol use, and progress in education--at intake,
6 months later, and 6 months after discharge.
FATHER FLANAGAN'S BOYS' HOME,
BOYS TOWN HOME CAMPUS
--------------------------------------------------------- Appendix I:3
The program seeks to provide food, clothing, shelter, medical care,
education, spiritual development, and treatment for the behavioral
and emotional problems of homeless, abused, neglected, and delinquent
youths who require out-of-home placement. In doing so, it hopes to
give them the skills they need to live in a larger society and lead
useful lives.
SETTING
----------------------------------------------------- Appendix I:3.0.1
Boys Town's Home Campus consists of about 1,400 acres in suburban
Omaha, Nebraska. It contains a high school and middle school,
churches, a hospital, a farm, research and training facilities,
administrative offices, and 76 homes--each of which houses two family
teachers and four to eight youth.
In addition to the Boys Town Home Campus residential care, Father
Flanagan's Boys' Home provides a variety of services, including
emergency shelters, therapeutic foster care, family preservation, and
parent training. The organization has used programs developed at the
home campus as models for Boys Town USA sites it has established in
13 cities across the country. It also provides training and
consultation to other programs and operates a national hot line.
NUMBER OF YOUTHS SERVED
IN 1992
----------------------------------------------------- Appendix I:3.0.2
The maximum capacity was 562; the average population at a given time
was 558. The total served was 847.
CHARACTERISTICS OF YOUTHS
SERVED
----------------------------------------------------- Appendix I:3.0.3
Boys Town serves mainly boys and girls who are 13 to 19 years old.
The average age at admission is about 15. Most are referred to the
program by social service agencies. They typically come from
low-income families who live in midwest urban neighborhoods that are
marred by crime and drug problems. They have an average of two prior
placements such as foster care or group homes, and about 30 percent
have juvenile court arrest records. Fifty-eight percent are white,
24 percent are African-American, and 18 percent are other minorities.
Nearly 73 percent of the youth admitted are considered out of control
of parental authority. Other common problems include vandalism and
theft, verbal aggression, and school learning problems. Program
officials estimate that about 80 percent of the girls and 35 percent
of the boys have been victims of sexual abuse. About 60 percent of
the youths served have exhibited all four risky behaviors: poor
performance in school, substance abuse, delinquency, and early,
unprotected sexual activity.
LENGTH OF STAY
----------------------------------------------------- Appendix I:3.0.4
The average length of stay was 18 months; stays ranged from 10 months
to 6 years.
COST PER YOUTH
----------------------------------------------------- Appendix I:3.0.5
For 1 year of treatment, the cost was $49,279. For an average stay
of 18 months, the cost was $73,918.
FUNDING SOURCES
----------------------------------------------------- Appendix I:3.0.6
Percent
---------------------------------------------------------------------- --------
Private contributions 33
Father Flanagan's Foundation 26
Fees from public and nonprofit agencies 23
Legacies and bequests 16
Miscellaneous 2
--------------------------------------------------------------------------------
TREATMENT APPROACH
----------------------------------------------------- Appendix I:3.0.7
Boys Town's Family Home Program uses family teachers--specially
trained married couples who live in homes on campus with four to
eight youths on a year-round basis. The family teachers function in
a role analogous to parents--providing counsel, taking the youths
shopping and to medical appointments, and teaching them how to live
in the family and community. Family teachers also function as the
primary treatment agents. They strive to motivate youths to learn
appropriate behavior and reduce destructive behavior, offering both
praise and corrections throughout the day. They also coordinate the
youths' treatment with other agency service providers.
As part of a program emphasizing skills needed to operate in family
and societal settings, the program teaches skills to resolve disputes
and solve problems. Boys and girls are taught to organize their
thoughts and daily activities, participate in family life activities,
negotiate satisfactory relationships with others, and solve problems
rationally.
Youths are initially placed on a point system on which they earn or
lose points depending on their daily conduct. Positive points earn
the youths special privileges for the next day and can be accumulated
for larger privileges in the future.
Boys Town boys and girls attend the campus high school or middle
school whose curricula and teaching methods are designed to address
both academic and social skills that will be relevant in school, in
their home communities, and in employment settings. Because many
youths are reading several years below their grade levels, Boys Town
has established a Reading Center where youths receive remedial
reading classes and staff conduct research to diagnose and develop
new ways to address reading deficiencies.
EFFECTIVENESS DATA
----------------------------------------------------- Appendix I:3.0.8
Routinely collected data. In June 1993, Boys Town began to collect
outcome data on all youths discharged from its programs--including
residential care and family preservation--90 and 180 days after
discharge. Boys Town social workers are conducting interviews with
the youths and, when appropriate, the families. Information gathered
includes where the youths are living, their employment history, and
their education status. Boys Town plans to collate the data in
quarterly reports that will be used to evaluate treatment
effectiveness and modify and improve their programs. Boys Town also
hopes to compare the cost effectiveness of its residential care and
family preservation programs. The data collection will be expanded
to include a random sample of youths 1 year after discharge.
Special studies. Boys Town has conducted recent studies of its
residential program using comparison groups.
Boys Town conducted a longitudinal follow-up study of 497 former
residents--who entered Boys Town between May 1981 and June 1985--and
compared their progress with that of a group of 84 youths who had
been accepted to Boys Town during the same time period but who did
not attend. Participants were interviewed by telephone before,
during, and every 3 to 6 months after their stay at Boys Town. Final
interviews took place in 1989. Results indicated that the Boys Town
group did significantly better in such things as rate of graduation
from high school, grade point average, and attitudes about the
importance and chances of attending college. For example, 83 percent
of the Boys Town youth graduated from high school or completed a GED
certificate, while 69 percent of the comparison group did so.
Another study conducted by Boys Town compared its 1987-1989
graduates--surveyed in 1990--to a sample of "typical" high school
graduates. Boys Town graduates were asked about their lives after
program completion, in areas such as employment, post-secondary
education, and church attendance. Interviewers were able to contact
121 of 193 Boys Town graduates. Study results showed that Boys Town
youths--who typically have had more behavior and academic
problems--did as well or better than the comparison group in several
areas. For example,
93 percent of the Boys Town youths were in school and/or had a job
compared to 88 percent of the comparison group and
84 percent of the Boys Town youths reported that they did not use
drugs other than alcohol, compared to 62 percent of the
comparison group.
THE HYDE SCHOOL
--------------------------------------------------------- Appendix I:4
The Hyde School seeks to provide a learning environment in which
individuals develop character and discover a purpose for their lives.
Originally founded as a more general boarding school, the Hyde School
has an education approach that emphasizes effort over achievement,
which has moved it in the direction of working more closely with
youth with behavior problems.
SETTING
----------------------------------------------------- Appendix I:4.0.1
The Hyde School in Bath, Maine, is located on a 150-acre campus--the
former estate of shipbuilder John S. Hyde. The original mansion has
been restored and now houses classrooms and faculty offices. Classes
are also held in a converted carriage house. The campus includes 6
dormitories for 12 to 24 students each; a sports complex and several
outdoor playing fields; a family learning center for parent weekends
and retreats; and a student union, which contains a performing arts
center, the student/faculty dining room, and a study hall.
NUMBER OF YOUTHS SERVED
IN 1992
----------------------------------------------------- Appendix I:4.0.2
The maximum capacity was 200; the average population at a given time
was 195. The total served was 195.
CHARACTERISTICS OF YOUTHS
SERVED
----------------------------------------------------- Appendix I:4.0.3
Hyde students are boys and girls aged 13 to 19. About 60 percent are
male and 40 percent are female. Most students are white; about 10
percent are minorities, including Asian, African-American, and
Hispanic. Most students come from upper-income families and
neighborhoods. Students come from many states with about 15 percent
of them coming from Maine.
Most of Hyde's students have a history of family problems. Primary
reasons for referral are rebelliousness, lack of respect for
authority, and poor performance in school. About 10 percent of the
students have been in drug rehabilitation programs. Hyde has an
ongoing program to accept a total of five students selected by the
Boys Clubs of New York City and the Boys and Girls Clubs of
Washington, D.C., based on their potential as students.
LENGTH OF STAY
----------------------------------------------------- Appendix I:4.0.4
The average length of stay was 2 school years; stays ranged from 1 to
5 school years.
COST PER YOUTH
----------------------------------------------------- Appendix I:4.0.5
For 1 year of treatment (including the Summer Challenge Program), the
cost was $20,073. For an average stay of two 9-month school years,
the cost was $33,846.
FUNDING SOURCES
----------------------------------------------------- Appendix I:4.0.6
Percent
---------------------------------------------------------------------- --------
Tuition payments 92
Contributions 8
--------------------------------------------------------------------------------
TREATMENT APPROACH
----------------------------------------------------- Appendix I:4.0.7
Hyde School is a nonsectarian college preparatory boarding school for
grades 8 through 12. Most students live in dormitories on campus.
Each dormitory has a school staff member serving as resident house
mother or father. Student roommates are matched so that one is an
older student and one is a younger or new student. Students are
responsible for keeping their rooms clean and for dormitory
maintenance, such as cleaning the bathrooms or vacuuming the living
room. Students, faculty, and staff eat meals together in the dining
hall. Students are required to participate in sports and encouraged
to participate in performing arts activities and community service.
Hyde students are graded on both their academic achievement and their
level of effort in school. Their effort grade must be at least as
high as their achievement grade to be acceptable.
Hyde maintains that the first step toward appropriate behavior may be
just going through the motions but that, eventually, the student will
begin to make an effort and finally take responsibility for his or
her success.
Students are expected to report all inappropriate behavior to staff
and are taught that reporting is an act of caring. Students
encourage each other to self-report. However, if a student knows,
but does not report, that another student has broken school rules,
such as by drinking or using drugs, both are treated as equal
offenders. Students are not expelled for their inappropriate
behavior, but must work on eliminating it.
