Traditional drug treatment for teens often means being sent to an inpatient facility, far from family and friends. The young people might stop abusing drugs but then, soon after they return to their neighborhood they revert to their old ways.

A program developed by the non-profit Vera Institute has been trying to address this problem with a different kind of treatment: short-term therapy, in a teen's home, with the teen's whole family.

In partnership with the Office of Children and Family Services and other New York state and city agencies, Vera has been testing the program, called Adolescent Portable Therapy, with teens in juvenile detention.

" We recognized that there was a population of kids and families whose needs were not being met, who needed a different kind of intervention," said Evan Elkin, the program's director.

Researchers found that one in every five youth admitted to the city's juvenile justice system had been using drugs, usually marijuana, almost every day for the previous month before being admitted to detention. But in detention, many of those teens were not receiving treatment or saw it interrupted when they moved to another placement or returned home. The portable in APT is key: It is designed to be a support that can move with the teen from detention back into the community. The hope is that such portable therapy can help prevent teen drug users from being placed in residential care.

Teens who decide to participate are assigned a therapist who will stick with them no matter where they are placed. The therapists continue to meet with the teens for four or five months after they are discharged from whatever program they're in and readjust to being back in their neighborhood. The program's therapists also meet with the teen's family or other supportive adults and come to the family's home or any other place the teen and family feel comfortable.

" It's family therapy, but we expand the definition of family," said Elkin. "The first thing we do is sketch out a map of the supportive adults in the young person's life."

If a youth is in foster care, a program therapist might work with the foster mother, group home staff or with someone from the birth family.

In addition to its focus on family therapy and treatment wherever the teen is living, what sets APT apart from other programs is its emphasis on the young person's strengths.

" Often kids will be very confused by our approach," Elkin said. "It's not the Alcoholics Anonymous model. We don't want to bring teens in and make them admit that they're powerless. We believe people are inherently able to change and inherently strong."

How It Works

Mike (not his real name), a 17-year-old who entered the program last year, said he liked the individual attention it provided.

" A therapist came to see me, and once I went upstate she called me every week," he said. "She talked to me about how I felt like when I smoked and how I felt now that I was clean, and we compared the two. I realized there was a lot of stuff I'd been missing out on when I was high. And it was just helpful to have someone to talk to."

Eric Kolb, one of the program's therapists, said a lot of the therapy involves figuring out what kinds of situations tempt kids to use drugs and how they can be avoid such situations or cope with in different ways.

" For instance," Kolb said, "say a kid fights with mom at night, and the only way he can get calmed down enough to go to bed is to get high. We'd identify that and then talk about what it is about the fights with mom that get him so upset. And then we'd try to bring mom into that conversation, find out if she could say things differently. We take it moment by moment. We let the family know—these are other things you could try."

Mike was recently discharged to a group home, and his therapist comes to see him there. He said they plan to start family meetings with his biological mom and his little brother, and he'll continue the program for several more months. But he already feels APT has put him on the right track.

" Before, quitting was just something I said," he explained. "I'd tell people, 'Yeah, I'm going to quit,' but I never did. After I started talking with my therapist, I actually wanted to."

This article is adapted from the pages of our partner Youth Communication.  

One night in 1999, Sharwline Nicholson’s former boyfriend showed up at her house and assaulted her when she opened the door. While she was in the hospital being treated for her injuries, the city’s Administration for Children’s Services took her children from the neighbor’s home where they were staying and charged Nicholson with “engaging in domestic violence.”

Nicholson became the lead plaintiff in a class action suit against the New York City foster care system aimed at stopping the practice of removing children from victims of domestic violence solely because the parent has been abused. The plaintiffs won the case. Since then, ACS has had to dramatically change how it handles cases involving domestic violence. It can no longer remove children from victims of domestic violence solely because they are victims.

As a result of the lawsuit, a committee of experts reviewed the child welfare system’s policies and training. The agency then directed more staff and funding to domestic violence programs and improved training. Since the lawsuit, experts say, there is more of an institutional commitment to work with victims of domestic violence and to get them the help that they want or need. The city, however, still removes children from the homes of victims of domestic violence.

While ACS needs to protect children from abuse, it also does not want to unnecessarily separate children, many already scarred by scenes of violence in their homes, from their parent.

The Dangers of a Violent Home

Research shows that domestic violence between adults frequently goes hand in hand with child abuse, and the U.S. Advisory Board on Child Abuse suggests that spouse or partner abuse violence may be the major precursor to child abuse and neglect fatalities in the country. About half of men who batter their partners also frequently abuse their children, and women who have been hit by their husbands are twice as likely to hit a child. Children who are exposed to domestic violence are more likely to exhibit behavioral and physical health problems including depression, anxiety and violence toward peers than children who are not exposed to violence at home. Children in homes with domestic violence are also more likely to attempt suicide, abuse drugs and alcohol, run away from home, engage in teen prostitution and commit sexual assault.

