The Children's Aid Society

The Youth Diversion Process

March 20, 2002

TESTIMONY AT JOINT HEARING ON PERSONS IN NEED OF SUPERVISION (PINS) CONDUCTED BY ASSEMBLY STANDING COMMITTEE ON CHILDREN AND FAMILIES AND ASSEMBLY STANDING COMMITTEE ON JUDICIARY

Submitted By: Michele Dubowy, ACSW
Director, PINS Diversion & Court Related Services The Children's Aid Society
December 5, 2001

INTRODUCTION
My name is Michele Dubowy and I am the Director of PINS Diversion and Court-Related Services for the Children's Aid Society. I have worked in the PINS Diversion Program since 1984 and have been witness to significant changes in the PINS population as well as the diversion process in the past 17 years. I appreciate the opportunity to share some of my observations and recommendations with you.

THE ROLE OF THE CHILDREN'S AID SOCIETY (PAST & PRESENT)
The Children's Aid Society has been at the forefront of innovative and effective programming for PINS (Persons In Need of Supervision) and their families for over two decades. In 1978, as a response to the growing controversy over Family Court jurisdiction of PINS cases, The Children's Aid Society commissioned a study by Herman Piven, a professor at the John Jay School of Criminal Justice. This study found that the Family Court process heightened the adversarial relationship between parent and child leading to an escalation of the conflict. It emphasized the need for non-judicial, non-adversarial alternatives to the court process focusing on the family, not only the child. In response to the needs identified by Dr. Piven, the Society pioneered in the early 1980's, the first parent-child mediation program in four New York City Family Courts and a court diversion model providing clinical assessment, case management, service coordination, and referral services in the Manhattan and Brooklyn Family Courts.

Our diversion model was replicated throughout New York City and served as a model for legislative change, resulting in the 1985 enactment of the New York State PINS Adjustment Services Act. This Act, implemented in New York City in February 1987, established Designated Assessment Service (DAS) Units in each Family Court, blocked immediate Court access, and initiated the policy of mandatory diversion for families seeking PINS petitions. The DAS units act as a conduit to bridge the distance between the Court and the community by providing comprehensive assessments and individualized referrals for each family. Today, The Children's Aid Society continues to receive funding from the Administration for Children's Services, supplemented by the Department of Mental Health, to operate the DAS units in Manhattan and Brooklyn Family Courts. Our DAS units have worked with over 22,000 families since 1987. Since July of 2000 we have also received ACS funding to operate long-term PINS preventive programs that are attached to our DAS units and accept referrals from them as well as the ACS field offices. By integrating our ten year old Youth Empowerment for Success (YES) Mentoring program into our long-term preventive program we are able to provide wrap-around individual, family and group counseling; educational advocacy; substance abuse counseling and referrals; psychiatric consultation; psychological testing; social activities; and mentoring as indicated.

THE PINS POPULATION TODAY
The PINS population of today is not the same as the one of 18 years ago when the Diversion model was first conceived. As we progressed through the late 1980's and entered the 1990's the societal horrors of AIDS, crack, and rampant, random community violence, have produced family constellations with even more fragmented, chaotic and debilitated foundations. Many of the PINS adolescents of the 1970's who later went on to survive the crack and AIDS epidemics, are now the parents of today's PINS youngsters. They are often inadequately equipped emotionally, educationally, and economically to provide adequate concrete and emotional nurturance for their children. Other PINS youngsters, orphaned at very early ages as a result of parental AIDS or substance abuse, are being raised by either elderlyrelatives or siblings who are barely out of adolescence themselves. Some of these youngsters have significant neurological deficits as a result of their parents' substance abuse and have academic, social and behavioral difficulties related to these deficits.

Since the tragedy of 9/11 there has been much talk about the impact of trauma on our every day functioning. Many of the parents and children that we see in our PINS programs have been victims of multiple traumas including physical and/or sexual abuse; emotional neglect; domestic violence or community-based violence; as well as the loss of family members or friends as a result of immigration, relocation, abandonment, incarceration, divorce or death. The PINS allegations of truancy, substance abuse, absconding, incorrigible behavior, etc. represent the youngsters attempts to address the feelings of anxiety and/or depression that are engendered by unresolved reactions to past or current traumas. These traumas may be related to a current family problem or even an unresolved event from the parent's past. We thus view the youngster's behavior as a cry for help for the entire family, not merely the youngster alone. Furthermore, we perceive the entire family as owning responsibility for the problem as well as the solution.

