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When administrators discuss early- intervention and prevention programs, they talk about families. The idea is to focus on what a family does well, build on its strengths and treat everyone -- not just the kid. If a teen is given counseling after being arrested then is sent back to the same negative home situation, most likely he will revert to bad behavior. "If you haven't worked with the family, if you haven't done anything to strengthen that family, they're not going to be any better equipped to deal with the child," says Bruce Kamradt, director of Wraparound Milwaukee, one of the most successful prevention programs for mentally ill juvenile offenders.
Wraparound's caseworkers form a team of family, friends and teachers to work with each adolescent. The idea is to wrap services around a child to protect and help him. Instead of focusing on what the kid can't do and what is wrong with the family, caseworkers try to look at what the family is doing right and build on that. If a student is failing every class but art, then Wraparound tries to involve the teen's art teacher in nurturing that skill.
"We've overused institutional-based care, and the outcomes are very poor," Kamradt says. "Kids get back in trouble."
Kamradt visited Houston in August to help the Texas Integrative Funding Initiative, a pilot project in the Alief Independent School District, to model itself after Wraparound. Based at the Alief Alternative Learning Center, a case manager works with four families (eventually they plan to serve ten). Normally, there are restrictions on how money can be spent, but the program's funds can be used for anything that will help the family function, says Dr. Regina Hicks, deputy director of child and adolescent services for the Mental Health and Mental Retardation Authority of Harris County. For instance, the caseworker can pay the family's electric bill or buy the child a membership to the YMCA. Wraparound Milwaukee spends $30 million a year treating 1,000 kids. The Alief project has only a $75,000 grant, which has to pay the salaries of two staffers before it can spend money helping children.
Dallas County has used wraparound services for three years, says Mike Griffiths, executive director of the Dallas County Juvenile Probation Department. "Their outcome measures weren't that stellar," he says. "It sounds good and it feels good, but there wasn't the research to back up expanding that program." In January, Dallas County began contracting with the Memphis-based Youth Villages program Intercept, which uses a "multi-systemic therapy" approach. Instead of a caseworker coordinating a family's services, a therapist does all the coordination and care himself. Four therapists work with four families for three- to six-month stretches and are on call 24 hours a day. All treatment is done in the home, and most of the therapy is focused on the parents, says Lee Rone, regional director for Youth Villages. "Parents have their own personal problems," Rone says.
Wraparound services and multi- systemic therapy are employed once a child enters the system. Another facet of the $35 million legislative project, state Representative Sylvester Turner says, is to train Texas juvenile judges to identify signs of mental illness when a kid enters the courtroom. Already in Houston, as part of the TRIAD prevention program, case managers sit in selected courtrooms and recommend counseling and intervention programs "instead of grunt work or fines, which don't work," says Joel Levine, TRIAD director.
Formed in 1974, TRIAD is a consortium of three county agencies: Children's Protective Services, MHMRA and the Harris County Juvenile Probation Department. TRIAD offers two programs specifically geared toward prevention and early intervention for mentally ill juvenile offenders: Choices and the Family Preservation Program. Choices (formerly known as the First Time Offenders Program) is for kids aged ten to 17 who have been identified with a mental illness and have either just committed their first offense or have one foot out the door, says Jeff Demoss, MHMRA's clinical team leader over Choices and Family Preservation. Counselors teach kids conflict resolution and decision-making skills.
TRIAD's Family Preservation Program works off the idea that it's better for a child to be at home than inside a detention center. Counselors do in-home therapy once a week for up to three months and treat the entire family.