This is something that Princess, a former writer for Represent, a magazine written by teens in foster care, knows firsthand. "I've gone through a lot in my life, including being abused myself, but watching my mother being hurt is the worst thing I've ever gone through," Princess wrote in Represent. "I'm 21, and I still feel such a fear of an unexpected attack that I always double check my doors and windows to make sure they're locked. Sometimes I wake up crying. And I don't think I will ever be able to hear the words 'I'm sorry' without feeling anger at the fact that you may not mean them."

Child protective services can still remove children in Princess' situation if the violence is repeated and serious, and the children are clearly suffering serious emotional harm or the risk of physical harm. They can also remove children if the mother is offered meaningful help and decides not to act on it – if, for instance, a caseworker recommends that the mother goes to a shelter but she does not. In those cases, the battered parent can be charged with “child neglect,” meaning that she did not protect her child from violence or the threat of violence.

Keeping Children and Mothers Together

The Nicholson case raised awareness that many children living in homes with domestic violence should stay with their mothers, so long as the mother is taking steps to protect her children from the violence at home. It's something that many children living with domestic violence want as well.

Merli, another writer for Represent, remembers the trauma of watching her father beat her mother, but she says it would have been even more traumatic to be separated from her mom. "My mother was the most important person in my life," she wrote in Represent. "She needed help to get away from my father, but I needed her. If I had been taken from her, I would have been devastated."

Now removal solely on the grounds that a parent is being abused is not supposed to happen. “Obviously, that doesn’t mean that it never happens,” says Jill Zuccardy, one of Nicholson’s lawyers. “Some caseworkers make threats of removal inappropriately, but now it’s the exception and it’s against the law.”

The Victims’ Perspective

An increasing awareness of the perspective of domestic violence victims as well as the overlap between child welfare and domestic violence has permeated the foster care system over the past decade. Advocates say ACS workers are far more sensitive to the issues surrounding domestic violence. The agency has begun working closely with advocates and survivors to develop better policies for cases involving domestic violence, and Commissioner John Mattingly has met with domestic violence survivors to learn about their experiences with the agency. Members of Voices of Women Organizing Project, an advocacy group of domestic violence survivors, now sit on ACS’ Domestic Violence Advisory Committee and the Parent Advisory Workgroup.

Batterers often make false accusations of child abuse or neglect against their victims. Voices of Women and ACS have worked together to come up with protocol for child protective workers to follow when they suspect a report is false. Voices of Women founder and director Susan Lob said the group recently worked on a case where ACS was called about 30 times to a home because of a false allegation. “That’s traumatic to the family and a waste of the city’s time and resources,” said Lob.

Determining whether a report is false or not can be a life or death matter for a child. But partly due to the work between the two groups, ACS developed a protocol that acceptable to both child advocates and advocates for domestic violence survivors. When ACS workers suspect false reports, they now are supposed to contact the liaison between Child Protection and the district attorney’s office. In their latest media campaign, ACS even included a line warning that false and malicious reports are a crime, and the warning now appears on their Web site and brochures as well.

Turning the System Around

Voices of Women members also have made recommendations about the kind of training about domestic violence ACS workers should receive. But coming up with policies has been easier than changing day-to-day casework, said Lob. “On paper, the policies are really great,” she said. “Now we’re working on actually making those policies happen on the front lines.”

Voices of Women keeps a 16-point list of recommendations of policy and practice improvements and tracks the progress made on each point.

“Changing the system is often compared to turning the Queen Mary around in a small channel,” said Lob, “but I feel positive about the direction that ACS is going in. It’s a good sign that survivors are, for the first time, involved in giving feedback to the commissioner and staff and that the domestic violence staff are responsive.”

Sharwline Nicholson remembers that, before her lawsuit, survivors of domestic violence would advise each other in court, “Don’t fight the system. Whatever they give to you, just do it so you can get your kids back.”

After the lawsuit and lobbying for changes, Nicholson has begun began to sense a shift. “I could truly sense the anger the parents were feeling and the encouragement and empowerment I had to give,” she wrote in Rise, a magazine by and for parents in the child welfare system. Nicholson hopes her efforts will help "push forward legislation that will encourage more parent voices in the system, and bring about changes for the better for parents and children dealing with domestic violence.”

This article is adapted from Rise, a magazine by and for parents in the child welfare system, published by our partner, Youth Communication.  

United Community Child Care Center in East New York. (Photo by: Tara Siegel)

For thousands of hardworking low-income New Yorkers with preschool children, the stress and financial burdens of finding a safe, nurturing daytime environment for their kids while they work can be an insurmountable challenge. Yet many of the government day care subsidies earmarked for families in need are left untouched. Why? The reason lies in a number of unnecessarily stringent and seemingly arbitrary barriers to eligibility, which has caused day care programs across the city to be underutilized.