We strongly believe that by conceptualizing the diversion effort as Families in Need of Supervision the onus for the problems would be removed from the children and give the message that the family has a part in the problem as well as the resolution of the problem. In calendar year 2000, the Brooklyn DAS unit received a total of 1055 referrals of diverted PINS youngsters. 188 or 18% of these families were active in the ACS Field Offices where allegations of abuse and/or neglect were being explored at the time of referral to our DAS. While conducting our assessment, our workers who are all mandated reporters, had to initiate an additional 220 calls to the State Central Registry for suspected abuse and/or neglect. This represents suspected abuse or neglect on an additional 21% of our total referrals for this year. 115 of the 220 SCR reports called in by our DAS staff were initiated because the parents or caretakers failed to follow through on urgent referrals made by our workers for either psychiatric, medical, substance abuse, or mental health treatment. Thus, 39% of all of the families referred to us in calendar year 2000 evidenced behaviors warranting State Central Registry notification related to suspicion of child abuse or neglect. This further supports our belief that families, not only youngsters, are in need of supervision.

The PINS population is one in which 35% of the youngsters can be classified as seriously emotionally disturbed. They evidence behaviors and/or emotional disturbance that seriously impact on their activities of daily living, relationships with peers, teachers and family, as well as on their academic functioning. In calendar year 2000, 210 youngsters representing 20% of our total intake, presented with acute suicidal and/or homicidal ideation or acute symptoms of psychosis at our intake session and were referred to community-based hospitals or mobile crisis units for emergency psychiatric consultations. An additional 159 youngsters (15% of the total intake) with more chronic symptomatology such as severe impulse control problems, extreme aggressivity and violent behavior, sleep or eating disorders, auditory or visual hallucinations, or past suicide or homicide attempts, were referred to our on-site psychiatrists during the assessment process. Some of these youngsters utilize alcohol or drugs to self-medicate the depression and anxiety that pervade their lives. They are considered Mentally Ill Chemical Abusers and require specialized MICA services.

Since the mid-1990's there has been an alarming increase in the severity of mental illness, physical and sexual abuse, and community violence which impacts on both the adults and children that we see. The resurgence of gangs, particularly in the Borough of Brooklyn is in large part responsible for this. I would like to offer brief snapshots of our recent caseload.

· A 9 year old girl, in a class for the gifted, is setting fires at home, ordering pornographic movies from Pay TV, and is using adult sexually explicit language in her 4th grade classroom.

· A 13 year old female adolescent with a history of psychiatric hospitalization beginning at age 7, foster care related to physical abuse by the father, a pregnancy at age 12, motherhood at age 13, gang involvement including witnessing a murder and participating in retaliation, and ACS involvement related to educational neglect as well as neglect of her infant.

· A 15 year old boy rejected by his substance abusing mother at birth and raised by his father, with a history of suicidal thoughts of "jumping off of a bridge," PINS allegations of truanting, running away, and stealing from father, and past ACS involvement related to the father physically abusing him as well as new allegations of the father sexually abusing the boy for the past 3 years.

· A 14 year old female who had been raped by members of a gang as part of her initiation, is currently involved in prostitution and is in fact procuring other girls for prostitution, is abusing drugs, and has rejected past referrals for mental health and substance abuse treatment.

· A 15 year old male who was being raised by an elderly aunt after the AIDS related death of his mother, had been psychiatrically hospitalized a number of times for violent, explosive outbursts at home, school, and community including our office, demonstrated non-compliance with the use of psychotropic medications and failure to follow through with out-patient treatment following discharge, was allegedly involved in a group rape and had a delinquency case concurrent with the PINS. A specialized home-based psychiatric program refused to treat him due to his extreme violent behavior.

Although truancy, running away from home, undesirable companions, and smoking marijuana, are the most frequent allegations for youngsters under the age of 16, you can see from the above brief descriptions that many of our youngsters are involved in situations that endanger themselves and others. Our feeling is that we will encounter an even higher incidence of serious delinquent behavior, greater gang involvement, more serious substance abuse, more entrenched emotional illness, and a longer and greater disaffiliation from school in the over 16 population. Moreover, school is only compulsory until age 17. Thus there will be no leverage in enforcing a youngster to return to school once they are 17. We also believe that the families of the 16 and 17 year olds will very likely be less inclined to "own" their part in the presenting problems as well as the resolution of the problem, and will merely be "dropping off their youngsters at Family Court so that we can "fix them." This again points to the importance of changing PINS to FINS.

