Keeping troubled teens at home

By Bonita K. Lantz

Like many other public child welfare agencies, Valley West Social Services in Kearns, Utah, was confronted in the early 1980s with increasing requests for out-of-home placements while service expenditures and staffing commitments remained the same or were decreased. There was a cry to "work smart"--to do more with less. The Child Welfare Act of 1980, P.L. 96-272, included an expectation that beginning October 1, 1983, "reasonable effort will be made in each case to prevent or eliminate the need for placement ..."

In reviewing programs to determine intervention effectiveness, concerns were raised regarding the use of out-of-home placement--foster homes, group homes and psychiatric facilities--to treat minor delinquents and status offenders. Such cases required extensive staff time with little evidence of success. Typically, while these adolescents moved unsuccessfully through several programs and positive change became more remote, the goal of return home was abandoned by the agency workers, child, parent and family members. Then, when they were released from care at age 18 with nowhere else to go, they went home.

These concerns, coupled with recent training in a family systems behavioral method, led the agency to develop a strategy to serve status-offending adolescents more efficiently through intensive family therapy and tracking. 

While Valley West Social Services was interested in replicating these results, we were even more concerned about determining whether increasing the skills of family members would have an impact on the family's ability to remain together. Another desired result was that placement resources would be reserved for those children and families for whom temporary separation was the best alternative.

To supplement to therapy component, a paraprofessional "youth advocate" worked with each adolescent, serving as an objective friend to listen to the child's concerns and to make suggestions or discuss strategies for behavioral change. The advocate assisted the adolescent with job hunting or school placement, tracked his or her progress in school, at work and at home and acted as a role model. The advocate met daily with the therapist to discuss each case.

When the experimental program first began, two social workers provided regular, court-ordered protective services for 25 to 30 families and also offered Functional Family Therapy at least once a week to six to 12 families whose members included an acting-out or status-offending adolescent. Although the adolescents had received counseling or probation services, they had failed to benefit from these services and a juvenile court screening committee had determined they were in need of out-of-home placement.

While this method succeeded in increasing family members' skills and keeping the family intact, the agency believed that more intensive services would enhance success rates in 70 percent of the cases. Additional staff would also be needed, for the therapists--who had carried double caseloads for over a year--were exhausted!

Based on the experience of the experimental program, the agency received a grant in FY 1983 from the Children's Bureau, ACYF, to conduct a pilot project staffed by one Functional Family Therapist, two paraprofessional advocates and one half-time supervisor. Families were expected to receive therapy for 60 to 90 days, with a caseload size of 12 families for the therapist and six adolescents for each advocate. Families received therapy twice a week for the remainder of treatment. Advocates met daily with the adolescent at first, then decreased intervention over the span of treatment. Therapy sessions were held in the office or at home and each family was seen at home at least once. The advocate's contact with the adolescent was frequently in the field--at school, home or work.

Treatment included assessment, therapy and education. All behavior within the family was seen as a reflection of a relationship payoff: a family member was using closeness, distance or "midpointing"--a blend of distance and closeness. One example of a relationship payoff of closeness might be a child who runs away, then calls home crying that she's been hurt and asks to go home. She arrives home to her mother's open arms--and receives her total attention. Essentially, when the "dust settles" the child achieves closeness.

Once the therapist assessed the function of the family members' behavior, then therapy and education phases "fit" skill building and technical aids to these functions to allow the person to maintain the same relationship in more efficient ways. Cases were terminated when family members were able to freely engage in problem-solving without the therapist's assistance.

In order to provide adolescents in the program with peer group support, as well as reward desired behavior, a Youth Council organized a variety of group activities--trips to movies and an arts festival, a visit to the local juvenile detention center and talk sessions to share feelings and concerns. To maintain the program's focus on the total family and to dispel parental concern over one child receiving attention for "bad" behavior, siblings were also encouraged to participate.

Since a number of the youths had to pay fines imposed by the juvenile court, the team coordinated with the court to allow the adolescents to work off the fines, under the supervision of the advocates, by performing a variety of tasks around the offices--shoveling snow, pulling weeds, picking up litter, cleaning and painting. In cooperation with the agency's adult service unit, we also arranged work for youths who had been required to make restitution. The young people helped prepare sandbags for an expected flood and provided a variety of services for older and handicapped members of the community, with whom they worked exceptionally well.

Program Operation

The case of 16-year-old Larry White and his family illustrates how the program opertes.

Larry lives with his younger sister and moter, June Green, who had remarried about four years ago after being head of the household for five years. Two older married sisters live in the Salt Lake area. Mr. Green works as an auto mechanic and Mrs. Green works two jobs as a waitress. Larry's natural father, Harry White, is in prison in Illinois and has had no contact with Larry in the last nine years. In school, Larry reads on the 4th-grade level and is a behavior problem. Larry had been placed in several special programs, but the school reports frustration with his non-attendance and poor attitudes. He also is seen as easily led by friends. The family has received counseling previously but feels it has not helped.

