“Hard to Place” Youths – Challenge and Response

Shimon E. Spiro and David JacksonTel Aviv University and Geha Mental Health Center, Israel

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.

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.

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.

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.

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”.

Characteristics of the Residents of the two homes (percent)

0

10

20

30

40

50

60

70

80

90

100

6560

7570

25

40

95

70

77

89

71

17

77

24

94

65

Boys Girls

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.

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.

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.

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.

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.