Hyde believes that parental participation in the program is
imperative--if the youth is to make permanent life changes, the
parent and family must participate and change as well. Parents of
Hyde students must attend monthly meetings and a yearly retreat held
in their home regions of the country, a 3-day campus seminar, and
on-campus family weekends in the fall and spring.
EFFECTIVENESS DATA
----------------------------------------------------- Appendix I:4.0.8
Routinely collected data. Hyde keeps records of the number of
students who go on to 4-year colleges. School officials report that
about 90 percent do so.
Special studies. None
NEW LIFE YOUTH SERVICES, PAINT
CREEK YOUTH CENTER
--------------------------------------------------------- Appendix I:5
The program seeks to provide comprehensive, high-quality services
tailored to the individual requirements of youths convicted of
felonies such as aggravated burglary or manslaughter. The goal is to
change the youths' values so that they can stand up to negative
influences when they return to the community.
SETTING
----------------------------------------------------- Appendix I:5.0.1
Located east of Cincinnati on 32 rural acres in Bainbridge, Ohio,
Paint Creek consists of very spartan, barracks-like dormitories and
classrooms, an office building containing a kitchen and dining room,
and a recreational area. The facility also includes a woodworking
shop, basketball court, playing field, and two tennis courts.
New Life Youth Services, Inc., a private, nonprofit organization in
Cincinnati, provides a variety of residential and community-based
programs.
NUMBER OF YOUTHS SERVED
IN 1992
----------------------------------------------------- Appendix I:5.0.2
The maximum capacity was 33; the average population at a given time
was 28. The total served was 51.
CHARACTERISTICS OF YOUTHS
SERVED
----------------------------------------------------- Appendix I:5.0.3
Paint Creek serves boys aged 15 to 18 at the time of admission.
These boys, who come from southwest Ohio--principally Columbus,
Cincinnati, and Dayton--have been convicted of a class 1 or 2 felony,
such as aggravated burglary. Between 50 and 75 percent come from
low-income families, and between 60 and 70 percent are from
crime-ridden neighborhoods. About 60 percent are white; the rest are
mainly African-American. Seventy-one percent come from single-parent
families and another 11 percent are reported as having no parent.
Youths may be referred by the sentencing judge but must pass
screening by the Ohio Department of Youth Services. Youths accepted
into the program must be able to function in a group and be housed in
a facility that is not physically secured. The program does not
serve youths who have been convicted of murder nor high-profile
youths such as gang leaders. About 77 percent of the youths served
have exhibited all four risky behaviors: poor performance in school,
substance abuse, delinquency, and early, unprotected sexual activity.
LENGTH OF STAY
----------------------------------------------------- Appendix I:5.0.4
The average length of stay was 17 months; information on the ranges
of the stays was not available.
COST PER YOUTH
----------------------------------------------------- Appendix I:5.0.5
For 1 year of treatment, the cost was $35,188. For an average
17-month stay, the cost was $51,023. Costs exclude medical costs,
which are billed directly to Medicaid, and education services, which
are provided on site by the local school district.
FUNDING SOURCES
----------------------------------------------------- Appendix I:5.0.6
Percent
---------------------------------------------------------------------- --------
Ohio Department of Human Service 93
U.S. Department of Agriculture lunch program 3
Subsidy from New Life Youth Services 3
Wood shop sales and miscellaneous 1
--------------------------------------------------------------------------------
TREATMENT APPROACH
----------------------------------------------------- Appendix I:5.0.7
Paint Creek uses a combination of therapeutic approaches in a strong
peer culture. First, boys are required to acknowledge that they have
criminal personalities, which they have to overcome by adopting a new
way of thinking. Second, they are required to accept responsibility
for their own behavior and--individually and collectively--for their
rehabilitation. For example, peers (as they refer to one another)
call each other to task for behaviors that reflect "thinking errors,"
such as physical or verbal abuse of others or projecting blame.
Paint Creek is second only to state correctional institutions in
terms of restrictiveness. Youths move around the campus single file
with one hand on the shoulder of the youth in front. During
meetings, one youth is assigned to sit in front of the door to
discourage others from leaving.
Youths are required to earn their way out of the facility,
progressing through three levels of increasing privilege. Initially
youths must earn such basic amenities as permission to hang a poster
behind their beds. Later, youths earn permission to participate in
community service activities and to have personal radios.
Ultimately, youths earn permission to move around the campus
unsupervised after notifying staff and checking in with staff upon
their return.
While at Paint Creek, boys attend school. The curriculum is intended
to parallel the one used in public schools. The program provides a
special education section and a high school section into which boys
can progress when ready.
During a period of intensive aftercare, a community services worker
is assigned to the youths as a support person. Initially, a boy can
leave the house only with the community service worker's permission
and accompanied by a parent, except to go to school, work, or an
appointment arranged by Paint Creek staff. Gradually, the youth
progresses to increasing freedom of action and less supervision.
EFFECTIVENESS DATA
----------------------------------------------------- Appendix I:5.0.8
Routinely collected data. None
Special studies. A Rand Corporation study of Paint Creek examined
rates of recidivism within 1 year of discharge. The study compared
75 youths assigned to Paint Creek between February 1986 and April
1988 with a randomly assigned control group serving time at two state
correctional institutions.
The study found Paint Creek youths had a 51-percent rearrest rate
compared to 61 percent for the control group. The reincarceration
rate was 23 percent for Paint Creek youths compared to 29 percent for
the control group. Neither difference was statistically significant.
The 1993 Rand report suggested that, despite the lack of
statistically significant differences, the Paint Creek study should
lend support to the argument that such programs can be run as cost
effectively as training schools and without undue risk to the public.
PINEY WOODS COUNTRY LIFE SCHOOL
--------------------------------------------------------- Appendix I:6
Piney Woods' objectives are to strengthen students' reading, writing,
and critical thinking skills; to develop good study habits and a
strong work ethic in each student; and to eliminate the sense of
academic futility and build a sense of academic achievement. The
school believes that, throughout the United States, there are
students, especially black students, who have the capability to
succeed, but do not have the opportunity to do so for financial or
other reasons.
SETTING
----------------------------------------------------- Appendix I:6.0.1
The school is 21 miles southeast of Jackson, Mississippi, on 2,000
rural acres that include woods, lakes, farmland, and 50 acres of
campus. On the campus are several dormitories, classroom buildings,
a cafeteria, a recreation center, administrative offices, a general
store, faculty and staff homes, and the log cabin that served as the
original school building.
NUMBER OF YOUTHS SERVED
IN 1992
----------------------------------------------------- Appendix I:6.0.2
The maximum capacity was 345; the average population at a given time
was 345. The total served was 345.
CHARACTERISTICS OF YOUTHS
SERVED
----------------------------------------------------- Appendix I:6.0.3
Piney Woods is a private school serving male and female boarding
students in grades 7 through 12. Most students come from low-income
families--many from dangerous urban neighborhoods. While most
students are not currently exhibiting problem behavior, many students
are at increased risk of academic failure or delinquency and other
personal troubles. All students are black--about half are from
Mississippi, and the rest are from 22 other states and 3 African
countries.
To be admitted to Piney Woods, students must have a minimum C-minus
grade average and be in good standing with their current schools.
They can have no prevailing substance abuse or delinquency problems.
LENGTH OF STAY
----------------------------------------------------- Appendix I:6.0.4
There is no representative average stay. Some students stay from
grade 7 through high school graduation. Others begin in grade 11 and
remain 2 years. The school rarely accepts grade 12 students because
it prefers to have students for more than 1 year.
COST PER YOUTH
----------------------------------------------------- Appendix I:6.0.5
The cost for a 9-month school year was $19,443.
FUNDING SOURCES
----------------------------------------------------- Appendix I:6.0.6
Percent
---------------------------------------------------------------------- --------
Gifts and grants 34
Endowment fund and other investments 52
Student tuition 7
Miscellaneous income 7
--------------------------------------------------------------------------------
TREATMENT APPROACH
----------------------------------------------------- Appendix I:6.0.7
Students live in dormitories on campus and are housed two to a room.
The daily schedule of a dormitory for girls in grades 9 through 12
provides an example of their routine. Wake-up time is 5:30 a.m.;
room check is at 6:30 a.m. (beds must be made with hospital
corners); breakfast is at 7:00 a.m. (all students must be present).
Students attend classes until about 2:00 p.m. After school they are
responsible for housecleaning and other chores at the dormitory. On
weekday evenings, students must do homework from 7:00 to 9:00 p.m.
Students must sign out when they leave the dormitory, saying where
they are going. They must have a pass signed by the dorm parent if
they are out after 5:00 p.m. Lights out is at 10:00 p.m. for grades
9 through 10 and 10:30 p.m. for grades 11 through 12.
In addition to their studies and dormitory cleaning responsibilities,
students in grade 7 and above are required to participate in the
student work program 10 hours per week to receive meaningful work
experience and to earn work credit toward tuition charges.
Assignments include grounds maintenance, working at the souvenir shop
and book store, and working in the administrative offices. On
Sunday, students are required to attend Sunday school and church
services.
On Thursday, Friday, and Saturday evenings, there are recreational
activities at the campus recreation center. These include playing
computer games, swimming, and watching TV and movies. Parties are
held around holidays.
The school has strict grooming, dress, and behavior codes. Students
can be suspended or expelled for such things as failure to attend
class; use of tobacco, alcohol, or drugs; and failure to follow the
dress code.
EFFECTIVENESS DATA
----------------------------------------------------- Appendix I:6.0.8
Routinely collected data. The percentage of students who go on to
college is calculated each year. Officials report that it ranges
from 90 to 95 percent for each graduating class.
Special studies. None
SALESMANSHIP CLUB YOUTH AND
FAMILY CENTERS, INC., YOUTH
CAMP
--------------------------------------------------------- Appendix I:7
The program seeks to provide a wilderness environment in which young
people can experience success and learn problem-solving skills under
the supervision of trained counselors.