In 30 years of working in social services for families and children, and as the executive director of an agency that provides day care for nearly 800 children in New York City, I have seen first-hand how available childcare slots remain vacant because parents are unable to take advantage of the public funding that could help them afford day care. Families struggling to make ends meet need both parents working to have a decent living; and if both parents are in the workforce, someone else needs to care for their children.

But day care is expensive, which is why subsidies are available for parents who have children from 2 months to 12 years old. A limited number of vouchers, which are available on a first-come, first-serve basis, can be used at any day care facility; thereafter, subsidies are granted for specific local day care facilities, which contract with the state.

This should be a win-win situation: Subsidies provide childcare so both parents can work and better provide for their families. But it doesn't turn out that way. The most egregious of the obstacles is an unfair Catch-22 intended to gauge a family's need for financial assistance.

Currently, a working couple who - like most - cannot afford their own nanny is NOT eligible for state-subsidized day care if their gross household income is a nickel more than $45,000 combined - that is $433 a week per parent before taxes. If that working couple has two children, they would just barely qualify for a day care subsidy; but even then the family would have to pay a weekly fee of $83 - over 19 percent of one parent's gross weekly pay.

And if one parent gets a raise, the family's eligibility disappears. They then would need to pay the full, unsubsidized rate for day care - an average of $170 per week, or almost 40 percent of one parent's gross weekly pay.

Thanks to this artificial, low-income ceiling and restrictive eligibility guidelines, hundreds of available seats for day care in New York City stay unused and empty. Instead, too many children are at home because their low-income parents cannot qualify under the current guidelines.

Consider Linda, Robert and their 3-year-old daughter Mona of Manhattan (who declined to give their last name for confidentiality reasons). Although Robert was unemployed, Linda had a job, and, thanks to their day care subsidy, they were able to enroll their daughter in a local day care center. Mona, who had had behavioral problems in the past, blossomed in day care, where her social skills and creativity began to develop. Then one day Robert came in beaming with the news that he had found a job. But when it came time for the family to be recertified for their subsidy, they were shocked to learn that they were no longer eligible, because with Robert employed they made too much money.

But they didn't make enough to pay the full, unsubsidized fee. So they were suddenly left with an untenable choice: Forego the extra income or scramble to find a less-desirable childcare situation for Mona.

The inexplicable low-income ceiling is not the only reason the city's day care subsidy program is underutilized. Several other barriers to eligibility prevent families from receiving the assistance they need. Among them:

Child support restrictions: A single parent is denied childcare when he or she does not pursue the other parent aggressively for child support. Yet it is widely known that many single parents fear pursuing child support in court: It often upsets fragile, but workable informal agreements between the parents. In other cases the father may be an abuser or unstable or poses another threat.

Red tape: It can take several weeks to get government approval for a subsidized day care slot. Parents must make an appointment at their local resource center, where waits are long. The appointment only comes after an at least three-week processing period. In some neighborhood programs, parents can fill out applications on site, which are then brought by staff to the local resource center. But there is still often a long wait for approval. Job offers and training programs rarely wait that long, so parents often must seek other, usually less desirable, solutions. It is not unusual for a parent to opt for other forms of child care in order to begin a job or start training.

Immigration rules: Any child born in the U.S. is eligible for day care, regardless of whether his or her parent is in the country legally. But rather than simply accept a legal birth certificate as proof of eligibility, current regulations require parents to provide additional personal information. Many do not, for fear of deportation, and so their children cannot participate.

In June 2007 there were 57,673 subsidized day care slots being used by low-income New York City families. That is down from 61,699 the year before - a loss of 4,026 slots or a reduction of 6.5 percent. The slots were cut by the city because they went unused, but not because they were unneeded. The number of slots that are filled still falls far short of the total need. That makes it all the more tragic that outdated policies and bureaucratic red tape have shut out many parents from taking advantage of these valuable services so important to their children's well-being.

It is incumbent upon our city and state elected officials to review these barriers and make the necessary changes to allow existing day care programs to serve their communities by filling empty seats and opening their doors to those who need their services most.

Robert H. Gutheil has served as the executive director of Episcopal Social Services since 2004. Episcopal Social Services is a community service based organization offering comprehensive foster care, family preservation and adoption services; Early Head Start and day care services; after school programs and others. During his tenure, Gutheil has concentrated on the expansion of childcare services. 

Lanette Murphy is raising four children on the Lower East Side, one with a form of autism and two with chronic asthma, by herself. At one point when a health maintenance organization, or HMO, covered her kids, she was spending $100 a week on doctors visits on a salary of $34,000. Murphy, 43, is uninsured.

"I didn't have enough money to feed them," said Murphy shaking her head at the cost of medical care under the HMO. "For me, OK. Don’t worry about me. But what about the children?"

Murphy has since abandoned her HMO and, at the insistence of a community health center on the Lower East Side, enrolled three of her children in a state and federally subsidized children's insurance program.

Known as Child Health Plus in New York and referred to as the State Children's Health Insurance Program throughout the country, the program allows some low-income families that are ineligible for Medicaid to receive free or at least discounted health care for their children.