THE ROLE OF THE DESIGNATED ASSESSMENT SERVICES (DAS) UNITS

This brings me to the role of the Designated Assessment Services (DAS) units and I would like to underscore our utilization of a family-based assessment. In addition to the primary child welfare goal of safeguarding the physical and emotional well being of children and families, the DAS units are charged with four other mandates. These include:

* preventing unnecessary foster care placement;
* averting Court processing of PINS petitions whenever possible;
* providing comprehensive, family-oriented psychosocial assessments of the child, family and community to determine the underlying issues leading to the symptomatic behaviors exhibited by the youngster;
* developing and implementing service plans that address the identified needs of each family.

The Program obtains and accepts all of its referrals of PINS cases from the Department of Probation PINS Intake Unit, once the Probation Officer has determined suitability and eligibility for diversion. Families often come to Family Court with the hope and expectation that a PINS petition will result in court-ordered supervision, placement in foster care, or in more recent years placement in a boot camp. Our DAS units have become particularly skilled in engaging even the most entrenched and troubled families in a purposeful, goal-oriented assessment process; in enabling families to understand the connection between the child-oriented problems and the functioning of the entire family; and in contracting with the family on both emotional and behavioral levels to engage in on-going neighborhood-based services.

Collaboration with community resources is a key function of the DAS units, starting from the very first session of the assessment process and continuing through the successful implementation of the family's referral to a community agency. We have telephone or in-person case conferences with personnel from the schools, medical facilities, community-based therapists, ACS staff, Probation etc. as well as request written reports from agencies who have been involved with the family in the past or are currently involved.

The first session of the assessment process is focused on enlisting the child and family's participation in the assessment as a way of understanding what has gone wrong, identifying what steps will be necessary to change things, and conveying the concept that things can be improved when we understand what has gone wrong and why. We also explore and attempt to rule out emergency psychiatric problems such as suicide/homicide, child abuse/neglect, sexual abuse and domestic violence early on in the process. Immediate referrals are made upon discovery of an emergency situation.

In the next stage of our assessment, we explore the development of the parents or caretakers as well as of the children, with questions about psychosocial development and cultural/historical family factors. By exploring both the current functioning of the family as well as the history of relevant caretakers, we are able to determine the impact of past events on their current functioning. The workers also determine how the external stressors of inadequate housing, unemployment, immigration, medical problems including AIDS, and educational difficulties impact on the child's development and family functioning. In-depth second level assessments conducted by the full-time Educational and Substance Abuse Specialists, as well as consultations with on-site psychiatrists and psychological testing are utilized as indicated by case circumstances.

The final part of the assessment process is the contracting stage. This involves a review with the youngster and family of how their unresolved feelings, roles and patterns from the past may be repeating themselves or are impacting on the child's current behavior and family functioning. When family members come to understand the meaning of the PINS behavior, why and what the youngster is acting out for the family, and what each family member needs to work on to bring about change, they are ready to commit to an on-going treatment process.

The assessment process results in the stabilization of crisis; prioritization of the service needs of the family and youngster; and a determination of, and referral to, community-based mental health, preventive, substance abuse, recreational/vocational, and medical facilities that will offer on-going treatment and ancillary services so that the families can continue to work on the issues identified in the assessment process. The successful resolution of the identified problems ultimately leads to a strengthening of family functioning and the preservation of the integrity of the family unit. The entire DAS assessment process is completed within one to six sessions, over a period ranging from one to three months. The average case duration is 45 days and is dependent upon the family's ability and readiness to participate in the assessment process; the complexity of needs presented by the family; the need for the family to participate in a more in-depth second level assessment in a particular service area; the presence of life threatening emergency situations which require immediate attention; the cooperation of other service systems; and availability of referral slots in community-based agencies.

During the two decades that the Children's Aid Society has been operating the PINS Diversion Designated Assessment Service Units, it has become increasingly evident that many of the PINS adolescents and their families have deeply entrenched emotional or behavioral problems, diagnosable psychiatric disorders, and longstanding family dysfunction evidenced by poor communication, child abuse/neglect (physical, sexual or emotional), and depression related to multiple loss. Internal and external life stressors including poverty, substance abuse, mental illness, criminal activity, and community/domestic violence impact upon the lives of the youngsters and their families and because of this the Children's Aid Society's PINS Assessment Model strongly endorses a Families in Need of Supervision approach.