SETTING
----------------------------------------------------- Appendix I:7.0.1
The Youth Camp is located on a 1,250-acre wilderness site east of
Dallas in Hawkins, Texas. It is organized into three boys' and three
girls' campsites grouped by age and developmental level. Each group
consists of about 12 youth and has 4 counselors. Youths build their
own tents with wood floors to serve as living quarters, weekend
kitchen and dining facilities, and bathroom facilities. The site
includes a school, central dining hall used on weekdays, and
recreational facilities.
The camp is one of three programs for at-risk youth and their
families that the Salesmanship Club of Dallas operates. The other
two are a comprehensive day treatment center and school program for
at-risk youth and an intensive outpatient family therapy program,
both in Dallas.
NUMBER OF YOUTHS SERVED
IN 1992
----------------------------------------------------- Appendix I:7.0.2
The maximum capacity was 72; the average population at a given time
was 65. The total served was 158.
CHARACTERISTICS OF YOUTHS
SERVED
----------------------------------------------------- Appendix I:7.0.3
The camp serves boys aged 12 to 14 and girls aged 13 to 16 from the
Dallas metropolitan area who are experiencing emotional or behavioral
problems at school or home. Most boys and girls are white and are
from lower-middle or lower income families. Typical participants
have problems in school, are substance abusers, and have behavior
problems such as defiance of authority. Many have been physically
and emotionally abused, and many are suffering from depression.
To be accepted into the program, youths must have an intellectual
capacity of slow normal to bright, be physically capable of
participating in normal camp routine, and cannot be pregnant or
dependent on drugs. Boys and girls are generally not accepted if
they have sexually abused other children, are actively psychotic or
suicidal or have parents who disagree on the need for placement or
refuse to participate in therapy. Most youths are referred to the
program by their parents and are not in the custody of a public
agency. About 29 percent of the youths served have exhibited all
four risky behaviors: poor performance in school, substance abuse,
delinquency, and early, unprotected sexual activity.
LENGTH OF STAY
----------------------------------------------------- Appendix I:7.0.4
The average length of stay was 6 months; stays ranged from 4 to 12
months.
COST PER YOUTH
----------------------------------------------------- Appendix I:7.0.5
For 1 year of treatment, the cost was $25,738. For the average stay
of 6 months, the cost was $12,869.
FUNDING SOURCES
----------------------------------------------------- Appendix I:7.0.6
Percent
---------------------------------------------------------------------- --------
Salesmanship Club 86
Program service fees 10
United Way 2
Miscellaneous 2
--------------------------------------------------------------------------------
TREATMENT APPROACH
----------------------------------------------------- Appendix I:7.0.7
Each group of about 12 boys or girls is viewed as an independent
therapeutic community that must work together to meet its needs in
such areas as shelter, food, and emotional support. Counselors live
with the youth around the clock in the camp setting, with two on duty
at any one time. The groups design and build their tents and plan
their daily activities, including trips away from the wilderness
site. They attend school on site for 3 hours a day and return home
at least one weekend a month.
Difficulties in group interactions, including problem behavior, are
dealt with immediately through "huddle-ups." In these huddle-ups,
group members help one another address and resolve problems with the
objective of building the social skills and self-esteem needed to be
successful. Family participation is also an important element of the
program--the youths' families are required to participate in family
therapy in Dallas and are encouraged to continue therapy for up to 6
months after the youths complete the program.
EFFECTIVENESS DATA
----------------------------------------------------- Appendix I:7.0.8
Routinely collected data. Cumulative data on campers and their
families are collected routinely and reported in special studies such
as that described below.
Special studies. The Salesmanship Club programs have an evaluation
system that--since 1983--has gathered data and reported on the
characteristics of the families and youths served as well as the
impact of services provided. The current study group consists of 314
youth and families served by the Salesmanship Club's
programs--including 157 discharged from the youth camp--between July
1989 and April 1991. Youths and families are interviewed at intake,
at discharge, and for several years after leaving program services.
For a September 1991 report, the program was able to contact and
obtain information from 76 of 133 families at 6 months after
discharge. While program officials caution that data are not
necessarily representative of all families in the program, they
believe the families who participated in the study are making clear
progress. For example,
72 percent of the youths had been receiving special education
services before they entered the program compared to 29 percent
receiving them 6 months after discharge and
family satisfaction ratings were high, with 81 percent of the
families rating themselves a 5 or 6 on a scale ranging from
"very unsatisfied" with the program (1) to "very satisfied" with
the program (6).
STARR COMMONWEALTH SCHOOLS,
CEDAR VILLAGE RESIDENTIAL
PROGRAM
--------------------------------------------------------- Appendix I:8
The program seeks to provide for the care, education, treatment,
counseling, and nonsectarian spiritual guidance of troubled children
and youths. Its goals are for participants to develop positive
attitudes and values, recognize and reach for their potential,
improve their self-image, increase their self-confidence, and return
to their home communities.
SETTING
----------------------------------------------------- Appendix I:8.0.1
Cedar Village is located on Starr Commonwealth Schools' Albion,
Michigan, campus, a 350-acre wooded area in rural south central
Michigan. The campus includes cottages, school and recreation
facilities, and administrative offices. Cedar Village is one of
three residential programs on the campus.
The Albion Campus residential programs served 361 youths in 1992 and
are located on one of three residential campuses operated by Starr
Commonwealth Schools. In addition to residential care, Starr
Commonwealth also provides community-based services such as an
alternative education program and in-home care. In 1992, Starr
Commonwealth Schools served 4,950 children, youths, families, and
adults in Michigan and Ohio.
NUMBER OF YOUTHS SERVED
IN 1992
----------------------------------------------------- Appendix I:8.0.2
The maximum capacity was 57; the average population at a given time
was 58. The total served was 121.
CHARACTERISTICS OF YOUTHS
SERVED
----------------------------------------------------- Appendix I:8.0.3
The program serves boys, aged 14 to 18, largely from low-income,
single-parent families living in poor communities in eastern
Michigan, from the upper peninsula down through the Detroit area.
All youths entering the program are delinquents, typically with
multiple felony convictions such as breaking and entering, assault,
motor vehicle theft, and drug sales. Of the 83 youths released in
1992, 53 percent were African-American, and 34 percent were white.
Most boys in the program have had previous placements, usually in
youth homes. Of the youths released in 1992, 64 percent have a
substance abuse problem, about 36 percent have experienced physical
abuse or neglect, and 50 to 60 percent have been sexually abused. To
be accepted by the program, boys must be able to socialize in a group
and, among other things, not be highly violent or chronically truant.
About 70 percent of the youths served have exhibited all four risky
behaviors: poor performance in school, substance abuse, delinquency,
and early, unprotected sexual activity.
LENGTH OF STAY
----------------------------------------------------- Appendix I:8.0.4
The average length of stay was 10 months; stays ranged from 7 to 14
months.
COST PER YOUTH
----------------------------------------------------- Appendix I:8.0.5
For 1 year of treatment, the cost was $51,373. For the average stay
of 10 months, the cost was $42,811. Costs include special education
costs not covered by the school district.
FUNDING SOURCES
----------------------------------------------------- Appendix I:8.0.6
Percent
---------------------------------------------------------------------- --------
Michigan State Department of Social Services per diem (about 33 94
percent federal Title IV-E Foster Care)
Federal food reimbursement 2
Investment income 2
Contributions 2
--------------------------------------------------------------------------------
TREATMENT APPROACH
----------------------------------------------------- Appendix I:8.0.7
Typically a boy begins his stay by taking educational and
psychological tests. Staff use the test results with other input
such as staff observations to develop the boy's individual growth
plan. Based on vacancies in cottages and on the boy's compatibility,
he is then assigned to a peer group of 10 to 12 boys within a
cottage. Seven staff are assigned to each cottage. Except for
individual counseling or medical treatment, the boys live, eat,
attend classes, and undergo therapy with their peer group.
Through the group process and under the guidance of staff counselors,
the boys develop a sense of self-worth and learn to take care of
themselves and others. Once the peer group is satisfied that a boy
has dealt with the group's feedback on his problems and is resolving
them, the group makes the initial recommendation that he is ready for
release. Staff consider the group's recommendation in deciding
whether a boy has achieved the goals in his growth plan and is ready
to return to the community.
Staff maintain contact with the boy's family throughout the program.
When the boy arrives at Cedar Village, staff counselors and a family
service worker immediately begin working with the family to develop a
post-placement plan. The goal is to create a supportive environment
for the boy once he is discharged. Counselors and the service worker
may hold family conferences to strengthen family relationships or
address problems such as substance abuse in the family. Families are
encouraged to visit the campus, where apartments are available for
their stay.
EFFECTIVENESS DATA
----------------------------------------------------- Appendix I:8.0.8
Routinely collected data. Starr Commonwealth Schools collects data
on outcomes at 3 and 12 months after discharge. A comparison of some
outcomes for the 52 youths who successfully completed Cedar Village's
program in 1991 follows. While only 47 boys could be contacted for
the 3-month survey, all 52 boys were contacted for the 12-month
survey. Of those contacted,
47 were in a less or equally restrictive setting relative to Cedar
Village at 3 months after discharge; at 12 months, 41 were;
43 were in school and/or working at 3 months after discharge; at 12
months, 40 were; and
4 had been rearrested at 3 months after discharge; at 12 months,
the cumulative number of boys who had been rearrested was 12.
Special studies. None available
YOUTHCARE, THRESHOLD PROGRAM
--------------------------------------------------------- Appendix I:9
The program is designed to help young women leave street life by
providing a safe, stable place to live, a stable source of income,
effective role models, and some resolution of family issues.
Threshold's goals include helping the women to work and live
effectively in their current situation and to be prepared for their
future role as adults.
