NEW YORK'S New Approach to Juvenile Rehabilitation Services.
Throughout the nation, programs serving children and families have been scattered among numerous agencies with overlapping jurisdictions and confused roles. Pataki recognized that today's social problems are complex and interconnected: Children's needs must be addressed in the context of the families and the families' needs must be addressed in the context of their communities, all of which cannot occur in a fragmented delivery system. As a result, New York is making revolutionary changes in the way services are organized, managed and delivered within one of the nation's largest human services jurisdictions.
OCFS is responsible for administering more than $3 billion in public funds. A large portion of these funds are for the out-of-home care, treatment and custody of 50,000 children placed in the system by either child welfare or the juvenile justice system. Additional resources, designated for counties, communities and service providers, support development and prevention approaches that promote the well-being of New York's 5.1 million youths and their families.
As the lead agency for this population, OCFS develops policies for all child welfare, youth services, juvenile justice and day care programs, as well as programs for other vulnerable populations including the visually handicapped and the elderly. In its child welfare role, OCFS oversees social service organizations in 57 counties and in New York City. Also, the agency directly operates 49 juvenile justice facilities for youths placed in its custody by the courts.
A growing body of research indicates that the most cost-effective way to address at-risk populations is to prevent problems from occurring in the first place (Tierney, 1995; Greenwood et al., 1996; Kellerman et al., 1997; Catalano et al., 1998; American Youth Policy Forum, 1999). If OCFS can develop healthier families and communities, it will reduce the need for costly services they otherwise may have required in the future. With that in mind, OCFS is committed to long-term, broad-based strategies to build community support systems for all children and families.
Division of Rehabilitative Services
Despite the emphasis on asset development and prevention services, some young people continue to engage in violent and criminal behavior, leading them into the juvenile justice system. Through its Division of Rehabilitative Services, OCFS pursued initiatives to provide services that are more responsive to adolescents who have become involved in the juvenile justice system.
The Division of Rehabilitative Services is responsible for about 2,200 juveniles placed in the agency's custody by the courts. These youths are served by nearly 50 OCFS facilities and programs ranging from secure facilities to community-based settings. The agency's goal is to rehabilitate the young people in its care and return them to their communities as productive citizens, thus promoting public safety.
OCFS has been involved in a major undertaking to enhance public safety through its programming for youths in its custody. Its intent is to provide the most effective rehabilitative services in the most cost-efficient manner, with a greater impact on reducing recidivism.
In an effort to identify and release the juveniles most likely to succeed in the community, the agency began closer examination of the factors used to determine who is ready for release from residential programs and what is the appropriate level of aftercare supervision.
OCFS developed a comprehensive system, called Prescriptive Programming, that draws on the available and current research on risk factors and interventions. This unique approach changes the way every component of the OCFS residential care system operates, including intake, classification, residential programming and aftercare, with each focusing on the behaviors and factors most associated with reduced risk of re-offending. In support of the development of Prescriptive Programming, in 1996, the National Institute of Corrections (NIC) awarded the agency a technical assistance grant, which also provided consultation with several national experts.
OCFS' efforts to develop the most effective treatment model led to the realization that many traditional approaches to determining service needs and levels of supervision had to be altered. Research has shown that resources are most effective when they are targeted at the risk-related needs of high-risk youths (Lipsey et al., 2000). The key is to identify and target the factors and behaviors predictive of, and most likely to lead to, successful release from residential programs to the community.
Prescriptive Programming consists of four phases that cover the entire period of custody, including intake, residential rehabilitation, release readiness and community management. Also, the system is dynamic: As factors affecting a youth's likelihood of re-offending change, appropriate adjustments to programming and level of supervision can be made to facilitate the optimal outcome and efficient use of resources.
Inherent in the Prescriptive Programming system are the coordination and consistent application of system requirements. To impact the risk of re-offending, all components of the residential care continuum -- intake, classification, residential programming and aftercare -- focus on the criminogenic factors most likely to result in successful community re-entry. These factors are identified and assessed at intake for each youth and are used in the classification process to determine the type of residential program best suited to a youth's risk level and treatment needs. In the facility, treatment services are provided to address risks and needs. Current behavior, one of the elements of release readiness, is periodically reassessed. Before determining a youth's release potential, aftercare counselors evaluate the current level of home support and availability of needed services in the community. The results of each assessment are compiled to prescribe an appropriate level of community supervision. Throughout a youth's participation in the aftercare program, routine reassessment of criminogenic factors is conducted to determine whether modification of the level of community supervision is warranted.
Thus, from intake to discharge, youths and community factors are continuously assessed and programs are modified to maximize the impact on the elements related to the recidivism risk. As a result, Prescriptive Programming provides a case management system focusing on reducing that risk. The agency is pursuing development of a system to automate Prescriptive Programming and will replace existing systems that support the functions of the residential care continuum.