CHALLENGES FACED BY THE DAS UNITS
Our DAS workers have become exceptionally skilled in engaging families in our assessment process and in fact completed assessments on 79% of the Brooklyn families that we saw in calendar year 2000. This year our completed assessment rate is over 90%. However, the success of the Diversion effort is not only contingent upon the family's completion of the assessment, but also on our ability to connect the family with appropriate on-going services. There are no "quick fixes" for our families. It is often a daunting task to find appropriate resources either community-based or in-patient, for some of our more emotionally disturbed clients. Some of the adolescents that we see are persistently suicidal or homicidal but cannot gain admission to Kings County Hospital, the only hospital in Brooklyn that has psychiatric beds for adolescents, as they are judged to not be acutely at risk on the day they are seen. After struggling with managed care insurance carriers, we have at times been successful in getting the chronically, severely depressed youngster hospitalized at a private hospital. However, usually only very short hospital stays are approved. It is also difficult to gain in-patient care for some of our other clients who may carry a MICA diagnosis and are also violent. Some hospitals will accept them and then want to discharge them after a day or two because they cannot control them. The home-based Intensive Case Management Programs and the Assertive Community Treatment Program funded by DMH have been helpful with some of our more chronically disturbed youngsters, but are limited in their ability to work with more violent acting- out youth.

A rather small percentage of PINS youth require some form of placement, ranging from a six-week stay at a diagnostic reception center to longer residential treatment. From the late 1980's to the early 1990', the DAS units had access to beds at diagnostic reception centers. These facilities have expertise in working with troubled adolescents for whom out-patient services have proved inadequate and cannot be sustained in the community. The youngsters undergo comprehensive psychiatric, psychological, educational assessments during the six-week stay at these in-patient facilities in addition to ancillary family assessment. Approximately 3% or 30 youngsters seen by the Brooklyn DAS in calendar year 2000 were referred for placement in a diagnostic facility because of the severity of their emotional disturbance and difficulty being maintained in the community. However, as we are no longer able to access this service voluntarily as ACS does not provide voluntary placement for adolescents, we are forced to refer to Court for a judicial referral. When the judiciary remands PINS youngsters to diagnostic placement, most of them end up at group home placements for several months while awaiting transfer to a diagnostic. Isn't it ironic that youngsters deemed to be "in need of supervision" are placed in congregate care, offering little structure and supervision while providing these youth with greater opportunity to act out? There is an urgent need for the DAS units to have access to a continuum of residential treatment services for the relatively small number of PINS youth under age 16, requiring these services. Without adequate treatment, this population often goes on to commit serious delinquent acts. We expect that there will be an even greater need for residential treatment for older adolescents. Although some of the existing residential treatment centers can and do work with youngsters in early, mid, and late adolescence, there is such a paucity of available RTC and RTF beds that youngsters have to wait up to a year to gain admission.

It should be noted that 31% of the 1055 families we received in 2000 were referred to mental health services, 20% were referred to preventive programs, 14% were referred to our educational specialists for on-going assessment and advocacy, 8% were referred to our substance abuse specialist for in-depth assessment, short-term inventions, and referrals for on-going treatment, and 11% were closed to ACS for abuse/neglect based partially on the parents failure to follow through with urgent services.

We are expecting that the 16 and 17 year olds will evidence more greatly entrenched and serious mental health problems, greater involvement in gangs, a higher rate of violent delinquencies including assault and armed robbery, more extensive substance abuse, and complete disaffiliation from school. The gaps in resources applying to the younger PINS population will thus have an even greater impact on the older adolescents. As education is compulsory up until the age of 17, there will be no leverage with the 17 year old who hasn't been attending school. Another factor impacting on mental health resources, is the cut off age of 16 for adolescent clinics in the municipal hospital system. Our older adolescents will have to be sent to the adult psychiatric emergency rooms and if indicated, hospitalized on the adult wards at Kings County Hospital. Some of the administrators in adolescent programs at Kings County Hospital have expressed great concern about this. The cut off for ACS funded preventive services is age 18. If we get a referral of a youngster nearing his 18th birthday, we will have a very short window of opportunity to work with this youngster and family. Additional preventive service monies are definitely required for New York City to provide DAS services for the 16 to 18 year olds as well as community-based, long-term preventive services for the additional families referred by the DAS units. However, there is an equal and perhaps greater need, for mental health monies to fund specialized programming for older adolescents.

