“Rethinking Mental Health” Award Submission to Changemakers: Ashoka Corporation and Robert Wood Johnson Foundation

Submission Date: August 4, 2009

Lourdesmont / Good Shepherd Youth & Family Services 537 Venard Road Clarks Summit, PA 18411

Project Name: Lourdesmont Multisystemic Community Based Program

Person in Charge of Project: Judy Neri, Chief Operating Officer E-mail: [email protected]

Contact Person: Dorothy Allen, Director of Development E-mail: [email protected]

Changemakers Taxonomy: Behavioral Issues

Project Summary (550 characters):

Most juvenile delinquency programs deal with adjudication and incarceration and many social services for at-risk youth concentrate primarily on only client behaviors. This Program instead uses a PROSOCIAL approach to build youth and family strengths (protective factors) that are known to counteract risk factors for juvenile delinquency. Since these factors are found within the youth’s family and community, treatment is home based, emphasizing family involvement and parental empowerment, which facilitates treatment and maintains treatment gains.

Why Project is Being Nominated – Innovativeness and Effectiveness (750 characters):

Residential treatment, psychiatric hospitalization, or incarceration fail to address known causes of antisocial juvenile behavior and fail to alter the social environment to which a youth will return. Empirical studies show that antisocial behavior is determined by an interplay of individual, family, peer, school and neighborhood factors. This Program incorporates active involvement of parents, other family adults and siblings, to address a youth’s problems. The Program combines a family-based therapeutic approach with a community-based system of human services, educational, and social resources to create a “community” approach to juvenile delinquency prevention and intervention in which the impact of the sum is greater than its parts.

Program Details:

Who the Program Serves: The target population consists of adolescents who are referred by the Lackawanna County, Pennsylvania, juvenile justice, child welfare, or the mental health systems for issues related to juvenile social maladjustment. Program Needs and Challenges: The discernable problem was the issue of juvenile crime, particularly juvenile crime of an increasingly violent nature and related to serious juvenile social maladjustment, in Lackawanna County, Pennsylvania. Data on the spectrum of juvenile crime in the county was obtained from the Pennsylvania Electronic Juvenile Justice Databook, a special analysis of unpublished data collected by the Juvenile Court Judges’ Commission (2005).

Although the evident problem was the manifestation of socially unacceptable, and sometimes illegal, behavior on the part of certain adolescents, empirical evidence indicates that serious antisocial behavior is determined by underlying causes in an interplay of individual, family, peer, school, and neighborhood factors. Restrictive out-of-home placements, such as residential treatment, psychiatric hospitalization, and incarceration, fail to address the known determinants of serious antisocial behavior and fail to alter the social environment to which the youth will eventually return.

Research based programs, such as the Communities That Care model, identify standardized risk factors that predict youth problem behaviors and protective factors that buffer children from risk and help them succeed in life. Following that model, the Pennsylvania Youth Survey was administered to students in the Scranton School District. Based on analysis of the results by a Resource Assessment and Evaluation Work Group under sponsorship of the Employment Opportunity & Training Center of Northeastern Pennsylvania, a Community Action Plan for Lackawanna County was drafted. To coordinate strategic planning to support positive change in the delivery of a continuum of services related to criminal justice, including prevention and intervention, a consortium of key administrators of agencies and organizations that are involved or associated with the justice system formed the Lackawanna County Criminal Justice Advisory Board. Lourdesmont’s CEO, Dr. John A. Antognoli, serves on this board.

How the Program Works: The Lourdesmont Multisystemic Community Based Program was designed with fidelity to the Multisystemic Therapy (MST) model. MST posits that youth antisocial behavior is multidetermined and linked with characteristics of the individual youth and his or her family, peer group, school, and community contexts. As is true of the MST model, the Lourdesmont Multisystemic Community Based Program’s interventions are designed to attenuate risk factors by building youth and family strengths (protective factors) on a highly individualized and comprehensive basis. The provision of home-based services circumvents barriers to service access that often characterize families of serious juvenile offenders. An emphasis on parental empowerment to modify the natural social network of their children facilitates the maintenance and generalization of treatment gains.

