Barely 17, Jonathan has been lots of places. Psychiatric hospitals in the Bronx and Westchester, three times over. Three different drug treatment programs. Jail, briefly, after a friend of his was charged with murder. And now a group home in Rockland County, where he feels like an alien among trees and suburban kids, across the Hudson River and an hour’s drive from the people and places he knows.
Once Jonathan started shuttling between care facilities at age 14, he saw Crotona, his Bronx neighborhood, less and less frequently, until he finally never saw it at all. Leaving home was both a nightmare and, for lack of other options, a necessity. For it was in Crotona that a barely pubescent Jonathan had found friends, girls, excitement–and angel dust.
“I started bugging out,” he says matter-of-factly, speaking of his ordeal with a distance that years and extensive therapy have given him. Jonathan, wearing a blue and white warmup jacket, will hold a penetrating gaze for long stretches of time, then drift into his own private zone. Seated at a table in a Bronx office of St. Dominic’s Home, the agency that runs his Rockland group residence, he scribbles and scribbles with a ballpoint pen, drawing tiny graffiti tags and geometric shapes over every inch of a paper napkin.
Jonathan’s studied calm can’t hide the fact that after three years he’s frustrated to still be in institutional care, though he’s been told he may soon be moving back to his home in Crotona. The program he’s been in for a year now at St. Dominic’s, called Return to Family, helps kids who’ve been bouncing back and forth from foster care to psychiatric institutions get out of these systems and back to their family and neighborhoods (the agency requested City Limits not use the last names of patients and family members).
In Jonathan’s case, the drug PCP–a pharmaceutical wrecking ball under the best of circumstances–sent his already fragile emotional life careening between rage and detachment. “I was a problem child,” he readily acknowledges. “I used to always throw rocks at cars. I used to always give people beatings.”
Among his targets was his mother, Loida. Petite, earnest and talkative, she wrings her own napkin as she describes what life was like back then. As Jonathan’s drug use became more intense, the physical and verbal abuse escalated to the point where she was terrified to be in his presence. She tried sending Jonathan to live with her mother in an apartment downstairs, but the problems kept getting worse, including truancy and frequent late-night visits from cops escorting him home.
“There were times the police felt sorry for him,” Loida recalls, now sitting comfortably at her son’s side. “They knew the trauma we were going through. And I didn’t know where to find help.”
She decided that she had no choice but to seek psychiatric care for Jonathan. He was sent to New York Hospital-Cornell Medical Center in White Plains, then back home. Soon after, he spent seven months in the Bronx Children’s Psychiatric Center, where he was transferred to a drug treatment program in Westchester for another four months, then back to Bronx Children’s Center again.
There was nowhere else for Jonathan to go, and nowhere for him and Loida to get the help they needed for Jonathan’s psychological and substance-related problems–a complicated web of a severe mood disorder and abuse of PCP, alcohol and marijuana. “When I first went to the psychiatric hospital I thought I was crazy,” Jonathan recalls, breaking into a knowing smile. “I was like, damn, there are kids in here talking to themselves! The only reason I ended up in the hospital was because I was using drugs.” Paradoxically, the destructive influence of drugs harbored hope. For if it was substance abuse that pushed him over the edge, maybe radically positive intervention–and efforts to directly confront the stresses tearing his life apart–could bring him back home.
Opened in 1995, Return to Family operates ten beds for teenagers who have been moving from placement to placement with no end in sight. Four are for New York City kids like Jonathan; the rest are for Rockland residents. They come from foster homes, group homes, youth shelters, drug-treatment facilities and endless combinations thereof. The program’s record-holder was one 13-year-old who already had been committed to care 12 separate times, including seven hospitalizations, before she came to St. Dominic’s. All of the kids at Return to Family meet the criteria for being “seriously emotionally disturbed.”
In the parlance of the foster care system, these nomads are “hard-to-place children,” a designation that has done little to get them appropriate care. “In the 1950s, hard-to-place meant black children,” says Dr. Karen Oates, associate executive director of St. Dominic’s Home. “The label has always been more reflective of the system’s priorities than of the youngsters’ needs.”
No one knows exactly how many of the roughly 53,000 young people currently in foster care in New York State fit in the hard-to-place category, which is defined by the city’s Administration for Children’s Services (ACS) as having lived in five or more situations away from home. Such transience, child welfare experts say, is almost invariably a result of emotional problems on the extreme end of the spectrum.
“The foster care system has a lot of very troubled kids who manage to do okay anyway,” says Gail Nayowith, executive director of the advocacy group Citizens’ Committee for Children of New York. “A lot of them end up succeeding with medication or treatment. There are many group care facilities that can address their needs. But occasionally you end up with behavior that’s risky, and the family and child need to be protected from each other.”