The Division of Rehabilitative Services' information systems are mostly manual and rely heavily on paper transfer. Where information technology support does exist, it is difficult to use and most often involves electronic mail services and preprogrammed character-based data entry and look-up screens.
The redesigned system will reflect changes in the type of information collected and the way it is collected, which will impact case-planning. The centralized collection of all the information pertaining to youths will provide direction and support for case managers and decision-making. Also, it will document which services were provided and how much progress was made. This initiative will bring about major changes in the rehabilitation system's operations, from the delivery of direct services to the establishment and monitoring of guiding policy and procedure in program areas.
Because what works in one place or for one population is not always transferable, OCFS is testing and refining the initial Prescriptive Programming system as each phase is developed. Once the system is fully implemented, there will be an evaluation to determine which components, information items and prescribed levels of supervision actually contribute to successful community release.
During the intake phase, the intake home visit and youth risk assessment are used to evaluate the juveniles. The OCFS Bureau of Classification and Movement uses scores identifying low-risk youths as a basis for diversion to voluntary agency programs.
In 1998, a pilot study at two OCFS facilities led to a single means of residential behavior assessment for the facility level, allowing the integration of the Youth Development System -- OCFS' standard behavior management system -- with Prescriptive Programming. Subsequently, staff at five pilot facilities were trained to use the new residential behavior assessment instrument and the revised version of the Youth Development System. Personnel at the other facilities have been trained and are implementing the integrated residential behavior assessment. Further, a matrix of service interventions that respond to specific risk factors is being piloted.
In the aftercare program, counselors have been using an interim form of the prerelease community assessment for recording the results of prerelease home assessments. As a first step in implementing the community risk reassessment for community supervision-level determinations, training is in place for aftercare staff. Also, an automated case management system that will connect the assessment results and actions taken during each phase is in the design stage. Once all the resources have been garnered, the design project will be completed in 18 months and will be followed by the implementation stage.
Full implementation marks the beginning of system validation. Based on the experiences of adolescents released from that point on, the system will be modified periodically to enhance prediction and achievement of successful community outcomes. The Prescriptive Programming initiative is an evolving process based on continual testing and evaluation. The system is data-driven, providing a means for ongoing improvement and updating of the agency's approach to juvenile rehabilitation.
The Division of Rehabilitative Services has taken steps to initiate additional program enhancements that will support the goals of the Prescriptive Programming project.
Reception Center. Since November 1997, offenders have been admitted through the OCFS reception center allowing the agency to better identify their risk and treatment needs. During the 14-day process, each adolescent receives a thorough assessment, which includes medical, educational, psychological and mental health evaluations, and then are transported to the most appropriate residential program.
The reception center concept promotes family involvement in the rehabilitative process, setting the stage for each youth's re-entry into the home and the community. Parents or guardians are contacted as soon as youths arrive at the reception center and are visited at their homes by an intake staff member, who performs a home assessment. The home-risk component is part of the initial risk-assessment score for Prescriptive Programming. Attendance at the reception center's family orientation day programs has been overwhelmingly high. To make it easier for upstate New York area families to participate in the reception center program, OCFS plans to use teleconferencing. In the interim, three-way calling is available for the family to talk to intake and reception center staff.
Family Advocacy Bureau. The Family Advocacy Bureau provides support services and resources to the immediate and extended families of juvenile offenders in OCFS custody, who have been referred based upon the Prescriptive Programming initial risk-assessment score determined at intake. A family advocate works closely with the families in collaboration with intake, facility, aftercare and OCFS Division of Development and Prevention Services staff. When it's necessary, family advocates also work with outside agencies to meet offender or family needs.
While youths are in residential care, the family advocates assist their families in determining what services will be needed to provide a stable environment when the adolescents return home. Also, the advocates coordinate parent groups, workshops and training sessions for families. Prior to each youth's release, the family's advocate meets with the aftercare counselor to discuss the situation, including what additional services are needed and what services the youth's family already has received. After the offenders are returned home, the family advocates remain involved with the families for about 30 days.
Youth Development System. The residential behavior assessment, also a component of Prescriptive Programming, provides periodic reassessments that document offender risk-factor levels, program needs and progress toward release readiness. The assessment also provides data relevant to the Youth Development System, the residential behavior management system used to monitor, correct and provide incentives for good behavior during residential treatment. The developmental system is predicated on residents learning and demonstrating specific pro-social skills, displaying increased self-control and problem-solving skills, and accomplishing program responsibilities. As adolescents advance through the four stages, they are required to demonstrate a higher level of skill development and self-control, which allows them to earn more privileges. In addition, staff are highly directive with adolescents at the lowest stage and as youths progress, so do the staff's teaching styles to coaching, then participating and finally d elegating.
Special Needs. While youths are in residential programs, individual needs are addressed through a variety of specialized services. For adolescents in need of continued special needs services after release, access to appropriate services in the community receives on-going attention. In terms of mental-health and substance abuse treatment, OCFS has developed unique program responses in partnership with other New York state agencies.
