“Hard to Place” Youths – Challenge and Response

1. Shimon E. Spiro and David Jackson Tel Aviv University and Geha Mental Health Center, Israel “Hard to Place” Youths – Challenge and Response

2. Background: Children in Group Homes • In Israel, about 6500 children and young persons have been placed in group homes due to the inability of their families to care for them. • Group homes are graded according to the severity of the emotional and behavioral problems of the children placed in them. • The more severely disturbed children are in “Treatment homes”. Some of these are designed for mentally ill children and youths.

3. Background (contd.) • The Ministry of Social Welfare is responsible for the placement of children in group homes. • The ministry pays for the upkeep of the children, sets standards, and supervises the homes. • The homes are owned and operated by NGOs, by private owners, or by local governments. • A home can accept or reject a child referred to it.

4. The “Hard to Place” • Every year, 50-100 youngsters, mostly in the 12-18 age group, cannot be placed. • These children are rejected by the homes to which they are referred, or expelled after a short stay. Some may have been shifted between as many as a dozen group homes and foster families.

5. Who are the “Hard to Place”? • They pose a danger to themselves and/or to other children and staff. • They have a record of attempted suicides, or of sexual and physical assaults on fellow residents and staff. • Some have been diagnosed as mentally ill. Others have records of juvenile delinquency. • Attempts to engage them in educational or therapeutic processes have been unsuccessful.

6. The Bureaucratic Response • The ministry of welfare responded to the problem by issuing a tender offering to pay an enhanced fee to group homes that accept all youths referred to them, and promise not to expel anybody. • Two private operators accepted the challenge and opened two small homes, one for 20 boys and one for 25 girls. • The two homes did accept all those referred to them, and for two years were able to contain and retain almost all of them. • The manner in which they operated can be characterized as “trial and error”.

7. Characteristics of the Residents of the two homes (percent)

8. Designing a Model • The ministry was not satisfies with the bureaucratic solution, and wanted to develop a model for a group home designed specifically to cope with the most challenging population. • A task group was established, composed mostly of professionals with many years of experience in treatment group homes. • The group was asked to prepare a report within one year.

9. On what did we base our recommendations? • The experience gained by the staffs of the two homes in their first two years of operation. • A systematic review of the literature from various parts of the world. • The combined knowledge and experience of the 14 members of the task group.

10. The Vision • The proposed home shall not only contain and maintain the youngsters referred to them, but offer them hope for a full and meaningful life and successful integration into society.

11. Main Elements of the Proposed Model • Homogeneity by age, sex, and main problem (mental illness vs. delinquency). • Emphasis on “milieu therapy”, with very limited exposure to the outside world. • Well structured daily schedules and routines. • Individually tailored treatment programs. • Long term stay (till age 18). • Small (12 residents) and staff intensive. • Attachment to existing larger homes, to provide professional and logistic support, or networks of small specialized homes, with some joint operations.

12. Outlook • The proposed network of homes will necessarily be very expensive. It is as yet unclear whether the government will accept and implement the recommendations of the task force.