As a result of their transience and special needs, hard-to-place children are disproportionately represented among the clusters of kids sleeping overnight in ACS offices awaiting placements. For the past two decades, the state’s Council on Children and Families has tried to make sure that these foster care kids aren’t lost as they get shuttled among the social service, mental health and educational systems, but few facilities offer the comprehensive services they really need. Currently, only 130 care slots in the state are designated for the hard-to-place population–not nearly enough, caregivers insist, to meet the demand.
Return to Family is one of the rare programs that offers a stable place for hard-to-place children. What makes it even more unusual is its treatment philosophy. The program’s seemingly quixotic goal is to return emotionally distressed young people home for good. To accomplish that, the staff is willing to promise kids like Jonathan that while they are in St. Dominic’s care, they won’t be removed from the program for any outrageous behavior.
Collaborating with the children and their estranged families, the staff of Return to Family has safely returned 14 young people to their neighborhoods–to family members, to adults with whom they have had a meaningful relationship, or, in a few cases where no other options existed, to stable residential care with the long-term goal of independent living. Three other kids, unable to make the transition, have returned to institutional care. The program’s cost of about $250 per day per child–or a little more than half the price of hospitalization–is paid for by foster care allowances from the state and Medicaid support available for the mental health needs of children in foster care.
With Jonathan, it didn’t take long for a team that included him and his mother, a program director, a pair of social workers, a psychologist and a child-care staff member to identify a plan: At the end of his stay in Rockland County, Jonathan would be going back to live with Loida. From Jonathan’s point of view, it was better to come to grips with his conflicted feelings about his mother and Crotona than to continue facing the grind of institutional life. He says he misses the active social scene in his neighborhood, where playing baseball and listening to gangsta rap were part of the self he was forced to leave behind. “St. Dominic’s gets really boring,” he says with his usual candor. “It’s good to live there, but it’s hard because I can’t see my main homies.”
In a surprising number of cases, it isn’t hard to identify a willing caretaker, even after so many years of separation. Rather, the main obstacle to returning home, as Loida and Jonathan have been learning, comes in getting the child to trust the adult, and vice versa, after all that has conspired to destroy that trust.
“I was the one who had to put him in the hospital,” recalls Loida, trying not to cry. “Jonathan didn’t understand why I did that. It wasn’t like he was going there because he had a fever. He would stay for days, weeks, months, years, and he would always come home. And then I would always have to put him back in the hospital. It’s like you’re putting your kid in jail. But as he’s gotten older, he’s realized that it was hard for me to put him there, and that I put him there for a reason.”
Cycling in and out of psychiatric hospitals is typical for children who end up in his program’s care, says Dr. John Shaw, the director of mental health services for St. Dominic’s and the creator, along with Oates, of Return to Family. Over and over again, he’s worked with kids who’ve paid the price of living in institutions that aren’t prepared to deal with their complicated needs. Psychiatric hospitals tend to be the dumping ground for kids with chronic behavior problems that other agencies can’t or won’t handle–arson, sexual and physical assault, multiple runaway episodes, chronic truancy. Among New York City children with high numbers of placements, nearly one quarter have attempted suicide.
Often, says Shaw, well-meaning psychiatric hospital personnel will refer a kid to drug treatment, or a drug program will send a kid to psychiatric care, without ever addressing the fact that absence from home is a big source of the problems.
That appears to be what happened to Jonathan, who was discharged from his first drug-treatment stay with the explanation that he had accomplished what he could there, and now needed to focus on mental health issues. “The only thing the kids have in common with one another is that they have not succumbed and adapted to the systems that are caring for them,” Shaw explains. “And that’s because they’re primarily focused on the fact that they’ve been deprived of their home.”
Caught between their rage against authority and the pain of displacement, they respond, he says, with “one loud, angry protest that’s been consistent in every system of care they’ve had. But what’s been seen as their deficit can really be capitalized on as their strength.” For instance, Return to Family’s staff has helped Jonathan discover aspects of his personality, such as his willfulness and introspection, that they hope he can use to shield himself from the temptations he will face when he is back in Crotona.
And because of Return to Family’s no-eject policy, Jonathan knows that no matter how outrageously he behaves, no matter how many chairs he throws when he’s upset, he will not be kicked out of St. Dominic’s.
“They try to calm me down, but after a while they just pay me no mind,” Jonathan says mildly, shaking his head while keeping his eyes cast down at his drawings. He’s clearly aware that this behavior is not right. “In the other places they’d throw my ass in the quiet room. That’s where they put you when you’re acting out, and they shoot you with Thorazine if you don’t know how to act.” The quiet room is a rubber-walled cell that’s a standard feature in mental health facilities–quiet only, Shaw observes, if you’re not the person locked inside. But Return to Family has no quiet room, just the bedroom Jonathan shares with two other boys. When he gives the staff attitude, they ignore him until he gives up and slumps off to his room like any other teenager.