SETTING
----------------------------------------------------- Appendix I:9.0.1
Threshold uses a number of residential settings in and around
Seattle, Washington, for its three-phased program. Phase I is
located in a shelter for runaway youth. The shelter, a brick house
in an urban neighborhood, has six bedrooms and is close to bus lines.
A licensed group care home in Seattle serves as the phase II
residence. During phase III, girls aged 18 and older live
independently, such as in their own apartments, while younger girls
live with foster families.
YouthCare, a Seattle-based private, nonprofit agency, provides
residential programs and counseling, education, and medical care and
other services to meet the needs of youth in crisis in the local
community.
NUMBER OF YOUTHS SERVED
IN 1992
----------------------------------------------------- Appendix I:9.0.2
The maximum capacity was eight (four in phase I and four in phase
II); the average population at a given time was six for phases I and
II. The total served was 10.
CHARACTERISTICS OF YOUTHS
SERVED
----------------------------------------------------- Appendix I:9.0.3
Threshold serves girls aged 14 to 18 who have been physically,
sexually, or emotionally abused or neglected and who have histories
of prostitution or are at high risk of becoming involved in
prostitution. Girls come from low-income families in the county and
usually have had prior placements or interventions such as foster
care and family counseling. All girls are referred by state child
protective services. Of the 1992 participants, six were white, three
were African-American, and one was Native American. Girls accepted
into the program must be motivated to stop such behaviors as abusing
drugs or alcohol, engaging in prostitution, or assaulting others.
About 75 percent of the youth served have exhibited all four risky
behaviors: poor performance in school, substance abuse, delinquency,
and early, unprotected sexual activity.
LENGTH OF STAY
----------------------------------------------------- Appendix I:9.0.4
The average length of stay was 7 months for phase I plus 12 months
for phase II; stays ranged from 3 to 8 months for phase I and from 12
to 16 months for phase II.
COST PER YOUTH
----------------------------------------------------- Appendix I:9.0.5
For 1 year of treatment, the cost was $28,927; for the average stay
of 19 months, the cost was $45,802. Costs cover phase I and II only.
Local school districts pay for the education of girls who attend
district schools. Phase III services are funded by YouthCare
unrestricted funds and not by the Washington state grant.
FUNDING SOURCES
----------------------------------------------------- Appendix I:9.0.6
Percent
---------------------------------------------------------------------- --------
Washington State Department of Social and Health Services grant 93
United Way 7
--------------------------------------------------------------------------------
TREATMENT APPROACH
----------------------------------------------------- Appendix I:9.0.7
Phase I, which is very structured, is designed to stabilize the
girls' behavior and allow staff to assess individual needs and
develop a trusting relationship with the girls. Initially, the girls
must stay in the house except to attend school and go on occasional
outings with other residents and staff. The girls must sever all
ties with their former associates. They are also expected to attend
individual counseling sessions with their Threshold caseworker,
pursue at least a GED certificate through local schools or programs,
learn job-finding skills, find jobs if they are old enough, and
perform household chores. Many residents for the first time learn
how to clean their rooms, wash laundry, prepare meals, budget, and
shop. The girls must demonstrate cooperation, motivation, and
responsibility to earn privileges such as 1-hour walks or overnight
stays with friends or relatives. Girls attend a weekly meeting where
they may discuss problems arising from communal living or any topic
of interest to the group.
After demonstrating they have the skills to live in a
semi-independent manner, girls graduate to phase II. The phase II
group home operates as a family home, allowing the girls to earn the
right to be alone in the house, carry keys, and have friends over.
In addition to pursuing education and employment goals, girls
continue to care for themselves, taking on more responsibility for
cleaning and meals. Because many of the girls missed the opportunity
to participate in, and learn from, recreational activities while they
were growing up, the program provides many activities such as camping
and visits to local parks.
In phase III, girls move to independent living situations or
supportive foster care homes where they continue to receive support
and care from Threshold staff for 6 months to a year or more.
EFFECTIVENESS DATA
----------------------------------------------------- Appendix I:9.0.8
Routinely collected data. None
Special studies. Six months after they left Threshold's phase II, 24
girls who had entered phase II between January 1987 and July 1989
were assessed by YouthCare. YouthCare found 10 girls (42 percent)
were living in a stable situation, employed or attending a school or
vocational training program, and were free of substance abuse and
involvement in crime. Eight girls (33 percent) had returned to
street life or were abusing drugs, and no information was available
on 6 girls (25 percent) who could not be contacted.
PROGRAMS GAO CONTACTED BY
TELEPHONE
========================================================== Appendix II
The following descriptions of nine programs we contacted by telephone
contain data obtained from interviews with program officials and
written material they provided. We did not verify the
data--including program costs and the effectiveness studies and
reports. The methodologies used to measure program outcomes and the
factors they measured varied, thereby preventing comparison among
programs. Programs are listed in alphabetical order.
THE CHILDREN'S VILLAGE,
TOMPKINS TRANSITIONAL CARE
PROGRAM
-------------------------------------------------------- Appendix II:1
The program provides comprehensive services to the most at-risk
segment of the Children's Village population to move youth
successfully to a less restrictive Children's Village or other
program.
SETTING
---------------------------------------------------- Appendix II:1.0.1
The Tompkins program is located on the Children's Village campus in
Dobbs Ferry, New York. It is housed in a single cottage at the
center of an ellipse of 21 residential treatment cottages, which are
divided into seven "neighborhood" units.
The Children's Village has provided residential care for children
since 1851. Currently, in addition to its campus-based residential
treatment, it provides community-based group homes for boys, and
foster family care homes for boys and girls.
NUMBER OF YOUTHS SERVED
IN 1992
---------------------------------------------------- Appendix II:1.0.2
The maximum capacity was 12; the average population at a given time
was 12. The total served was 15.
CHARACTERISTICS OF YOUTHS
SERVED
---------------------------------------------------- Appendix II:1.0.3
Tompkins serves boys aged 8 to 15. All have had previous placements:
approximately half are in the next stage of their recovery after
release from a mental hospital; and the other half are referred from
other Children's Village programs where their behavior has suddenly
deteriorated due to some trauma. Their specific problems include
conduct disorder, lack of impulse control, depression, episodes of
violence, attention deficit disorder, hyperactivity, or being a
danger to themselves or others. All are from New York state,
principally New York City and nearby counties, and are referred by
the New York Department of Social Services. Tompkins excludes boys
for whom a less restrictive approach would be appropriate.
All come from families whose income is below poverty level. About 20
percent are reported as having no parents; the remaining 80 percent
are from single-parent families. Between 60 and 70 percent have been
sexually abused and 90 percent have been physically abused or
neglected. About 10 percent of the youths served have exhibited all
four risky behaviors: poor performance in school, substance abuse,
delinquency, and early, unprotected sexual activity.
LENGTH OF STAY
---------------------------------------------------- Appendix II:1.0.4
The average length of stay was 15 months; stays ranged from 6 to 24
months.
COST PER YOUTH
---------------------------------------------------- Appendix II:1.0.5
For 1 year of treatment, the cost was $65,496; for an average stay of
15 months, the cost was $79,141. This included all costs except
fundraising and investment counseling fees and education, which is
provided by an on-campus public school.
FUNDING SOURCES
---------------------------------------------------- Appendix II:1.0.6
Percent
---------------------------------------------------------------------- --------
New York Department of Social Services 71
Medicaid 14
Investment income 6
Contributions 3
Reimbursement for services 3
Local districts 2
Food programs 1
--------------------------------------------------------------------------------
TREATMENT APPROACH
---------------------------------------------------- Appendix II:1.0.7
Tompkins is the most intensively staffed of the Children's Village
residential treatment cottages, providing around-the-clock coverage
by therapists trained to use the living environment as a treatment
tool. Tompkins' higher staff-to-youth ratios and more intensive
clinical services allow treatment of youth who would otherwise
require psychiatric hospitalization.
As with other Children's Village programs, cottage life is important
to the Tompkins program. To provide a firm structure that
establishes boundaries of behavior, cottages have clear rules as well
as clear consequences for breaking them.
Each boy has a primary case manager and must sign a contract that
commits to specified behaviors. A daily checklist reports and
rewards acceptable behavior. Group therapy uses life events to teach
appropriate behavior. The program uses special events such as
carnivals, circuses, and art fairs to develop youths' skills and
thereby enhance their self-esteem.
EFFECTIVENESS DATA
---------------------------------------------------- Appendix II:1.0.8
Routinely collected data. None
Special studies. No special studies have been conducted specifically
of the Tompkins program.
One study, which has aftercare as a principal component, is under way
for selected participants of Children's Village. This study, now in
its ninth year, examines a program called Work Appreciation for
Youth, which involves intensive counseling, work ethics education,
and financial incentives for saving money.
Work Appreciation for Youth participants--who are about 80 percent
minorities and are all academically deficient--receive these services
both while at Children's Village and after discharge. The study
tracks the performance of 65 of these participants and compares it to
another group of youths who did not participate in the Work
Appreciation for Youth program while at Children's Village--and who
received less intensive aftercare services.
Based on data from the first 6 years of the study, youths who have
remained in the Work Appreciation for Youth program have
significantly outperformed the comparison group with respect to not
dropping out of school, completing high school, and earning some
money. For example,
40 percent of the Work Appreciation for Youth participants have
graduated or received a GED certificate, compared to 18 percent
of the comparison group; and
12 percent of the Work Appreciation for Youth participants have
dropped out of school, compared to 29 percent of the comparison
group.
EASTERN NEBRASKA COMMUNITY
OFFICE OF MENTAL HEALTH
ADOLESCENT TREATMENT FACILITY
-------------------------------------------------------- Appendix II:2
The program aims to make boys more self-aware and more controlled in
behavior and emotions. The intent is that they be reunited with
their biological families, if available, or with surrogate families
or placed in other long-term or permanent situations.