Mental Health Services
Consistent with nationwide trends, there has been a steady increase in the percentage of OCFS youths identified at intake with mental health problems and service needs. These adolescents have documented histories of psychiatric hospitalizations involving contact with state, county or private mental health systems prior to their admissions to OCFS, as well as current serious mental health needs.
In response, OCFS and the New York State Office of Mental Health (OMH), developed a discrete mental health unit model. This unit, a multipurpose program at the OCFS Highland Residential Center, is designed to meet the needs of youths with chronic and serious emotional disturbances, but who are not in need of psychiatric inpatient care; meet the transition needs of youths returning to OCFS residential care from psychiatric inpatient care; and provide intensive mental health treatment services to juveniles. Staffed jointly by OMH clinicians and OCFS child care/counseling staff, the unit represents a partnership serving residents who might otherwise be served only during periods of acute crisis. Youths have benefited from treatment services and a link to community-based mental health services, which promote the continuity of care for youths with serious mental health needs.
To expand service availability, Pataki allocated $1.6 million in the 2000-2001 fiscal year budget for OMH to "enhance the delivery of mental health services to youths in OCFS care and custody." Six additional mental health unit sites will establish discrete mental health unit treatment capacity at OCFS' three levels of security.
Substance Abuse Services
There is general widespread agreement that the most effective means of alcohol and drug prevention involves several components, such as treatment services, prevention education, cognitive restructuring services and programs, and independent living skills.
OCFS facilities have primarily focused on cognitive restructuring and independent living skills through aggression replacement training, the independent living program, general counseling and other curriculum-based programs. As a result, the agency's alcohol and other drug prevention initiative was designed to concentrate mainly on treatment services and prevention education, both within the limitations of available resources and the cooperative ventures with the New York State Office of Alcohol and Substance Abuse Services (OASAS).
Alcohol and Drug Treatment Services. After identifying the need for specialized substance abuse services, OCFS successfully initiated alcohol and other drug treatment services in facilities with 25 beds or less in 1996. The facilities are satellites of the OASAS agency providing these services.
OASAS agencies assess all youths with high substance abuse needs screen scores to determine if there are diagnosed alcohol or drug problems. Once the agency decides which juveniles will receive treatment, it will provide the treatment, which includes a maximum of one individual and one group session per week for a period of up to 26 weeks. OASAS also participates in facility treatment team meetings and provides progress updates to ensure integrated treatment, develops discharge plans for youths after treatment and, if needed, helps locate community-based OASAS providers in the youths' home communities so treatment can continue into aftercare.
Discrete Substance Abuse Units. In several of its larger facilities, OCFS has discrete substance abuse units comprised of youths who have substantial alcohol and drug problems. OCFS has worked with OASAS to have the units certified by OASAS as drug-free residential programs. To receive the certification, units must meet a rigorous set of OASAS regulations that require specific unit policies and procedures, an extensive treatment planning process and documentation of a treatment plan that meets the youths' needs and is based on realistic goals.
Youths living in these units receive all the programs and services provided in the generic units in addition to drug treatment programs and services, such as individual and group counseling, relapse prevention groups, Children of Alcoholics groups and self-help groups. Unit programs may vary over time and across facilities due to changing needs of residents.
Middletown Residential Center Alcohol and Drug Program. Development of a substance abuse program at the OCFS Middletown Residential Center has been an intensive collaborative effort involving OCFS, OASAS and a local private agency. In addition to the generic educational and psycho-educational programs, juveniles at the center receive counseling services for a minimum of five hours per week.
Intensive Aftercare Program
An intensive aftercare program has been implemented for Middletown Residential Center alcohol and drug program youths from Monroe County and the New York City boroughs of The Bronx, Manhattan, and Queens to provide substance abuse services. This program model incorporates small caseloads. As a result, the program is unique in that services start on the day of placement and continue to aftercare. Intensive aftercare supervision is provided by OCFS aftercare staff in positions specifically designated for this function, and an integrated service plan is developed for youths and their families. Upon release to aftercare, substance abuse services are provided by local community-based agencies. OCFS also will be providing intensive aftercare for youths released from the certified Discrete Substance Abuse Unit at its agency-operated Goshen Residential Center.
As OCFS pursues broad-based strategies for prevention and asset-building, the agency also is promoting safer and healthier communities by redesigning its rehabilitation system for youths in custody. Through development of a model targeting the risk factors most likely to lead to successful community re-entry, OCFS will restructure the way business is conducted at all phases of its residential care continuum to impact youth programming and levels of supervision. In conjunction with unique partnerships to address mental health and substance abuse needs and other initiatives to support the system redesign, OCFS is moving toward full implementation of a comprehensive, data-driven case management system focusing on reducing recidivism risk and providing for optimal outcomes and efficient use of resources.
John A. Johnson is commissioner of the New York State Office of Children and Family Services.
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|Title Annotation:||objectives of Office of Children and Family Services|
|Date:||Apr 1, 2001|
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