Child Welfare Watch Vol. 18: Recommendations and Solutions
The governor of New York must use the federal Department of Justice investigation of the state's juvenile justice system as an opportunity to leverage financial resources and policy reforms. State officials should not wait for a lawsuit to force them to establish a more effective and humane system, nor can they wait for an era of more plentiful budgets. Some of the recommendations below, proposed by the Child Welfare Watch advisory board, will require new funding. But over time they will save resources by diverting more young people from lengthy stays in inappropriate and potentially damaging institutions. If the state had pursued such preventive strategies years ago, its fiscal burden for institutions would be less now. New York City and the state Office of Children and Family Services (OCFS) have made important recent advances, diverting a growing number of young people from detention and placement, both before and after adjudication of cases in Family Court. But there remain substantial gaps in the system that must be resolved.
FAMILY COURT JUDGES SHOULD INSTITUTIONALIZE JUVENILE DELINQUENTS ONLY WHEN THEY HAVE COMMITTED VIOLENT CRIMES OR THERE IS TRULY NO ALTERNATIVE.
Four-fifths of the young people in state facilities are juvenile delinquents tried in Family Court (rather than juvenile offenders accused of crimes such as rape or murder, who are tried as adults). Some have committed assault or other violent crimes. Some are in institutions largely because judges and probation officers believe placement is necessary to provide a troubled young person with mental health care or substance abuse treatment. Others are locked up because judges have little faith that a parent or caretaker is able to provide the structure that will keep the teen from committing further crimes.
In a more adequate juvenile justice system, young people with serious mental illness would be treated in a mental health facility or program. Young people institutionalized only because they have unreliable parents would be placed with relatives or foster parents along with wraparound supports, case management and counseling. These are ambitious but necessary goals, and the recommendations that follow aim to describe steps toward such a system. For the most part, they build on the strong elements of current programs and services.
THE GOVERNOR AND STATE BUDGET OFFICIALS MUST CHANGE THE FUNDING SCHEME FOR JUVENILES PLACED IN NONPROFIT-RUN RESIDENTIAL AND ALTERNATIVE-TO-PLACEMENT PROGRAMS.
Today, 50 percent of the youth in custody in state-run juvenile correctional facilities and 50 percent are in nonprofit residential treatment centers. This is a radical departure from just eight years ago when about 75 percent were in OCFS care. This trend toward privatization is not sustainable, because city and county taxpayers must bear the full cost of placements of juvenile delinquents in nonprofit centers, while the state pays half the cost of the remaining OCFS facilities. Similarly, the city pays the full cost of several alternative-to-placement programs. Thus state government has accrued more than a fair share of the financial benefits of the system's transformation in recent years. The cost-share formula should be restructured and equalized so that teenagers will benefit from whatever services they need, and so that nonprofit and alternative programs are not subject to the vagaries of exclusively local funding.
THE GOVERNOR MUST REQUIRE THE STATE MENTAL HEALTH SYSTEM TO DIVERT OF TRANSFER SERIOUSLY MENTALLY ILL CHILDREN OUT OF OCFS FACILITIES.
A juvenile correctional facility is no place for a child with a major psychiatric disorder. Family Court judges do not have the authority to send a child to a state psychiatric facility, and judges complain that it is next to impossible to persuade the state's Office of Mental Health (OMH) to admit a child to in-patient treatment or to find appropriate out-patient treatment. The state's residential treatment facilities, which provide long-term care for youth with serious psychiatric problems, routinely reject patients who are violent. In fact, OCFS officials complain privately that OMH transfers youths with psychosis and schizophrenia from hospitals to juvenile correctional facilities if their behavior becomes difficult to control. As a result, the juvenile correctional centers have some very sick, unmedicated children, in part because OCFS has inadequate resources to care for them. OMH must take responsibility for severely disturbed children by setting aside or developing residential treatment beds for violent youth and by giving court-involved youth priority in admission to their facilities.
THE STATE'S JUVENILE FACILITIES MUST EMPLOY PSYCHIATRISTS AND PSYCHIATRIC NURSES.
Even if the most seriously ill children are transferred out of OCFS facilities, many children with mental illness will remain. The state must improve the quality of care for all children in custody. About 50 percent of kids in OCFS custody have mental illness, yet there is not one psychiatrist or psychiatric nurse on the agency's staff. Teams of clinicians from nearby hospitals, including psychiatrists, visit the facilities but are typically available only a few hours a week. While OCFS recently hired two dozen clinicians, including social workers and psychologists, only a psychiatrist can prescribe and adjust psychotropic medications and only a psychiatrist or a psychiatric nurse can monitor the side-effects and effectiveness of these medications. OCFS has had difficulty recruiting highly-trained personnel to the remote, rural locations in which its facilities are located. If it is impossible to adequately staff facilities in remote locations, children with mental health needs should not be sent there.
THE GOVERNOR SHOULD CLOSE, OR SHRINK, THE LARGEST OCFS FACILITIES.
The state of Missouri has shown that conditions of confinement are dramatically improved by replacing large juvenile correctional centers with smaller homes where children and adults can form closer relationships. New York closed a number of relatively small facilities last year, reduced the number of young people at others, and has pledged to close more. But OCFS has run into political opposition. The unions representing workers at the facilities, fearful of losing jobs, have opposed these closings. Yet when institutional placement is necessary, a small facility closer to the young person's home is more likely to allow for productive engagement with parents and relatives during and after placement, which is likely to help reduce violence and re-incarceration rates.