Earlier this year, the state legislature and Governor Eliot Spitzer approved an expansion of the state subsidized program, which receives federal matching funds, and increased the income families could receive and still be eligible. The move promised to provide health care to all of New York's 400,000 uninsured children, many of whom live in families that, despite being well above the poverty line, can still not afford health insurance.

But then New York and other like-minded states ran into a huge obstacle. Last month, the federal Centers for Medicare and Medicaid Services announced regulations rolling back the program, making it nearly impossible for states to expand coverage to families whose income was more than 250 percent of the poverty line. The regulations, advocates and New York's state, city and federal officials say, are a leap backward and could potentially spark a heated battle between the federal government and the Empire State. That fight could wind up in court.

Expanding Coverage

Approved in 1997, the State Children's Health Insurance Program was financed for a decade and is slated to expire at the end of the month. The federal program targets children from families making less than 250 percent of the federal poverty level, or $51,630 for a family of four. (The federal poverty level is $20,650 for a family of four.) Under the federal program, states had been given flexible guidelines to design insurance plans and were granted waivers to expand coverage under special circumstances.

Prior to Spitzer's proposal to expand coverage, New York enrolled uninsured children in households below 250 percent of the poverty line.

Earlier this year, the state easily approved the program's expansion to children below 400 percent of the poverty line, or nearly $83,000 a year for a family of four. Seventeen other states and the District of Columbia have all attempted to similarly expand their coverage.

If it had been approved for a required federal waiver, New York State would have had the highest enrollment ceiling in the country.

But the state's plan was rejected by the federal government earlier this month.

“Together, with New York’s congressional delegation, we will ensure that the issue remains at the forefront of the national agenda," said Spitzer in a prepared statement following the plan's rejection. "We will continue reaching across state borders and, if necessary, making the case in the courts to ensure that the nation’s 11 million children have access to check-ups, immunizations and developmental screenings that put them on the path to a brighter, healthier future.”

Under the new federal regulations, which take effect next year, states are not allowed to expand coverage to children in higher income brackets until they cover 95 percent of children below 200 percent of the poverty line.

Not a single state has reached that level of enrollment. New York's participation rate is 88 percent – one of the highest in the country.

Congress and the Bush administration are currently battling over expansion and continuation of the insurance program. While both the House and Senate have approved legislation to expand funding for the program and several senators have introduced a bill that would effectively roll back the new regulations established by the Centers for Medicare and Medicaid Services, President George Bush has promised to veto any legislation that includes insuring "the middle class."

The Effects on New York City

By Mayor Michael Bloomberg's estimates, half of the state's uninsured children live in New York City. So, any cutback or limit on insurance, advocates said, could slash the number of kids covered in the five boroughs.

“Half of all the uninsured children in the state live in the five boroughs of New York City, and providing these youngsters with affordable health insurance is a goal that I wholeheartedly share with the governor," said Bloomberg in a prepared statement.

At the Ryan-NENA Community Health Center in the Lower East Side – the center Murphy has attended for over a decade – 30 percent of all patients are uninsured, said Dr. Roxana Cruz, the medical director. When confronted with uninsured children in particular, Cruz said, the center recommends the state's subsidized insurance program.

Any reduction in coverage within that plan, she added, is sure to affect them.

"If we're not able to do something about it at this time for children, the consequences are far greater than the costs are right now," said Cruz. "It seems each time SCHIP is looked at it gets cut even more. The battle is harder."

Murphy's children have been enrolled in Child Health Plus for less than a year, but she is already more satisfied with this program than any of her previous insurance plans. Because of her income and number of children, Murphy is not at risk of completely losing Child Health Plus eligibility, but she may have to pay a higher premium if she receives a raise in her job as a parent coordinator with the city's Department of Education.

Advocates fear similar consequences from the new federal guidelines, especially for those on the cusp of the program's income eligibility requirements. In New York City, where the cost of living is far higher than the rest of the country, increases in premiums could be difficult to afford.

"If you're living at 300 percent of the poverty level and you're in New York City and you were going to be able to get your kids on a low cost health plan and you can't now, it has a huge effect," said Elizabeth Swain, the chief executive officer for the Community Health Care Association of New York State. "It's a real tragedy."

Insuring the Middle Class

According to the United Hospital Fund, a New York City-based research and policy group, about 7 percent of all kids in New York City -- or approximately 140,000 children -- are uninsured. Of the uninsured children, more than 70 percent of them live in families with incomes under 200 percent of the federal poverty level.

Given that the vast majority of the uninsured already qualify for the program, some see Spitzer's proposal as unnecessary.

A New York Post editorial called Spitzer's proposed expansion "nonsense on stilts." Like many other opponents, the Post argues that the State Children's Health Insurance Program was designed to cover low-income families that could not afford insurance - not the middle class.