At the time of his referral to the program, Larry had stolen $300 worth of food stamps from a neighbor. On earlier court referrals he was found guilty of trunacy and possession of alcohol and tobacco. Both the court intake officer and Larry's parents felt that he needed to be out of the home; in fact, Larry's mother refused to take him home, saying "Someone else can take him and striaghten him up. "The juvenile court screening committee identified Larry as a child requiring placement.

Before the court date to adjudicate custody, the intensive family therapist met with the family to discuss alternatives to placement. The therapist listened to the family's concerns, explained the costs and realities of foster care and discussed the FFT program. By this time Larry had been out of the home a few days, and after the program was explained to Mrs. Green and she realized there would be follow-up, she was less insistent on her son's need for placement.

The therapist then identified and assessed the function of the family members' behavior and regular therapy sessions were arranged in the home. Larry returned home after the first session.

The advocate attended the first session and made an appointment to see Larry the next day. Over a period of three weeks, the advocate met daily with Larry. Larry stated that he hated school and wanted to work. He had a girlfriend who lived some distance away, which made regular contact with her impossible. Larry told the advocate that he wished he could do some of the fun things his stepfater did. Since Larry slept in an unfinished basement with no walls or privacy, his nieces and nephews got into his things and damaged them when they visited. Larry said he felt his family didn't care about him.

The advocate, therapist, parents and school counselor arranged for Larry to have work release status and attend classes to develop employment skills. Larry and the advocate went job hunting and Larry obtained employment washing dishes. The advocate also worked with Larry on communication skills and encouraged him to talk about his feelings and build relationships. Larry's sister and brother-in-law began taking a greater interest in him and he spent several weekends in their home. The brother-in-law, a milkman, took Larry with him on early morning runs. After five weeks, however, Larry lost his job because he had made cash overdraws that exceeded his wages. He and the advocate went job hunting again and Larry found another dishwashing job. Following the FFT model, each difficulty was reframed as an opportunity to develop alternative behavior and learn new skills. In school, Larry regularly attended his swimming and industrial foods classes but neglected math and English.

The family continued to meet weekly with the therapist for 10 weeks, during which time communication, negotiation skills and fair fight rules were taught. Larry's parents agreed to pay half the cost of a foot locker to protect his possessions and he reported that this gesture made him feel that his parents cared about him. A message center was established to improve communication within the family. The parents set aside one night a week to go out together, which improved their ability to communicate and work as a team.

Intensive therapy was terminated at this point, but since Larry had not fully paid his fines and restitution, his case was trnsferred to a case manager. Six months after termination Larry was working full time and had not been involved in any further delinquency.

Results

During the 12 months of the federal project, we provided services for 22 adolescents in 21 families. Statistical information about the youths and families served appears in Table 1.

It was originally thought that youths served would be 12 to 13 years old and that an equal number of males and females would be referred. Instead, the average age was 16 and two-thirds were male. Three months after the project ended, only four adolescents receiving services had been placed; therefore, 82 percent remained at home. Without intensive services, all the referred adolescents would have been placed out of the home. The average cost per child in the FFT program was $2,923. While actual baseline out-of-home placement costs for an adolescent in the State of Utah are not known, estimates range from $8,000 to $10,000 per year. Unlike young children, teens use many resources--psychiatric treatment and group homes--and frequently stay in placement longer than one year.

Conclusion

A program such as the Family Functional Therapy project requires extensive community cooperation and commitment, and ours received strong support. In turn, the community at large, as well as the families involved, have received many dividends. The community is becoming increasingly aware of services other than placement for children and families. When child welfare service administrators offer a continuum of preplacement services, the population is directed toward a more effective utilization of all community resources. The number of foster care caseloads has decreased while the number of protective service supervision caseloads has increased. If placement does occur after intensive intervention, parents, children and siblings have a better understanding of the agency's expectation and work toward returning the child home. Additionally, the family understands the costs of placement and realizes that every alternative should be exhausted before placement.

Children referred for placement after participating in this program also remained in plcement for a shorter time than the average adolescent in foster care. If placement occurred, the foster care worker received information to determine the best placement alternative and developed a specific behaviorally oriented treatment plan. There was a decrease in the number of cases referred for placement throughthe juvenile court screening committee and greater community case cooperation.

Agency workers not directly involved in the project became more creative in developing alternatives for children and families and more universally focused on the concept of permanency which begins with the child's own home. Sibling involvement also deters later sibling placement because family members work out problems rather than seeking placement as a solution.

Finally, because the family remains in charge during services and treatment, emphasis is placed on the importance f the individual, rather than the agency, finding solutions to problems.

In Utah, child welfare services have long focused on preserving families. In a population of almost 600,000 children under age 18, only 1,200 are in out-of-home placements. To help reduce that population even further, the State Department of Social Services has authorized funding and staffing for two 18-month state pilot programs based on the success of the FFT model. Other state social service offices are also experimenting with intensive services designed to keep increasing numbers of children in their own homes.

Everyone benefits from family preservation services. When family members learn skills to negotiate the struggles of adolescence, the family devises its own solutions to problems and each individual is strengthened. Administrative, management, court and monitoring costs are diminished. Seeing families make progress heightens staff members' sense of achievement. Preserving families for children through skill building is not only cost effective--it also makes good sense for the individual, the community and society.