SETTING
---------------------------------------------------- Appendix II:2.0.1
The Adolescent Treatment Facility is in a large group home in a
residential neighborhood in Omaha, Nebraska. It has its own fenced
black-topped tennis/basketball court.
The facility is one of three long-term residential treatment
facilities that the Eastern Nebraska Community Office of Mental
Health operates within a service spectrum that also includes
emergency short-term care, therapeutic foster care, and home-based
mental health services to children and adolescents. In addition, the
agency provides residential and day rehabilitative services for
adults.
NUMBER OF YOUTHS SERVED
IN 1992
---------------------------------------------------- Appendix II:2.0.2
The maximum capacity was 8; the average population at a given time
was 8. The total served was 14.
CHARACTERISTICS OF YOUTHS
SERVED
---------------------------------------------------- Appendix II:2.0.3
This program provides around-the-clock treatment and care for boys
aged 12 to 19 with diagnosable psychiatric disorders--such as major
depression or conduct disorder--for whom a less controlled treatment
setting is not considered appropriate. Boys must have sufficient
intellectual potential to respond to active psychological treatment.
They are referred by the Nebraska Department of Social Services, but
most have been charged as delinquents and have plea bargained to a
less serious charge with the understanding that noncooperation could
result in their being placed in the corrections system. All have
been through a psychiatric hospital and received a recommendation
against their return home.
Ninety-nine percent of the boys' families are below the poverty
level, and 80 percent are single-parent families. About 90 percent
of the boys come from the Omaha metropolitan area. Almost all of the
youths served have exhibited all four risky behaviors: poor
performance in school, substance abuse, delinquency, and early,
unprotected sexual activity.
LENGTH OF STAY
---------------------------------------------------- Appendix II:2.0.4
The average length of stay was 9 months; stays ranged from 5 to 12
months.
COST PER YOUTH
---------------------------------------------------- Appendix II:2.0.5
For 1 year of treatment, the cost was $24,740; for an average stay of
9 months, the cost was $18,555. These figures include all costs
except administrative and school costs.
FUNDING SOURCES
---------------------------------------------------- Appendix II:2.0.6
Percent
---------------------------------------------------------------------- --------
Nebraska Department of Social Services 83
Nebraska Department of Public Institutions 1 7
--------------------------------------------------------------------------------
TREATMENT APPROACH
---------------------------------------------------- Appendix II:2.0.7
The first day a boy is in the program, staff develop an interim
treatment plan; 2 weeks later, staff develop a comprehensive plan
with the participation of the boy, his family, and his Department of
Social Services caseworker. Others whom the family and youth
identify as important are also invited to participate. The program
identifies the boy's and family's strengths and weaknesses, and uses
an individualized approach to provide encouragement for the boy to
build on identified strengths. Efforts include working to empower
the boy by teaching social, coping, and living skills--thereby
boosting self-esteem.
To produce changes in behavior, the program uses a system of tokens
and positive reinforcement for good behavior. By accumulating
tokens, boys can progress to a higher level in the program in which
they are permitted to engage in more independent actions as they
demonstrate increased skills and self-control.
Criteria for returning youths to their families include improvement
of family dynamics, communication, and understanding so that the
family can function as an effective unit.
The treatment plan identifies strengths and weaknesses of the boy's
family and sets goals and objectives with time frames--for example,
to improve family communications or to teach parents to use
incentives for good behavior instead of punishment for inappropriate
behavior. The program conducts weekly meetings with parents and
helps the family identify and link with community supports that will
provide family survival skills.
EFFECTIVENESS DATA
---------------------------------------------------- Appendix II:2.0.8
Routinely collected data. Other than monitoring changes in youths'
scores on a standardized test of child behavior over the course of
the program, Eastern Nebraska collects data on a single outcome--the
setting to which boys are discharged. The program was able to
contact 10 boys who were discharged in 1991:
Of the five who were contacted 12 to 18 months after discharge,
none was in a correctional institution, one was in another
residential placement, and four were living with a biological
parent.
Of the five who were contacted 18 to 24 months after discharge,
three were in a correctional institution and the other two, in
foster care.
Special studies. None
EASTFIELD MING QUONG, LOS GATOS
INTENSIVE RESIDENTIAL TREATMENT
UNITS
-------------------------------------------------------- Appendix II:3
This program's intent is to help youth improve their social,
emotional, and behavioral functioning and move successfully to a less
restrictive setting.
SETTING
---------------------------------------------------- Appendix II:3.0.1
The Subacute Residential Services program is housed in three cottages
on a campus in Los Gatos, California. The cottages are family style,
with central living rooms and kitchens. The campus also includes a
gym, an activity room, a swimming pool, a playing field, climbing
equipment, and a jogging trail.
In addition to residential care, Eastfield Ming Quong operates a
variety of child and family mental health programs in Santa Clara
County, California, including child and adolescent in-home treatment,
a family clinic, and school-based day treatment.
NUMBER OF YOUTHS SERVED
IN 1992
---------------------------------------------------- Appendix II:3.0.2
The maximum capacity was 30; the average population at a given time
was 24. The total served was 36.
CHARACTERISTICS OF YOUTHS
SERVED
---------------------------------------------------- Appendix II:3.0.3
The program serves boys aged 10 to 15 with serious psychiatric
disorders, ranging from depression to medically controlled psychosis,
or major learning handicaps such as attention deficit disorder.
Approximately 70 percent are referred by the California Division of
Family and Child Services, 20 percent by the county mental health
emergency center, 6 percent by the schools, and 2 percent each by
health care facilities and family members.
About 73 percent of these boys are white; 15 percent, Hispanic; 8
percent, African-American; and 4 percent, Asian. Their family
incomes average $9,500, with 92 percent below the poverty level.
About 62 percent are from single-parent families. Family problems
include domestic violence and drug and alcohol problems. Youths come
from Santa Clara County, California--generally from low-income
sections with high crime rates, some gang activity, and poor housing.
About 35 percent of the youths served have exhibited all four risky
behaviors: poor performance in school, substance abuse, delinquency,
and early, unprotected sexual activity.
LENGTH OF STAY
---------------------------------------------------- Appendix II:3.0.4
The average length of stay was 15 months; stays ranged from 12 to 18
months.
COST PER YOUTH IN 1992
---------------------------------------------------- Appendix II:3.0.5
For 1 year of treatment, the cost was $132,493; for an average stay
of 15 months, the cost was $165,616. These figures include all
direct and indirect costs except education. According to program
officials, costs also reflect high staff-to-youth ratios required by
the state licensing agency and by the rate classification system for
group homes.
FUNDING SOURCES
---------------------------------------------------- Appendix II:3.0.6
Percent
---------------------------------------------------------------------- --------
California Department of Social Services 65
State mental health program 15
Medicaid 13
Charitable contributions 6
School lunch program 1
--------------------------------------------------------------------------------
TREATMENT APPROACH
---------------------------------------------------- Appendix II:3.0.7
Treatment is based largely on using activities and relationships of
daily living as opportunities for addressing individual problems.
Each cottage houses 8 youths and has a primary therapist who is
responsible exclusively for youths in that cottage. Boys spend
after-school hours and weekends largely with the residents of their
cottage. The therapist is responsible for developing and
coordinating the treatment plan for each youth. The plan is woven
into all aspects of the program: individual therapy, group therapy,
recreational activities, family therapy, and--in coordination with
the community schools the youth attends--educational program.
Throughout its activities, the program uses a system that holds boys
responsible for achieving their behavioral goals and rewards positive
behavior with points that accumulate to earn promotion through four
levels to discharge.
Eastfield Ming Quong also attaches importance to family counseling,
though family participation is not a requirement. Family therapy
sessions occur once each week with the youths included at the
discretion of the primary therapist.
EFFECTIVENESS DATA
---------------------------------------------------- Appendix II:3.0.8
Routinely collected data. The program collects data on a single
outcome: the setting to which boys are discharged. For the 139
youth discharged during 1991 and 1992, 78 percent were discharged to
a lower level of care--such as a parent, relative, community group
home, or a foster home; 16 percent were discharged to the same level
of care; and 6 percent were discharged to a higher level of care (a
psychiatric hospital).
Special studies. None
ECKERD FAMILY YOUTH
ALTERNATIVES, INC., WILDERNESS
EDUCATIONAL SYSTEM, CAMP
E-HOW-KEE
-------------------------------------------------------- Appendix II:4
The program focuses on direct, daily care that promotes children's
self-esteem, interpersonal competence, success in school, and
positive involvement with family and community. The aim is to assist
children in developing appropriate social competencies, personal
values, and self-management skills that can be successfully
transferred to their home, school, and community setting.
SETTING
---------------------------------------------------- Appendix II:4.0.1
Camp E-How-Kee in Brooksville, Florida, is in a wilderness area in
the central part of the state. It is 1 of 19 programs operated by
Eckerd Family Youth Alternatives, Inc., of Clearwater, Florida.
These programs, which serve youth from seven states, include 13
wilderness camps, a juvenile correctional facility, a short-term
residential program for less serious offenders, and the Florida
Conservation Corps.
NUMBER OF YOUTHS SERVED
IN 1992
---------------------------------------------------- Appendix II:4.0.2
The maximum capacity was 60; the average population at a given time
was 56. The total served was 110.
CHARACTERISTICS OF YOUTHS
SERVED
---------------------------------------------------- Appendix II:4.0.3
Camp E-How-Kee serves boys aged 10 to 16 from the central Florida
area. They are primarily status offenders or truants. The boys
typically come from lower-middle-income urban families with a history
of child abuse, substance abuse, and marital problems. Most boys are
referred by the Florida Department of Health and Rehabilitation
Services. About 60 percent have been victims of sexual abuse. All
youths have had multiple failures in other treatment programs or
out-of-home placements such as foster care, short-term residential
psychiatric hospitals, and counseling. Of the 1991-92 participants,
about 52 percent have received court judgments, with an average of
three convictions; 19 percent of the judgments were for crimes
against persons. Eighty-five percent are white, 12 percent are
African-American, and 3 percent are Hispanic. Almost all of the
youths served have exhibited all four risky behaviors: poor
performance in school, substance abuse, delinquency, and early,
unprotected sexual activity.