"The argument that a program designed for children from low-income families ought to be expanded to a large number of families way above, I think is highly questionable," said Benjamin Zycher, a senior fellow at Center for Medical Progress at the Manhattan Institute. Insuring children from higher income families, Zycher said, would inevitably squeeze doctors, hospitals and pharmaceutical companies and make health care less accessible through low reimbursement rates from public entities.

Statewide, 82 percent of the uninsured children are already eligible for either Medicaid or Child Health Plus. Spitzer's expansion would cover the remaining 18 percent.

Even so, advocates claim that expanding the program could improve its visibility, enabling it to infiltrate a larger population of the poor and get more of New York City's children covered . Even with the program as is, the state has seen its uninsured rate for children climb slightly from 2005 to 2006–an increase of 7.4 percent to 8.4 percent, according to the U.S. Census Bureau.

"I think it's a big problem," said Danielle Holahan, United Hospital Fund's senior health policy analyst. "This being step one of a universal coverage agenda, to derail on your first building block out of the gate is frustrating."

Other advocates add that since the insurance program's premiums are on a sliding scale, families that make more would pay more.

A Legal Battle Ahead?

In both the Daily News and the Huffington Post, Spitzer has charged the Bush administration with abandoning the country's children and compared the new insurance regulations to a "poison pill." Last week, he joined the state's congressional delegation to call for a repeal of the restrictions or else.

Spitzer argues that because the Centers for Medicare and Medicaid Services did not give the public a comment period for the new regulations – state agencies learned of the changes in a letter sent out in August – the rules should be voided.

New Jersey Governor Jon Corzine is also reportedly looking into a lawsuit over the new regulations and is threatening noncompliance.

But those, like Murphy, who have been juggling HMOs and policies for years and who wait in doctor's offices and watch their children suffer from chronic illnesses, are not looking for a lawsuit – only health insurance.

" It's very stressful thinking, 'Oh my god I hope my child doesn't get sick,'" said Murphy. "If you are unable to afford health care for your children you shouldn't be penalized."

 

On a recent Tuesday afternoon, a parent in Manhattan Family Treatment Court faced Judge Gloria Sosa-Lintner. In a courtroom the size of an ordinary living room, the parent, a recovering drug user, sat in a bright orange plastic chair and told the judge and a roomful of lawyers and child welfare workers that she had been clean for 50 days.

“ How about some applause,” she demanded. Sosa-Lintner and the lawyers clapped enthusiastically. Then the judge granted her more visiting time with her kids. “You look good today,” Sosa-Lintner told the parent.

“ So do you!” the parent responded. “I love you guys! I love my program! I’m happy.” She turned to the bailiff and said, “I love you too!”

Such ebullience was understandable. This parent, one of many foster parents with a history of drug alcohol abuse, was one day closer to getting her kids back.

Substance Abuse and Child Neglect

According to the Child Welfare League of America, a least half of all kids in foster care have parents who abuse drugs or alcohol. The children of parents who abuse alcohol or drugs are three times more likely to be abused and four times more likely to be neglected than other kids. But typically, drug and alcohol treatment for parents with kids in care is kept separate from their dealings with family court and the foster care system. This makes it difficult for family court judges to monitor a parent’s progress fighting addiction and to make informed decisions regarding whether it will be safe for a child to return home.

Family Treatment Court tries to address that gap. At the court, parents who have lost their kids to foster care, or are in danger of losing them because of drug or alcohol problems, get support (and sometimes admonishment) for their efforts fighting addictions. The court provides intensive services and monitoring to help parents recover and get their kids back and enables judges to better assess parents' progress.

The court formed in response to New York City’s crack epidemic of the 1980s and 1990s that put so many kids in foster care. The program was one of the first of its kind in the country.

Back then, said court referee Susan Doherty, existing drug treatment programs were not working with people with crack addiction. Many kids whose parents were abusing the drug went into foster care and never went back home.

Much has changed since then. Now, when a parent charged with neglect is a substance abuser, New York City’s Administration for Children’s Services has the option to send them to Family Treatment Court. Parents are not forced to participate. Instead they are assigned a lawyer trained in addiction issues who helps them decide if they are ready for the program.

A Difficult Journey

“ What we tell them is that treatment court is harder [than regular family court], because they have to come to court more frequently and follow extra regulations, like taking drug tests,” said Doherty. “But it gives them a better chance of getting their kids back or of keeping them from going into the system, and it gives them a better chance of getting rid of their drug problem.”

Confronted with these options, not every parent says yes. “People have to be ready and willing to change,” said Sosa-Lintner who, like Doherty, has worked at the Manhattan court since 1998.

Once a parent decides to participate, they must first admit to being a substance abuser. “They have to tell the court, ‘yes, I have a drug problem,’” Doherty explained. This is not only the first step in recovery, but is legally required if the court is to take on the case.

Once in the program, each parent meets with a case manager who matches them with the appropriate drug treatment program: a day-treatment program, a residential program or evening sessions. Whatever the program, it must send the court a monthly progress report about how the parent is doing, and if he or she has been making visits with their kids.