THE STATE CIVIL SERVICE COMMISSION SHOULD CHANGE REQUIREMENTS THAT OCFS FACULTY DIRECTORS BE HIRED FROM WITHIN.
Currently, directors must be promoted from current staff, mostly from a pool of candidates who have worked their way up from the position of youth development aide, similar to a prison guard. Some of these directors are effective and resourceful. However, some are ineffectual and resist change. If OCFS had the opportunity to hire from outside existing staff, the pool of candidates could be expanded to include more clinicians, including social workers and psychologists.
THE STATE OCFS MUST BETTER TRAIN STAFF TO MANAGE VIOLENT YOUTH.
The Department of Justice found cases in which staff injured youth, causing broken bones and teeth. The staff at some OCFS facilities have undergone successful training in how to calm youth without causing injuries. In some facilities, staffers have learned how to deescalate volatile situations and, as a result, rarely resort to the use of "restraints." At some facilities, however, staff have resisted the training. "They are ignoring the training and doing what they please," says OCFS spokesman Eddie Borges. Staff members who violate OCFS rules are rarely disciplined, according to the federal investigation. The state must continue to provide adequate trainings. At the same time, staff who resist regulations on restraints must be disciplined. In addition, OCFS should have the authority to remove staff found to have abused children in their charge.
PRIVATE FOUNDATIONS, THE GOVERNOR AND CITY HALL SHOULD INCREASE THE AVAILABILITY OF ALTERNATIVES TO INCARCERATION FOR MENTALLY ILL YOUNG PEOPLE.
Every year, about 60 juvenile delinquents from Brooklyn and Queens are rejected by alternative-to-placement programs solely because they have a mental illness, and are sent to juvenile correctional facilities instead. Blue Sky, an alternative program run by New York Foundling, serves mentally ill children in the Bronx and Manhattan; Blue Sky and ACS are seeking philanthropic support for $1.3 million to expand this program to all five boroughs. Foundations should fill this gap as soon as possible, but ultimately this is government's responsibility. In addition, Medicaid waiver programs, including Bridges to Health, should be expanded to include juvenile delinquents who need community-based case management to treat mental illness.
Over time, the state and city might consider a managed-care model of alternative supports for families of court-involved youth. For example, an award-winning Wisconsin program called Wraparound Milwaukee coordinates services for several hundred children each year, crafting highly individualized plans and using more than 100 providers of a wide variety of supports, paid on a fee-for-service basis. The program gives families broad choice as to which services they use, from mentoring to day treatment and mental health care. It relies on personalized case management. This approach strives to give families the ability to identify their own needs and greater control of their own lives, and it is far cheaper than residential care.
THE STATE OCFS SHOULD INVESTIGATE DRUG TREATMENT AS AN ALTERNATIVE TO PLACEMENT.
Alternative-to-placement programs often reject youth who abuse drugs or alcohol. Moreover, drug treatment programs designed for adults are rarely appropriate for adolescents. However, other programs have been shown to be effective in reducing drug use among adolescents. For example, Adolescent Portable Therapy, a program of the Vera Institute of Justice, sends counselors into the homes of adolescent drug users and works with parents and their children together. "We have individual conversations with a kid about who they want to be," says Evan Elkin, a psychologist and program director. "You need to focus on what they want to be and what they are good at, connect them with social activities and a good peer group." Adolescent Portable Therapy has generally been used as a four-month intensive program after discharge from OCFS facilities, but it could be used as an alternative to placement as well, says Elkin.
THE STATE OCFS AND PRIVATE PHILANTHROPY SHOULD SPONSOR RESEARCH ON THE EFFECTIVENESS OF ALTERNATIVE-TO-PLACEMENT PROGRAMS.
Family Court judges and city officials say it can be hard to recommend alternatives to placement without knowing how effective these programs are at preventing violence and criminal behavior. Many alternative programs have been the subject of rigorous research in other states; however, these "evidence-based models" have been changed and adapted for application in New York City and the research published in other states may not be applicable. One thing is clear: the alternatives have been very successful in terms of keeping more than two-thirds of the children they serve out of institutional placements, at least for the period in which they are enrolled in the program. More extensive data have been collected about participants in New York's programs, but there have been no studies that provide information about long-term recidivism and re-arrest rates comparable across various programs. The Office of Children and Family Services should apply some of the money saved from closing juvenile correctional facilities to thorough, rigorous research.
FAMILY COURT JUDGES AND OCFS SHOULD MAKE GREATER USE OF FOSTER FAMILIES AND KIN WHO ARE TRAINED AND SUPPORTED TO WORK WITH COURT-INVOLVED YOUTH.
A young person without a supportive family is far more likely to be placed in an institution than one whose parents can be involved. A few programs, like Cayuga Home in the Bronx, place juvenile delinquents with specially trained foster parents and work closely with biological parents to improve a child's support network as well as his or her behavior. But Cayuga Home is underutilized, with a capacity of 20 young people but only 12 to 18 enrolled at any one time. We urge the city and state to make better use of this program.
Of course, not every young person requires this level of support, some simply need a relative to take them in and help provide structure in their lives. New York should also develop other, less expensive models in which host families, foster families and relatives can make use of wraparound family supports as they work with young people involved with the courts.