LENGTH OF STAY
---------------------------------------------------- Appendix II:4.0.4
The average length of stay was 13 months; stays ranged from 9 to 15
months.
COST PER YOUTH
---------------------------------------------------- Appendix II:4.0.5
For 1 year of treatment, the cost was $41,071; for an average stay of
13 months, the cost was $45,863.
FUNDING SOURCES
---------------------------------------------------- Appendix II:4.0.6
Percent
---------------------------------------------------------------------- --------
Fees from social service and juvenile welfare agencies 52
Private insurance 5
Eckerd Family Endowment 43
--------------------------------------------------------------------------------
TREATMENT APPROACH
---------------------------------------------------- Appendix II:4.0.7
Boys in the program live in a wilderness setting in small groups of
peers and counselors. The groups construct their own shelters, cut
their own wood for cooking and heating, make needed repairs, and
provide their own recreation. The program is designed to increase
the boys' feelings of self-worth by developing the skills they
acquire in providing for their own basic needs and by seeing how many
"luxuries" they can do without and still be content and comfortable.
Within these groups--through daily routines and special
activities--boys are taught to identify and resolve problems. Each
boy pursues an individual education plan that places priority on
listening, speaking, writing, and reading. While the boys are in
camp, parents are required to participate in parent therapy groups,
attend three family conferences yearly at the camp, and maintain
contact with Eckerd family workers. Youth make home visits for 4
days every 6 weeks to give them and their families a chance to
practice new skills.
The parent organization, Eckerd Family Youth Alternatives, Inc.,
provides aftercare services for up to 6 months to maintain and build
on the gains made at the camp. Aftercare includes identifying
individual needs, such as counseling or care for chronic health
problems, and helping families contact appropriate community service
agencies. A program family worker continues to work with the youth
and families through frequent face-to-face contact supplemented by
phone calls.
EFFECTIVENESS DATA
---------------------------------------------------- Appendix II:4.0.8
Routinely collected data. At 6 and 12 months after discharge, the
program collects outcome information. At the time of our study, the
program had 12-month data on 33 of the 42 boys discharged in fiscal
year 1992. The data showed the following:
Delinquency: 18 (55 percent) had no further encounter with the law
while 15 (45 percent) had--resulting in such actions as
commitment to a secure residential program or being put on
probation.
Education: 9 (27 percent) were truant or had dropped out of
school.
Living status: 59 percent (17 of the 29 for whom the program had
this data) were living with their natural or adoptive families;
the remainder were in placements such as foster care and group
homes.
Special studies. No special studies had been conducted for Camp
E-How-Kee. However, the Eckerd Wilderness Education System is
conducting a 3-year longitudinal study of 250 campers--50 from each
of 5 camps other than E-How-Kee--beginning with campers entering in
May 1990. Data will be collected for the period before the youths
entered the program, during the program, and 3 years after. The
preliminary report issued in June 1992 reported gains made by youth
at the time of discharge in academics, family functioning, behavior,
and self-esteem.
HARBOR SCHOOLS AND FAMILY
SERVICES, HAVERHILL PROGRAM
-------------------------------------------------------- Appendix II:5
The immediate tasks are to break the cycle of failure, stop the
victimization of self and others, and bring order to chaotic lives.
The goal is to stabilize the participants' behavior and move them
back with their families or to less restrictive programs.
SETTING
---------------------------------------------------- Appendix II:5.0.1
Haverhill Residential Facility is in a restored 19th-century house in
a residential neighborhood of Haverhill--a small city 35 miles north
of Boston.
Harbor Schools and Family Services operates a variety of youth and
family service programs in several locations in Massachusetts. In
addition to residential care, they include short-term (30-day
maximum) crisis resolution residential programs, day programs such as
special education and group therapy, and community services such as
family preservation and support services for teen parents.
NUMBER OF YOUTHS SERVED
IN 1992
---------------------------------------------------- Appendix II:5.0.2
The maximum capacity was 16; the average population at a given time
was 15. The total served was 22.
CHARACTERISTICS OF YOUTHS
SERVED
---------------------------------------------------- Appendix II:5.0.3
Harbor Schools' Haverhill facility serves girls aged 13 to 16 at
admission. About 80 percent are from families with incomes below the
poverty level. These families live mainly in poor urban or suburban
areas in New England--primarily in Massachusetts. Forty-eight
percent of the girls are white, 19 percent are African-American, and
20 percent are Hispanic.
The girls display an array of unmanageable behaviors, including
disruptiveness, sexual promiscuity, habitual truancy, and drug abuse.
Most are in Haverhill because of a status offense. Nearly all have
been victims of physical and sexual abuse, and 90 percent show signs
of chronic malnutrition and lack of regular medical care. Most
suffer from depression and feelings of isolation. About 5 percent
are psychotic and have been sent to Haverhill instead of mental
institutions. All have had previous placements and average about
five--mostly in foster care. About 90 percent of the youths served
have exhibited all four risky behaviors: poor performance in school,
substance abuse, delinquency, and early, unprotected sexual activity.
LENGTH OF STAY
---------------------------------------------------- Appendix II:5.0.4
The average length of stay was 1 year; stays ranged from 3 to 24
months.
COST PER YOUTH
---------------------------------------------------- Appendix II:5.0.5
For 1 year of treatment, the cost was $51,986; for an average stay of
1 year, the cost was $51,986.
FUNDING SOURCES
---------------------------------------------------- Appendix II:5.0.6
Percent
---------------------------------------------------------------------- --------
Massachusetts Department of Social Services 61
Massachusetts Department of Education and local school systems 29
Fees from out-of-state governments 7
Miscellaneous 3
--------------------------------------------------------------------------------
TREATMENT APPROACH
---------------------------------------------------- Appendix II:5.0.7
Harbor's Haverhill program treatment is designed to provide a highly
structured environment in which girls receive reinforcement for
positive behavior. The program uses an 86-point behavior checklist
as part of its comprehensive behavior management system. Girls are
taught new skills for dealing with anger, anxiety, and frustration.
Each girl progresses at her own pace from one level of the program to
the next less restrictive level.
Girls receive individual therapy each week from private clinicians
and also attend group counseling sessions supervised by staff and
clinicians. These group sessions serve in part to allow the girls to
make decisions about the daily operations of the program. Every girl
has an individual education plan and attends small classes of four to
eight students on the program premises. They also receive training
in practical life skills. They can join a work-study program, and
some hold down after-school and weekend jobs.
All girls are involved in the recreation program, which includes
sports, crafts, camping, scouting, and local movies. Family
involvement takes place through parental support groups and
individual contacts with a staff caseworker who provides information
about the girls' progress and about techniques for better parenting.
EFFECTIVENESS DATA
---------------------------------------------------- Appendix II:5.0.8
Routinely collected data. None
Special studies. No studies have been conducted exclusively of the
Haverhill program. However, in 1989 the Harbor Schools' executive
director conducted a one-time survey of 20 youths who had been
discharged from Harbor programs--including Haverhill--over a period
of 2 years. The survey found that, 3 months after discharge, 14 (70
percent) of the youths had returned to school, family life, and
part-time work.
HILLSIDE CHILDREN'S CENTER,
RESIDENTIAL TREATMENT CENTER
-------------------------------------------------------- Appendix II:6
The program's goal is to provide comprehensive, high-quality child
welfare, education, juvenile justice, and mental health services
based on the needs of children and their families. The program aims
to achieve each youth's individual treatment goals and a smooth
transition from residential care back to their families, communities,
and schools.
SETTING
---------------------------------------------------- Appendix II:6.0.1
The Residential Treatment Center cottages are in an urban
neighborhood of Rochester, New York, on a campus with several
programs, including Hillside Children's Center school and emergency
shelter.
The residential center is one of 20 programs operated by Hillside
Children's Center. Others include two psychiatric residential
treatment centers, day treatment programs, intensive family support
programs, and therapeutic foster homes.
NUMBER OF YOUTHS SERVED
IN 1992
---------------------------------------------------- Appendix II:6.0.2
The maximum capacity was 48; the average population at a given time
was 48. The total served was 100.
CHARACTERISTICS OF YOUTHS
SERVED
---------------------------------------------------- Appendix II:6.0.3
The Residential Treatment Center serves boys and girls mainly aged 6
to 17 from lower-income urban neighborhoods in New York state,
largely in Rochester. Sixty-five percent are white, and 25 percent,
African-American. Nearly half of the youths come from families with
a history of physical violence, and 27 percent come from families
with an adult alcohol abuser. Youths admitted are unmanageable or
unable to function safely in the home or school setting. The program
avoids admitting youth with severe violent behavior and active
substance abuse problems. Less than 5 percent of the youths served
have exhibited all four risky behaviors: poor performance in school,
substance abuse, delinquency, and early, unprotected sexual activity.
LENGTH OF STAY
---------------------------------------------------- Appendix II:6.0.4
The average length of stay was 12 months; stays ranged from 6 to 20
months.
COST PER YOUTH
---------------------------------------------------- Appendix II:6.0.5
For 1 year of treatment, the cost was $51,746; for an average stay of
1 year, the cost was $51,746.
FUNDING SOURCES
---------------------------------------------------- Appendix II:6.0.6
Percent
---------------------------------------------------------------------- --------
New York Department of Social Services 100
--------------------------------------------------------------------------------
TREATMENT APPROACH
---------------------------------------------------- Appendix II:6.0.7
Upon admission to the Residential Treatment Center, boys and girls
are assigned to one of three residential cottages. They live with
about 15 other youth of the same sex and similar age. In the cottage
setting, staff teach youth independent living skills and monitor
their behavior. The staff give points to the youths as part of a
reward system for appropriate behavior. Youth attend Hillside's
campus school and, in addition to psychiatric and psychological
services, receive specialized services such as recreation, art, and
dance therapy.