To graduate from the FTC, parents need to meet several goals. They have to complete a treatment program, stay clean for at least one uninterrupted year, be able to support their children and complete a parenting skills program. They also may have to find a new job or housing to get their kids back.

But even if parents do all of this, there is no guarantee that they will get their kids back. Some parents might take so long to finish the program that their kids have formed a bond with whomever is caring for them and they are staying with, and a judge may determine that it is not right to move them again While parents stay in the treatment court for an average of two years, it takes some much longer to stay clean and do what they need to do to care for their children.

Steps Forward – and Back

The potential for relapse is a reality in any drug or alcohol treatment program. Family Treatment Court tries to give most parents another chance, if they can explain why they relapsed and get back on track. “Parents relapse all the time. We recognize relapse is a part of recovery,” Doherty said. “What’s important for us is how they handle it.”

One afternoon in the court, one parent had tested positive for alcohol when she arrived. When the judge asked her about it, she revealed that she had downed some glasses of wine the night before at a party.

The judge got a little tough on the woman, reminding her that, if she wanted her kids back, she had to successfully complete a treatment program.

Another mother, who was in and out of her program, offered no explanation for dates she had missed. A court worker said that the woman had tested positive for cocaine that morning.

Sosa-Lintner said that the woman’s children would be placed at their grandmother’s house that night. The mother asked for a referral to a 28-day detox program. After that, she hoped she would be clean enough to continue through with the treatment program.

Other parents celebrated their success. One woman got a certificate as a reward for completing “Phase One,” after being clean for four months straight. Now she was ready for Phase Two, another four months of sobriety and treatment along with parenting skills classes.

Denise Dizzine, a court case manager, explained that the court uses rewards and sanctions. “Sanctions might be meeting with a case manager every week or writing an essay about why it’s important for them to be in treatment,” said Dizzine. Rewards include perks like a journal, a supportive message from the judge, or more visits with their kids.

This model has proven so successful that today there are 48 family treatment courts in New York State alone.

“ The court acts like a parent figure,” Sosa-Lintner in explaining its success. “The people that come before Susan and me are usually young people, who haven’t completed much in their lives. They are looking for praise, and they’re also looking for the court to chastise them if they do wrong. People come to treatment court because they’re hopeful something will click.”

And for many people who come through court it does eventually click. As of February, 2007, the court had worked with 916 parents from 816 families, and 354 parents had graduated. Doherty would like to see it reach even more families. “I think the court is working great,” she said. “I wish it was working better. I wish that these resources -- the close monitoring, the support -- were available to all parents in family court.”

This article by La’Quesha Barner, a writer for Represent, written by and for foster teens, is adapted from the pages of our partner, Youth Communication.  

New York City recently concluded its Summer Youth Employment Program, a highly regarded city-run initiative that placed more than 41,000 New Yorkers ages 14 to 21 into publicly subsidized temporary jobs this summer. Young people participating in the program worked for employers from major corporations like JP Morgan Chase to local libraries and day camps. The experience provided structure to their summer, helped them earn spending money and gave them an invaluable introduction to the world of work that, according to leading workforce experts, will greatly improve their chances of success later on in life.

Unfortunately, the program serves only a fraction of the young people who could benefit from it. While the number of job openings remained virtually stagnant from 2006 to 2007, applications jumped from about 72,000 to over 93,000. In other words, the city had to turn away more than 50,000 youngsters from across the five boroughs who applied for the program this summer. Overall, the Summer Youth Employment Program now serves 20 percent fewer participants than it did in 1999, when the federal government provided funding for it.

The Value of Work

The gaps in summer program are particularly troubling because teenagers here face the most challenging labor market in the country. New York has the lowest teen employment rate of any of the nation’s 20 largest cities, with fewer than 16 teens per hundred employed—less than half the nationwide rate. Labor market experts speculate that the city’s large number of immigrants compete with teens for entry-level jobs, explaining the dismal figure. Even worse, the likelihood of finding a job drops with family income: In 2005, teenagers from families earning less than $20,000 per year had less than half the work participation rate (9.9 percent) as their counterparts from families making more than $80,000 annually (20.6 percent). In other words, the kids who could most benefit from jobs are the least likely to get them.

Having a summer job undoubtedly gives city teens a leg up. In economic researchers Andrew Sum, Neeta Fogg and Garth Mangum found that the benefits of early employment are considerable and lasting -- particularly for young people who do not plan to attend college immediately. Those benefits include a smoother transition to the labor market and higher weekly and yearly earnings for up to 15 years after graduating high school. Early participation in the labor market is among the strongest indicators of sustained employment and higher earnings later on in life. There is even some evidence that suggests young people who work are less likely to drop out of high school than those who don’t have jobs.