RECOMMENDATIONS TO ADDRESS THE CURRENT SERVICE GAPS AS WELL AS ADDITIONAL SERVICE NEEDS FOR THE OLDER ADOLESCENTS

We are recommending funding for a continuum of adolescent/family services ranging from:
· Reinstitution of community-based preventive service programs that have psychiatric and psychological back-up and specialized expertise with the adolescent population, in addition to the long-term PINS programs attached to the DAS units.
· Alternative, vocationally oriented school programs for youngsters who are long-term truants.
· Day treatment programs for more seriously, delinquent, anti-social acting out or MICA adolescents with co-located clinical, educational, vocational, substance abuse, and probation services.

* Ready access to in-patient hospital beds for acutely suicidal or homicidal youth.
* Ready and timely access for DAS PINS clients of all ages to in-patient diagnostics specialized in working with the adolescent population and subsequent timely transfers to long term residential treatment centers or residential treatment facilities as needed.
* Community-based recreational/social/cultural activities for 16-18 year olds.
* Counseling, recreation, protective/advocacy services for gang-involved youngsters and their families.

New initiatives should have blended funding with consolidation of accountability. This funding should allow for creativity and flexibility of programming that is driven by the needs of the client population, and not solely by the accountability requirements of the funding agencies. All programs should provide a "community of care" that will ensure maximum safety, supervision and support for PINS families.

RECOMMENDATIONS FOR CHANGE IN THE DIVERSION PROCESS

As the traumas impacting on PINS youngsters and families have increased significantly in number and severity, our mission in working with this population has become increasingly more complex and challenging. Not only are we expecting the number of DAS referrals to double with the addition of the 16 to 17 year olds, we are also anticipating an increase in the complexity and severity of problems presented by this population and a greater difficulty in accessing appropriate referrals. The DAS units have uncapped, crisis-laden caseloads, can never close intake, and have onerous accountability requirements stipulated by ACS, DMH, Probation and the Office of the Criminal Justice Coordinator. Compliance with these multiple accountability systems consumes 50% of the workers' time, time that could be better utilized in direct service with the clients. In addition, each DAS unit undergoes three separate audits by different city agencies (ACS, DMH, Criminal Justice Coordinator's Office), each reviewing very similar materials. In order to sustain a high quality of assessment and case management, as well as to promote staff retention, we would like to propose the following changes:

* Cap DAS caseloads at 12 as we are really operating crisis/triage units for a difficult to engage population. Our work entails complex multi-system collaboration and unlike long-term preventive work, this requires more than 2 casework contacts per month. Case duration averages 45 days, not the 30 days projected in the original PINS plan;
* Change the due date of the DAS report from 30 days to 45 days and expand the amount of time that Probation has to monitor the family to 120 days;
* Consolidation of accountability requirements and audit oversight so there is one set of documentation required and one system taking responsibility for auditing compliance;
* So as to prevent duplication of service, families currently known to other community-based services including preventive, mental health, ACS field offices, could be screened prior to referral to DAS for emergencies and then "pushed back" to that agency for on-going assistance;
* Youngsters with either past or current Adult Criminal Court involvement or Family Court juvenile offender status should be excluded from PINS Diversion. It is contraindicated for these youngsters to be "pleaded down" and referred for a PINS when they have been involved in serious and dangerous criminal activities. The services most appropriate for these youth require Court referrals and Court monitoring that are not available in the PINS Diversion effort.

Finally, I would like to emphasize the need for New York City to bring together all of its resources so that all of the systems impacting on the lives of the PINS adolescents and families can take ownership of this population. The PINS population should not be the concern of ACS and Probation, alone. Many of the educational, vocational, social, and emotional needs of the 16 to 18 year old population have long been neglected. However, the change in PINS legislation has brought the older adolescent back into our focus. When the City was gearing up for the implementation of the 1985 PINS Adjustment Services Act, there was a consortium of City and State agencies that each came to the table to offer dedicated funding and specialized programming for PINS youth. The systems that were represented included: the Board of Education, Mental Health, Developmental Disabilities, Health and Hospitals, Child Welfare, Probation, Youth Services, Alcohol and Substance Abuse. Through the years, much of the dedicated funding for specialized community-based programming for the PINS population has disappeared. At this point in time, ACS and Probation are the major funders of the Diversion effort and DMH has made it possible for all of the DAS units to have monies for on-site psychiatric consultation. However, it is now time for the Board of Education, DMH, Health and Hospitals, OMRDD, OASAS, DYCD, VESID, ACS and Probation to again step back up to the plate to fund, design, and implement creative and flexible programming based on the developmental needs of the older adolescents and their families.

Thank you for this opportunity to share our testimony with you.

Respectfully Submitted By: Michele Dubowy, ACSW
Director, PINS Diversion & Court Related Services The Children's Aid Society
December 5, 2001