The program is designed to work with family members in planning
treatment for their child and for themselves. The family meets with
their child's social worker and program treatment team and is offered
assistance with and referral to other services as needed. After
discharge, the residential center offers continuing counseling
services for 6 months to help the youths make the transition to
community life.
EFFECTIVENESS DATA
---------------------------------------------------- Appendix II:6.0.8
Routinely collected data. The program gathers data on discharge
status such as whether youths leave Hillside for a more or a less
restrictive setting and the degree to which each youth's individual
treatment goals have been met. It reported that in 1992 there was a
slight improvement over 1991 in the rate of achievement of these
goals at the time of discharge.
Special studies. None
KIDSPEACE NATIONAL CENTERS FOR
KIDS IN CRISIS, PRESIDENTIAL
TREATMENT CENTER
-------------------------------------------------------- Appendix II:7
The program tries to teach life skills, develop self-discipline, and
foster respect for authority as well as individual rights. The goal
is to enable the youths to function independently with behavior
appropriate for their age and to facilitate their return to a less
restrictive environment.
SETTING
---------------------------------------------------- Appendix II:7.0.1
The Presidential Center consists of a complex of seven cottages in
Bethlehem, Pennsylvania. The program is one of several KidsPeace
programs that share a campus in a residential section of a suburban
community. The campus includes a large gymnasium, swimming pool, and
other recreational facilities.
KidsPeace National Centers for Kids in Crisis, a 111-year-old
organization, operates additional long-term residential treatment
facilities, a psychiatric hospital, and various other treatment
facilities at sites in Pennsylvania, Indiana, and New England.
NUMBER OF YOUTHS SERVED
IN 1992
---------------------------------------------------- Appendix II:7.0.2
The maximum capacity was 103; the average population at a given time
was 97. The total served was 150.
CHARACTERISTICS OF YOUTHS
SERVED
---------------------------------------------------- Appendix II:7.0.3
The program serves boys aged 8 to 18 and girls aged 10 to 13 and 16
to 18 (girls aged 14 to 15 are served in another KidsPeace program).
In 1992, 75 percent were male and 25 percent, female; 79 percent were
white and 18 percent, African-American. About half of the youths'
families receive some form of public assistance, and half are
single-parent families. Approximately 70 percent of the boys and
girls are documented sexual abuse victims.
Seventy percent of the youths are from suburban or rural communities.
The program draws participants from the 26 states east of the
Mississippi River, with 40 percent coming from Pennsylvania.
Ninety-two percent of the youths are referred by a state department
of social services, which may include court referrals. Eight percent
are private referrals with third-party insurance. Between 80 and 90
percent have been in a previous placement.
The program does not accept youths with an intelligence quotient of
less than 70 or with histories of homicide or aggravated assault.
Nor does the program accept youths who are heavily involved in street
gangs or severely psychotic or schizophrenic. About 50 percent of
the youths served have exhibited all four risky behaviors: poor
performance in school, substance abuse, delinquency, and early,
unprotected sexual activity.
LENGTH OF STAY
---------------------------------------------------- Appendix II:7.0.4
The average length of stay was 15 months; stays ranged from 10 to 18
months.
COST PER YOUTH
---------------------------------------------------- Appendix II:7.0.5
For 1 year of treatment, the cost was $84,168; for an average stay of
15 months, the cost was $105,210.
FUNDING SOURCES
---------------------------------------------------- Appendix II:7.0.6
Percent
---------------------------------------------------------------------- --------
Fees paid by public agencies 58
School 23
Medicaid 15
Third party insurance 3
State food 1
--------------------------------------------------------------------------------
TREATMENT APPROACH
---------------------------------------------------- Appendix II:7.0.7
After giving extensive psychological and psychiatric tests to an
entering youth, interdisciplinary program staff work together to
develop a highly individualized treatment plan, which is updated
monthly, and a discharge plan for the youth within 15 days of
arrival. An individual counselor and a therapist manage
implementation of the plan. In a highly structured environment, the
program sets out basic expectations, rules, and consequences of
breaking the rules. These consequences are enforced by a counselor
assigned to the youth. Youths live in cottages where the environment
is designed to nurture and provide support. They receive weekly
individual and group counseling and regular reviews of their progress
under the supervision of a staff psychiatrist.
Treatment staff monitor and grade behavior throughout all activities,
including recreational activities. Youths receive daily grades on
behaviors, and these form the basis for privileges such as
allowances, extended bedtimes, and outing participation.
Youths in the program go to one of three private schools that the
program shares with other KidsPeace programs. Families receive
counseling either from program staff--if the families live nearby--or
from clinical affiliates in their communities. Youths participate
with their families in that counseling either while on home visits or
by monthly conference call.
In developing a plan for discharge, a program social worker
coordinates with service resources in the community to which the
youth is returning. After discharge, program staff provide in-home
counseling to sustain program gains.
EFFECTIVENESS DATA
---------------------------------------------------- Appendix II:7.0.8
Routinely collected data. None
Special studies. The program is currently in the fourth year of an
evaluative research project looking at selected outcomes between 1
and 2 years after discharge. The project was able to contact 30 of
the 78 youths who were discharged in 1990 after completing at least 6
months in the program. Some did not answer all questions; however,
of those that responded, outcomes reported included
23 of the 30 (77 percent) were living in a less restrictive
setting;
15 of 27 (56 percent) reported they had not had any police
involvement, while 12 reported they had;
8 of 25 (32 percent) were employed; and
23 (77 percent) were satisfied with the care they had received.
OASIS CENTER, MICHAEL'S KIDS
HOUSE
-------------------------------------------------------- Appendix II:8
The program provides counseling services and training in the living
skills that will enable youths to live independently and to persevere
in an educational setting or a job.
SETTING
---------------------------------------------------- Appendix II:8.0.1
The Michael's Kids House group home in Nashville, Tennessee, is in a
residential community close to city bus lines. It contains three
bedrooms, two baths, a living room, dining room, kitchen, and office.
As part of the program, some youths move on to apartments in which
they live more independently.
In addition to Michael's Kids House, Oasis Center programs in
Nashville include a runaway shelter, crisis counseling, a teen crisis
line, and a youth employment program.
NUMBER OF YOUTHS SERVED
IN 1992
---------------------------------------------------- Appendix II:8.0.2
The maximum capacity was 13 (6 in the group home and 7 in
apartments); the average population at a given time was 13. The
total served was 32.
CHARACTERISTICS OF YOUTHS
SERVED
---------------------------------------------------- Appendix II:8.0.3
Michael's Kids House serves boys and girls aged 17 to 21 who do not
have any other safe living alternatives and who typically have had
numerous previous placements. All youths are in the custody of the
Tennessee Department of Human Services. They are referred by that
department or by the Tennessee Department of Youth Development
because of a lack of a suitable family environment or behavior
problems. Youths exhibit various problems, such as school failure,
emotional difficulties, and drug abuse, and many are victims of
parental abuse, neglect, or abandonment. About two-thirds are white
and about one-quarter are African-American.
To be eligible for the program, youths must be willing to pursue an
education plan and maintain at least part-time employment. They must
not be currently involved in destructive behavior such as drug and
alcohol use or stealing. Finally, they must have a level of
intelligence that will permit them to function within the program.
LENGTH OF STAY
---------------------------------------------------- Appendix II:8.0.4
The average length of stay was 9 months in the group home, although
data were not available for the apartment stay. Stays ranged from 9
months to 3 years for group home and apartment combined stay.
COST PER YOUTH
---------------------------------------------------- Appendix II:8.0.5
For 1 year of treatment, the cost was $24,321. This figure includes
costs of both group home and apartment phases. For an average stay
of 9 months, the program could not provide cost data.
FUNDING SOURCES
---------------------------------------------------- Appendix II:8.0.6
Percent
---------------------------------------------------------------------- --------
Tennessee Department of Human Services 75
Tennessee Department of Finance and Administration 13
Oasis Center 11
Food (U.S. Department of Agriculture) 1
--------------------------------------------------------------------------------
TREATMENT APPROACH
---------------------------------------------------- Appendix II:8.0.7
Michael's Kids House tries to provide a balance between freedom and
structure within the context of a group home. While youths are
encouraged to learn to make decisions on their own, they are required
to sign an agreement to live within house rules. With the help of a
primary counselor, youths develop a contract defining individual
goals and the training in skills that will be needed after discharge.
Youths who violate their contracts or house rules receive counseling,
may be put on probation, and may be expelled from the program.
Skills such as money management, comparative shopping, and eating
nutritiously are taught in course form, and staff ensure that youths
are given opportunities for supervised practice.
The program also provides education assessment and counseling to help
youths set appropriate educational goals. Additionally, it provides
employment services such as a week-long course to help youth identify
their strengths and weaknesses, instruction on how to get and keep
employment, and job placement. All youth are required to participate
in individual counseling and a group counseling session once a week.
While staff are responsible for enforcing rules against illegal or
destructive activity, their principal role is to guide youths in
making personal decisions and to provide support as youths experience
the consequences of those decisions. Staff work in shifts, with a
counselor always on call.
EFFECTIVENESS DATA
---------------------------------------------------- Appendix II:8.0.8
Routinely collected data. Oasis gathers information on Michael's
Kids House Program youths after discharge--through phone calls and
from what youths report at an annual homecoming event. Information
includes boys' and girls' living status and education. They report
that five of the nine youths (56 percent) who had completed the
program in 1992 had achieved all aspects of what the program
considers successful completion, meaning they (1) had been discharged
to a placement outside the state human services system or to an
independent living situation; (2) had a home to go to; and (3) had
demonstrated the skills of employability, money management, and using
support systems. All nine who completed the program were employed.