Funding Cuts

As the Center for an Urban Future reported in June, the Summer Youth Employment Program can’t serve more young New Yorkers largely because federal funding has all but disappeared over the last decade. In 1999, Washington provided the program with over $42 million. That figure fell to less than $5 million this year. The Bloomberg administration has admirably stepped into the breach, devoting $32.5 million in city funds toward summer jobs this year. And the city’s Department of Youth and Community Development has generally earned high marks for its management of the program. But city resources alone cannot be sufficient to provide a summer job to every kid who wants one—which should be the goal.

Before next summer, the city’s congressional delegation should push for a renewed federal commitment to summer youth programs in New York and elsewhere. At the same time, the city’s business community, which has a clear interest in ensuring the workforce of tomorrow will be well prepared, needs to become more involved in the program. While individual employers and certain sectors have invested time and effort in strengthening youth employment, far too few have made it a priority.

Mayor Michael Bloomberg should make a direct appeal to his former private-sector compatriots to take placements for the Summer Youth Employment Program and related programs, notably CAPITAL (Corporate Allies Program for Internships, Training and Leadership). Launched in 2006 as a “next step” for successful former participants in the summer youth program, who are deemed ready for more demanding work with business employers, CAPITAL expanded from 50 placements in its first year to a still-modest 82 in 2007. Given the size and scope of the city’s business community, the program very easily could accommodate 10 times that number by next year.

With so much to gain for the youngsters themselves and so much at stake for New York City’s economy, federal officials and local business leaders need to take action now to ensure that next year more than 50,000 New York City teens who want to work are not left idle.

David Fischer is project director for Workforce Development and Social Policy at the Center for an Urban Future.

 

For years government has given money to poor people. Usually the payment has been based on need—income, number of children, expenses and so one. Now Mayor Michael Bloomberg has taken a different approach. Hs administration plans to give money to poor people but they have to “earn” it by keeping jobs, sending their children to school and going to the doctor.

This approach, which has never been tried in this country, is part of Bloomberg’s second-term agenda for reducing poverty and increasing economic opportunity in New York. For now, it is privately funded, but, if it succeeds, the government could pick up all or part of the cost in the future.

While some hail the payments as a bold new approach, the plan has attracted controversy. Some charge it advances the idea that poor people are poor because of the things they do – or do not do. Others question whether poor people deserve a reward for doing things they should do anyway, such as take their children to the doctor.

The Payment Program

The family-focused pilot program will give money to families in three areas: early education, family health and adults’ workforce skills and job training. To test the idea, it will give money to 2,550 families with incomes below 130 percent of the federal poverty level -- around $22,000 for a family of three -- who have at least one child in public school in either fourth, seventh or ninth grade. The selected neighborhoods include Central and East Harlem in Manhattan, Brownsville and East New York in Brooklyn, and Morris Heights/Mount Hope and East Tremont/Belmont in the Bronx, among the city’s poorest communities

The design was largely based on Mexico’s Oportunidades conditional cash transfer program, which Bloomberg visited in late April. In explaining the idea at the time, Bloomberg said, “For all of us the stress of our daily lives can cause us to make decisions that aren’t always in our best interests. Living in poverty makes it even more difficult and can lead to missing a doctor's visit, for example.…The Opportunity NYC programgives New Yorkers in poverty a financial incentive to look ahead and to make decisions that will improve their prospects for the future.”

Jillynn Stevens, director of policy, advocacy and research for the Federation of Protestant Welfare Agencies, sees merit in at least trying this new approach. “It’s obviously directed at rewarding behavior that helps people improve their life situations,” she said. “And we think this is more productive than a punitive approach, like withholding or sanctions or any other numbers of things.”

The plan has attracted criticism as well. Heather MacDonald of the conservative Manhattan Institute says such payments deprive people of the normal inducements to properly care for their families. “It could destroy the ordinary incentive system that usually motivates people to engage in good" behavior, she has said. "You are going to create in people the expectation that they should do such proper things as take their children to school or study only if they are bribed by the government. I think the potential for unintentional consequences for this program are absolutely enormous."

Others see the payment plan as blaming the poor for being poor. “It just reinforces the impression that if everybody would just work hard enough and change their personal behavior we could solve poverty in this country, and that's not reflected in the facts," said Margy Waller, a domestic policy adviser in the Clinton administration and co-founder of Inclusion, a research and policy group in Washington.

PAYING FOR GOOD GRADES

Most of the criticism has focused on the education part of the program –giving students money for attending school, getting good grades and passing their state Regents exams.

The educational component was designed by Roland Fryer, a Harvard assistant professor of economics, who has taken a leave of absence to serve as the “chief equality officer” for the New York City Department of Education. He will also administer and assess the program.

Critics argue that kids should not be lured into learning by money. Tim Johnson, chairman of the Chancellor’s Parent Advisory Council, has said that the program will foster “ill will.” Other critics, such as Sol Stern, a senior fellow at the Manhattan Institute, expressconcern that instant money undermines the idea of learning for its own sake and that the money should rather be put into college funds.

