The First Program.

According to the Forensics Interagency Task Force, one of the strongest arguments for denying parole to people with serious and persistent mental illnesses is their potential for violence. That fear exists regardless of an individual's prior behavior or participation in treatment.

In early 1999, the Pennsylvania Department of Corrections (DOC) and the Pennsylvania Board of Probation and Parole (PBPP) held several meetings with medical professionals, advocates and interested parties concerning the prospect of developing a systematic approach for transitioning seriously mentally ill offenders from prison to the community. Through extensive discussions with Michael Harle, Gaudenzia Inc.'s executive director, the Alliance for the Mentally Ill of Pennsylvania, the Philadelphia Behavioral Health System, the National Alliance for the Mentally Ill (NAMI), and a diverse group of advocates and substance abuse/mental health professionals developed the idea of a therapeutic community (TC) for these offenders. The goal was to reduce the number of seriously mentally Ill offenders who become homeless, revert to anti-social behavior and reoffend because of inadequate or underused support services.

On July 1, 1999, the First Program opened its doors; it received its first resident Aug. 8, 1999. Located in Philadelphia, the First Program is run by Gaudenzia, a TC whose mission is to teach chemically dependent individuals to lead drug-free lives and to educate the public about chemical dependency and dysfunctional behavior. The program, which is funded by the Pennsylvania DOC, offers commitment, expertise and versatility to adult male offenders referred by the DOC's special needs unit. There is no upper age limit on eligibility and candidates are educated on the program's objectives and structure. Residents referred to the First Program have been diagnosed with severe and persistent mental health disorders and have histories of substance abuse as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. However, a substance abuse history or diagnosis is not a requirement for eligibility. The only requirement for admission is a mental health diagnosis and a psychologist's or ps ychiatrist's diagnosis within 12 months of referral. Experience has shown that mental health is a common denominator and should remain the primary focus of service.

CANDIDATES

First Program candidates are medically stable Philadelphia County residents who are willing to cooperate with the rules and physically able to participate in the program. Their commitment is essential and usually obtained through a face-to-face interview process. Although the approval process includes mental diagnosis, criminal history, family background, and education and institutional record assessments, personal interviews cannot be taken lightly. Often, written information can be misleading. Offenders age in the institution and, as a result, their attitudes and behaviors change faster than their records reveal.

POLICIES

Gaudenzia's policy states that institutional misconduct by offenders that occurred more than one year prior to the referral shall not exclude applicants from admission consideration. Misconduct often is the result of reactions or intolerance to medication, or directly relates to mental illness. To give offenders the best chance of success, offenders interview with counselors, case managers, unit managers and correctional officers from 26 different institutions throughout Pennsylvania. However, anti-social behavior, chemical addiction and mental illness are symptoms of underlying emotional disorders. Regardless of origin, these problems cannot effectively be addressed until a person is free from the institution and medically stable.

GOALS AND OBJECTIVES

Many expectations, goals and objectives set for Gaudenzia's fiscal year 1999-2000 either were met or exceeded in terms of planning, development, hiring, training, implementation, evaluation and community connections. Developing a treatment environment took the unified efforts of many staff members with TC experience. The program began slowly, implementing one component of the TC structure at a time, while encouraging staff to engage residents at their functioning levels. For example, expectations for certain individuals may be lowered when it is clear the individual may not be able to cognitively or physically comply with certain activities, information, tasks or assignments. A number of traditional engagement and interaction areas were modified to meet the emotional and cognitive needs of residents, Staff participated in training and conferences that focused on effective intervention strategies for offenders with co-occurring disorders.

The Philadelphia Office of Mental Health's cooperation with Philadelphia Community Behavioral Health (the city's mental health and substance abuse managed care gatekeeper) provided the program with intensive case management services. Through this service, resident entitlements and ongoing outpatient services were effectively obtained and facilitated. Additionally, service agreements have been developed with a number of community-based vocational, educational and intensive outpatient programs in the Philadelphia area. Residents of the program have an opportunity to establish and maintain support systems, which will assist them in addressing their social skills and developing pro-social activities.

OVERVIEW

The First Program has the capacity for 22 residents and is staffed by a program director, social worker, counselor III, counselor assistant III and seven house managers. Since July 1999, there have been 42 referrals of seriously mentally ill offenders. Subsequently, there have been 16 residents favorably completing the program. Incidents of residents leaving the program without authorization have occurred three times during an 18-month period. The program's goal is to continually reduce the instance of unauthorized exit from the program by using effective and compassionate intervention techniques.