Special studies. None
PRESSLEY RIDGE SCHOOLS, GRANT
GARDENS RESIDENTIAL PROGRAM
-------------------------------------------------------- Appendix II:9
The program seeks to break the cycle of repeated out-of-home
placements for status offenders, that is, youth with delinquent
behavior such as chronic truancy or running away. It is operated by
an organization that has the goal of being a national leader in
developing and providing services to children and families with
difficult problems. Pressley Ridge School at Grant Gardens was
established to serve status offenders.
SETTING
---------------------------------------------------- Appendix II:9.0.1
The residential program of Pressley Ridge School at Grant Gardens is
in Ona, West Virginia--a small, rural community east of Huntington.
Grant Gardens also provides community-based services such as family
preservation and therapeutic foster care. It is 1 of 12 programs in
Pennsylvania, West Virginia, Maryland, and Ohio operated by Pressley
Ridge Schools of Pittsburgh. Pressley Ridge's services include
in-home and family preservation services, a day-school, shelter care,
foster care, and three residential facilities.
NUMBER OF YOUTHS SERVED
IN 1992
---------------------------------------------------- Appendix II:9.0.2
The maximum capacity was 20; the average population at a given time
was 19. The total served was 35.
CHARACTERISTICS OF YOUTHS
SERVED
---------------------------------------------------- Appendix II:9.0.3
The residential program of Pressley Ridge School at Grant Gardens
serves boys and girls aged 13 to 17 from southern West Virginia. All
of its youths, who are about equally divided between boys and girls,
are in state custody for such offenses as truancy or being out of
parental control, though some may have delinquency adjudications as
well. About 90 percent of the youths have had previous placements.
Eighty percent come from families with incomes below $15,000, and 95
percent come from single-parent families. About half have a history
of physical abuse or neglect, and 30 percent have been sexually
abused. Eighty percent of the boys and girls are referred by the
West Virginia Department of Health and Human Services; 15 percent are
referred by probation officers; and 5 percent are referred by mental
health sources. About 50 percent of the youths served have exhibited
all four risky behaviors: poor performance in school, substance
abuse, delinquency, and early, unprotected sexual activity.
LENGTH OF STAY
---------------------------------------------------- Appendix II:9.0.4
The average length of stay was 7 months; stays ranged from 3 to 24
months.
COST PER YOUTH
---------------------------------------------------- Appendix II:9.0.5
For 1 year of treatment, the cost was $49,772; for an average stay of
7 months, the cost was $29,033. These figures include all costs
except school, which is provided by the county school district
without charge to the program.
FUNDING SOURCES
---------------------------------------------------- Appendix II:9.0.6
Percent
---------------------------------------------------------------------- --------
Department of Social Services 22
Medicaid 75
Department of Education Chapter 1 3
--------------------------------------------------------------------------------
TREATMENT APPROACH
---------------------------------------------------- Appendix II:9.0.7
For each youth, staff develop (1) an individual treatment plan that
addresses all identified issues, building on the youth's strengths,
and (2) a behavior management plan that teaches skills for
independent living. Each boy's or girl's progress toward achieving
behavior goals is assessed at the end of each day, with the youth,
staff, and peer group awarding points, as positive reinforcers, based
on their combined assessment of the youth's behavior. Members of the
peer group, which is central to the program, hold one another
accountable for inappropriate behavior. As conflict arises or youth
display inappropriate behavior, staff work within the group process,
discussing the consequences of behaviors. Staff use role modeling to
help youths learn appropriate behaviors in observed problem
situations and relate them to situations that might arise at home or
in the community. For example, when a youth loses his or her temper,
staff may discuss and demonstrate behaviors that could later help the
youth cope effectively with a family member's losing his or her
temper. Staff also work on identified problems with the youth.
Youths attend school on campus for as long as necessary until they
can function in a community school setting. Most youths attend
school on campus for about 25 percent of their stay at the
residential programs at Grant Gardens. Thereafter, they attend
community schools.
The program emphasizes family participation, recognizing that even
though the youth is in the custody of the state, he or she may return
to the family. Staff ask families what the families need to help
their youngsters achieve a successful outcome and try to help them
meet those needs. By scheduling meetings at the family's
convenience, the program is able to involve about 80 percent of
families.
Ninety percent of participants receive follow-up services in the
first 6 months after discharge, paid for either by Medicaid or by the
Department of Social Services on a fee-for-service basis. Based on
needs identified in formulating discharge plans, Grant Gardens has
also begun providing home services and child placement services for
those boys and girls who cannot return to their families.
EFFECTIVENESS DATA
---------------------------------------------------- Appendix II:9.0.8
Routinely collected data. According to Pressley Ridge officials,
because Grant Gardens was established in 1990, they do not yet have
outcome data for that program. However, they provided us with
outcome data from Laurel Park, a program established several years
earlier for status offenders in northern West Virginia. According to
Pressley Ridge officials, the two programs are comparable and would
be expected to have similar outcomes.
Outcome data have been collected 1 to 2 years after discharge for all
youths discharged from 1983 to 1990. Data include such measures as
going to school or working, restrictiveness of living situation,
educational placement, drug use, stealing, and negative police
contacts. Of 15 youths discharged from Laurel Park during the year
ending June 1990, for example, 10 (67 percent) were in school or
working 1 year later, 11 (73 percent) had earned a high school
diploma or GED certificate or were needing less support in school, 12
(80 percent) were in a less restrictive living situation, 3 (20
percent) were using drugs, and 3 (20 percent) had at least one police
contact.
Special studies. No special studies have been conducted at the
residential program at Grant Gardens, but one has been conducted at
Laurel Park. Pressley Ridge Schools collected outcome data for 3
years on youths discharged between July 1987 and June 1988. Pressley
Ridge staffs were able to locate 14 of 17 youths 1 to 2 years after
discharge and 12 of 17 youths 3 to 4 years after discharge from
Laurel Park to participate in this study. Staff interviewed the
youths' probation officers, caseworkers, other Pressley Ridge staff,
teachers, youths' families, and the youths themselves. Three to 4
years after discharge, some outcomes showed improvement compared to 1
to 2 years after discharge, and others did not. For example, 3 to 4
years after discharge,
all 12 (100 percent) were living in a less restrictive setting
compared to 12 of 14 (86 percent) 1 to 2 years after discharge,
6 of 12 (50 percent) were either going to school or working
compared to 5 of 14 (36 percent) 1 to 2 years after discharge,
2 of 12 (17 percent) were using drugs compared to 4 of 14 (29
percent) 1 to 2 years after discharge,
6 of 12 (50 percent) had been involved in a physically aggressive
act compared to 5 of 14 (36 percent) 1 to 2 years after
discharge, and
4 of 12 (33 percent) had negative police contacts compared to 3 of
14 (21 percent) 1 to 2 years after discharge.
While other Pressley Ridge programs that provide therapeutic foster
care, day school, or treatment in a wilderness setting showed better
results than Laurel Park on several dimensions--such as school or
work status--a larger percentage of Laurel Park youths were living
with their own family, with a foster family, or independently on
their own.
NAMES AND ADDRESSES OF 18 PROGRAMS
VISITED OR CONTACTED IN GAO STUDY
========================================================= Appendix III
Boysville of Michigan
Clinton Campus
8744 Clinton-Macon Road
Clinton, MI 48236
The Bridge Over Troubled Waters
Transitional Living Program
47 West Street
Boston, MA 02111
The Children's Village
Tompkins Transitional Care Program
Dobb's Ferry, NY 10522
Eastern Nebraska Community Office
of Mental Health
Adolescent Treatment Facility
885 South 72nd Street
Omaha, NE 68114
Eastfield Ming Quong
Los Gatos Intensive Residential Treatment Units
499 Loma Alta Avenue
Los Gatos, CA 95032
Eckerd Family Youth Alternatives, Inc.
Wilderness Educational System
Camp E-How-Kee
100 North Starcrest Drive
Clearwater, FL 34618
Father Flanagan's Boys' Home
Boys Town Home Campus
Boys Town, NE 68010
Harbor Schools and Family Services
Haverhill Program
26 Rolfes Lane
Newbury, MA 01951
Hillside Children's Center
Residential Treatment Center
1183 Monroe Avenue
Rochester, NY 14620
The Hyde School
616 High Street
Bath, ME 04530
KidsPeace National Centers
for Kids in Crisis
Presidential Treatment Center
5300 KidsPeace Drive
Orefield, PA 18069
New Life Youth Services, Inc.
Paint Creek Youth Center
1527 Madison Road
Cincinnati, OH 45206
Oasis Center, Inc.
Michael's Kids House
1219 16th Avenue South
Nashville, TN 37212
Piney Woods Country Life School
Highway 49 South
Piney Woods, MS 39148
Pressley Ridge Schools
Grant Gardens Residential Program
2580 Grant Gardens Road
Ona, WV 25545
Salesmanship Club Youth and Family Centers, Inc.
Youth Camp
106 East 10th Street
Dallas, TX 75203
Starr Commonwealth Schools
Cedar Village Residential Program
Starr Commonwealth Road
Albion, MI 49224
YouthCare
Threshold Program
333 First Avenue West
Seattle, WA 98119
MAJOR CONTRIBUTORS TO THIS REPORT
========================================================== Appendix IV
HEALTH, EDUCATION, AND HUMAN
SERVICES DIVISION,
WASHINGTON, D.C.
Gregory J. McDonald, Director, (202) 512-6805
Carl R. Fenstermaker, Assistant Director
William A. Schmidt, Advisor
SEATTLE REGIONAL OFFICE
Barbara A. Billinghurst, Issue Area Manager
Susan J. Lawless, Evaluator-in-Charge
Susie Anschell, Evaluator
Stanley H. Stenersen, Reports Analyst