On the one occasion when he had to be removed to an outside drug treatment program after he began using again on weekend visits home, the staff took advantage of his absence to come up with a treatment strategy for when–not if–he returned. “Other child care agencies would be looking for another placement at that point,” observes Cathy O’Brien, who supervises daily care for Jonathan and his peers. “It’s a difficult challenge to confront the problem directly, to think, ‘We’re frustrated, but what else can we do here?’” Currently, Jonathan’s service plan includes drug treatment sessions three times a week and placement in an alternative high school nearby that specializes in educating teens who live in group homes. A psychologist works with him on behavioral therapy, to help him learn to handle his emotions.
And there’s another essential player in this process–Loida. She and Jonathan meet regularly with a St. Dominic’s psychologist and social worker to learn how to deal with each other. It was evident to the staff that despite everything they’d been through, Jonathan and Loida cared very much for each other, and those feelings were deliberately chosen as the focus of their interpersonal work. They’re also learning how to defuse Jonathan’s hyped-up temper. After they were both ready, Jonathan was allowed to go home for weekend visits. “We’re still getting used to each other at home,” says Loida. “He doesn’t like me telling him what time to come home, or to eat breakfast.”
“I’m tired of people treating me like a little kid,” replies Jonathan, increasingly agitated as he begins to grind his pen into a styrofoam plate. “I’m not a little kid anymore.”
Return to Family can accomplish what traditional systems of care don’t even attempt because it’s understood that when a teen like Jonathan does go home, he’ll be returning to an imperfect environment. Though angel dust has fallen out of favor, marijuana is now the drug of choice in Crotona Park, which is right across the street from Loida’s apartment. While lots of his friends can smoke blunts and just lose a little time and munchies money, Jonathan recognizes that with his emotional problems the drug is unmanageable. Yet he’ll admit, in the presence of his caretakers, that on a home visit he went to Boston with a dealer friend, where he spent some of the dealer’s money on drugs.
Some negative influences are even closer to home, including an uncle who went from being a flashy drug dealer to a wasted nobody after he started getting high himself. Even now, Jonathan finds himself admiring the man’s faded success and the money it brought him. “It’s just going to be real ugly,” he says slowly. “In the Bronx, it’s like this. You go outside on a hot summer day and you got no money in your pocket, but you just want to have fun. You see a guy with a big chain and all this money in his pocket and he goes, ‘John, you want to work with me, yo?’ And I’m like, damn, I’m going to have to sell.” The next time, he hopes, he’ll be strong enough to resist.
The strategy sounds risky, but Return to Family operates under the unspoken credo that the emotional harm caused by keeping young people in institutional placement outweighs the problems they’ll confront back home. Jonathan’s social worker also feels secure sending him to the Bronx because he and Loida will have many kinds of help available to them. Return to Family routinely works to identify human resources in kids’ home communities, people who can form a real-world support network when they get back.
“If they mention a person at their favorite store, we’ll go talk to that person, follow up on that, and see what kind of resource is there for the kid,” Shaw says. “The immediate thing it provides–when we say, ‘We talked to your friend at the store’–is a real emotional boost. And then what we’d say to the store owner is, ‘Is there a possibility of a job here?’” So after Jonathan mentioned a psychiatrist who had worked with him at Bronx Children’s Hospital, someone arranged for the psychiatrist to call Jonathan and ask him how he was doing, extending their relationship from the past into the present and, implicitly, the future. Return to Family also contacted the uncle, who’s now in drug treatment, and asked him to come up for a visit.
This kind of radically individualized care is becoming increasingly common in the mental health field, where it’s been used for over a decade to provide a tailored menu of services to patients with complex problems. But Shaw and his staff know of no other program that uses this approach to send hard-to-place children back home.
Another important source of support will be the Home and Community-Based Waiver Program (see City Limits, February 1998). Open to emotionally disturbed kids who are eligible for Medicaid, it’s an intensive case management effort that works with the family to prevent young people from going into institutional care in the first place. Jonathan and his mom participated in it once before, but it wasn’t enough to avert hospitalization. Now that Jonathan is better off, the hope is that the program will provide the safety net he and Loida need to make the transition. “It’s a psychiatric hospital without walls,” says Rich Nelson, a St. Dominic’s social worker with the program in the Bronx. “It brings all those services into the family and the community.”
First, though, Jonathan will have to make it back home. Barring any further crises, that should happen by the end of this year, but insecurity and boredom have made him unbearably restless. “I want to become somebody,” he announces. “I want to be a star. I want an education. I want to do what I’ve got to do.”
Loida’s hopes might seem more pedestrian, but given all she and her son have been through, they’re really just as ambitious. “I hope when we say good-bye to St. Dominic’s,” she says, “that this time it’s good-bye for good.”
Alyssa Katz is a Brooklyn-based freelance writer.