The cumulative average daily census during fiscal year July 1999-June 2000 was 14.79 residents for 550 days. It should be noted that there were no admissions during July and only three during August. During the third and fourth quarters of 1999, however, the average daily census was 19.9 residents. The average stay has been eight months and to date, there have been few internal disciplinary problems. Demographic data from analysis of the target population show that 17 (40 percent) of the residents referred were diagnosed with schizophrenia, 12 (28 percent) with mood disorders, eight (19 percent) with anxiety disorders, two (4 percent) with an intermediate explosive disorder and three (7 percent) with an impulse disorder. All admissions have been successful in meeting orientation requirements and learning the TC didactic stipulations. TC didactic stipulations include learning: Gaudenzia's philosophy and unwritten philosophies, how to write one's "life history," effectively confront negative behavior, complimen t and demonstrate pro-social behaviors, and be prepared to meet level advancement requirements of the program.

Patients also are involved in numerous community-based vocational and educational projects, including, A.P. Orleans (vocational), Horizon House (day programming), Philadelphia Community College (adult basic education), the Wedge, Congresso (Latino drug and alcohol counseling), Gaudenzia Outpatient's Occupational and Vocational Rehabilitation Project, and the Veteran's Administration and Opportunities Industrialization Center. The goal is to have the majority in the community developing support systems preparing for discharge from the program.

The modified TC modality has proved to be an effective intervention and learning environment for this population. The 22-bed total capacity of the program lends itself to the effectiveness of the intervention and the closeness of the overall environment. This population responds well to "space" and consistent/positive engagement.

STAFF

To ensure that a continuum of culturally competent treatment services are available and accessible to residents, staff attended seminars and workshops, focused on co-occurring disorders and pharmacology. Staff attend NAMI meetings and present lectures relevant to co-occurring disorders to other community corrections professionals at DOC workshops in State College, Pa. The ratio of staff to residents in terms of security and accountability and every counseling and social worker position is complete as staff gear themselves toward providing the most inclusive array of services available to state offenders with mental illnesses.

Information surrounding new models of accountability, safety and clinical intervention are discussed at regularly scheduled staff meetings and monitored by management personnel. Employees have been encouraged and supported in their efforts to apply for and secure certification in the addictions field through the Pennsylvania Chemical Abuse Certification Board, and furthering their education by attending the Community College of Philadelphia and other institutions of higher learning.

There have been considerable success and progress within the First Program during the 18-month period from July 1999 to December 2000. Staff look forward to continued improvement in the coming year. Program managers will focus their energies on the changes in the systemic environment, while continuing to acquire additional training, education and certification. Changes in mental health and mental retardation forensic recovery, co-occurring disorders, security, cognitive rehabilitation, motivational interviewing and transitional living all are areas of service and intervention that will be addressed in the next fiscal year. The First Program is prepared to meet the challenges facing offenders with serious mental illnesses in the Philadelphia region.

Melvin Stokes is director of the First Program.

[Graph omitted]

  Total        Total     completion    Total     Average Length
Admissions  completions     rate     Discharges     Of stay

    42          16          57%          28         8 MONTHS
Gender          EthniCity

 MALE   FEMALE  AFRICAN-AMERICAN  CAUCASIAN  LATINO  ASIAN

  42      0            26             7        8       1
Age


0-17  18-24  25-34  35-44   45 [*]

 0      3     14     18      7
Drug Of Choice


              PRIMARY  SECONDARY  TERTIARY

  COCAINE       23         2         0
  ALCOHOL        5        17         0
 MARIJUANA       1        10         12
   HEROIN        3         2         0
AMPHETAMINES     1         1         3
BARBITURATES     1         0         0

NONADDICTED      8

SUMMARY OF THE FIRST PROGRAM'S STATISTICAL DATA JULY 1,1999-DEC. 31, 2000

* There were 42 admissions.

* There were 16 completions. Completions are those offenders whom have successfully gone through the program and have been paroled to an approved home plan by PBPP.

* The completion rate is an estimated 57 percent.

* There were six administrative discharges from the program.

* The walk-away or escape rate for residents was 9 percent -- four out of 42.

* Four residents were considered program failures.

* The average length of stay was eight months.

* Program participants consisted of 26 African-Americans, eight Latinos, seven Caucasians and one Asian.

* Crack cocaine was the major drug used, however, there was a total of eight admissions without a drug or alcohol diagnosis.

* The budgeted average daily census is not available at the time of this report. However, 17.5 residents per day represents 85 percent occupancy. The average daily census was 14.79 residents per day, based on 550 days. However, there actually were 516 days of operation resulting in an average daily census of 14.2 residents per day.

* Minimal staff turnover occurred as can be expected in any start-up program of this kind.