Program Innovation:

New Dimension of Performance: The Lourdesmont Multisystemic Community Based Program is a home based therapy in which the treatment incorporates active and increasing involvement of parents and other family, including significant adults and siblings, in addressing delinquency and related problems of the family member who is the targeted juvenile client.

Furthermore, the Program uses and enhances the existing collaborative relationships among social services providers, the school districts, and the community’s youth program providers. Thus the Lourdesmont Multisystemic Community Based Program combines a family-based therapeutic approach with a community-based system of human services, educational, and social resources. Integrating the MST approach with the existing county resources creates a “community and family” based approach to juvenile delinquency prevention and intervention in which the impact of the sum is greater than any its parts.

Program Results:

Specific Client Results: The Program’s discharge criteria are outcome-based, rather than focused on treatment duration or other criteria. Client success is measured by the following client discharge goals:  Youth is living at home (not in residential placement or juvenile detention).  Youth is attending school (not truant) and/or is employed in the work force.  Youth has remained drug free.  Youth has remained crime free.

Overall Program Results: The Program’s results accomplish objectives related to the goal of preventing externalizing behaviors by targeted juveniles who are “at risk,” or recidivism by previous juvenile offenders, and prevention of similar problem behaviors by siblings.

o Increased emotional competence among targeted juveniles (and other family members, including siblings), including the expression, understanding and regulation of emotions. o Decreased negativity in relationships between adults and targeted juveniles and their families, leading to the development of positive relationships with peers, family members, and adults in various community organizations. o Increased parenting skills that enable parents to deal more effectively with their youth’s behavior problems and know how to make best use of the complex of interconnected service systems. o Clear standards for healthy, law-abiding, pro-social behaviors, to enable youths and their families to reduce and/or eliminate intense negative attitudes and behaviors. o Increased knowledge and skill in drug use/abuse resistance among targeted adolescents and their families. o Reduction in the rate of arrest or recidivism among targeted juveniles.

Program Evaluation and Measurement:

The Lourdesmont Community Based Multisystemic Program has a set of “performance measures.” Each Lourdesmont therapist tracks the progress and outcomes on each case by completing case paperwork and participating in team clinical supervision and consultation weekly. Data and statistics on the following key indicators are tracked throughout the program, with periodic analysis of progress for reporting purposes: o Tracking of participation of the youth and other family members in treatment (MST therapist home visits) o Tracking of family functioning in support of positive behavior change, including level of engagement by adult family members with the MST therapist relative to parenting issues or crisis situations involving the youth o Tracking of the level of engagement of the youth in school or an appropriate vocational activity or training, including absences/truancy records o Tracking of the participation of the youth in prosocial activities and association with prosocial peers, including extracurricular school activities, community recreational activities, faith-based activities, and other prosocial pursuits. o Tracking of percentage of clients who complete treatment based on clinical assessment (not on placement into another program or drop out) o Tracking of whether the youth was arrested (or recidivism in the case of previous arrest)

Social Impact:

The majority of juvenile delinquency programs deal with adjudication and incarceration (i.e. punishment) and many social services targeted to “at risk” juveniles concentrate primarily on only the client (his/her behaviors). Many traditional programs only minimally address the role of parents/adults, siblings, peers, and other persons in the client’s life environment.

The Lourdesmont Community Based Multisystemic Program instead uses a prosocial approach. The Program defines a new parameter of performance in that:

-- it seeks results in the building of youth and family strengths (protective factors) that are known to counteract the risk factors for juvenile delinquency or recidivism

-- and since these protective factors are found within the youth’s family and community, the treatment is home based,

-- which places an emphasis on family involvement and parental empowerment to modify the social network of their children, which facilitates treatment and enables maintenance of treatment gains into the future.

Sustainability:

Lourdesmont’s Multisystemic Community Based Program has been successfully implemented and will continue to provide services to the targeted client population.

We have considered options toward eventually expanding the Program in the future into an adjacent county, depending on a needs analysis.

Lourdesmont has secured the means for funding of the majority of the costs for this Program through Community Care Behavioral Health of Northeastern Pennsylvania, the regional Managed Care behavioral health coordinating agency, for provisions of services on a fee for services basis through the clients’ eligibility for Medical Assistance.