Others fear cash payments will put even more pressure on already overwrought youngsters. Jane Hirschmann, co-chairwoman of Time Out From Testing, said she met with a group of such fifth graders recently. “I asked them what they thought,” she said, “and they said, ‘You can’t believe the pressure on us right now … My father will be on my back all the time because $300 is a lot to my family.’”

Despite the criticism, Fryer said the program deserves a try. “One can argue philosophically about whether incentives are a good thing,” he has said. “But the fact is that the average black 17-year-old reads at the same level as the average white 13-year-old. This problem is beyond philosophy, and we have to do something.”

Launching the Program

Whatever the criticism, enrollment for the program has already begun. Families receive different amounts of money for different achievements. For example, elementary and middle school students will get $25 per month for 95 percent school attendance and high schools kids will get $50. Money incentives will also be given for attendance at parent-teacher conferences, having a library card, accumulating credits and graduating. Students can get up to $600 for each Regent exam passed.

Under the health incentive, families will receive from $20 to $200 a month for maintaining health insurance and getting preventative health and dental care. The workforce incentives, ranging from $150 to $600, include payments for keeping full-time employment and attending training while employed.

Once a family is enrolled in the program, members are eligible for all of its components. They will learn about the incentives in orientation sessions.

Seedco, a national community development organization, will manage the implementation and operation of the program. Seedco has partnered with six community-based organizations in each of the targeted communities that are leading the outreach, recruitment and enrollment of families.

In Brooklyn, Seedco is working with Groundwork, which provides educational programs and support services to families living there. During the first week of June, Groundwork enrolled 25 families in the program. By mid August, the number reached 221. Erica Ahdoot, director of the family resource center at Groundwork said that a total of 850 families will receive incentives from the organization

To recruit people, Groundwork hired a team to knock on doors and make telephone calls. “Some people are skeptical that this can’t be true, but we are trying to encourage people that this is a long term benefit,” Ahdoot said. “We contact them numerous times to make sure we exhausted out effort to get them to participate, but once they are past the idea that it’s an actual program, for the most part they are excited.”

What Next?

Opportunity NYC is privately funded by the Rockefeller Foundation, the Starr Foundation, the Robin Hood Foundation, the Open Society Institute, the American International Group, the Broad Foundation, Mayor Bloomberg and other sources. Eventually though the project could be publicly funded.

Before that can happen though, the government must determine whether the effort has been successful. To do that, MDRC, a non-for-profit social policy and research firm, will compare families receiving the incentives with those in a control group.

“The pilot …will run for two to three years depending on funding levels,” said Dawn Walker of the mayor’s press office. As the program proceeds and for as many as four years after it ends, she said, a “long-term evaluation will help identify what long-term impacts the incentives have on participant families.”

The results of that study could determine whether this pilot program eventually changes the way we address poverty in New York City and beyond.  

When Philneia Timmons’ children were placed in foster care, the last thing Timmons felt like doing was the one thing she was required to do to get her kids back home: cooperate with the very system that had broken her family apart.

“I felt angry,” she wrote in Rise, a magazine by and for parents involved in the child welfare system. “The system offered me no help before taking my kids, and my side of the story didn't seem to matter. I felt robbed, cheated and railroaded in every way.”

Many parents whose children have been placed in foster care have similar reactions, putting parents and child welfare workers in a difficult, often adversarial relationship. And often parents have been shut out of this discussion. But now, the city’s child welfare system is relying more and more on parent advocates to help foster care agencies work more effectively with parents. For their part, the agencies have begun to recognize that children benefit when the system works with birth parents -- especially since the goal for most kids in foster care is to return them home to their families.

WHAT THE PARENTS DO

Today, Timmons is actively involved in this effort. She first became involved at the Child Welfare Organizing Project, which helps parents with kids in New York City’s foster care system advocate for themselves. Through the project, Timmons learned about her rights as a parent with children in care and how to work with the system to get her kids back home. She also got emotional support from other parents in a similar situation.

Eventually, her interest in the Child Welfare Organizing Project went beyond her own needs, and she became an advocate for other New York City parents whose kids had been placed in care. Timmons urged caseworkers and supervisors in the foster care system to remove kids only as a last resort, and whenever possible, to offer services to help keep the family together. She used her own experiences to explain just how traumatic it can be for a family to break apart, and how difficult it is for parents and kids to build a relationship after the kids have been removed.

Timmons is not alone. In the last five years, partly as a result of CWOP’s work, dozens of agencies have hired birth parents. Today, approximately 60 parent advocates work at different foster care agencies in New York City. These parents, many whom are paid advocates, work hands-on with other parents whose kids are in foster cares, run parenting classes and support groups and give one-on-one support to parents with kids in care. They meet with child welfare leaders, help train caseworkers and speak at conferences about the foster care system.

WHAT THE PARENTS OFFER

The parents, says Dana Guyet, director of Advocacy for New York City’s foster care system, are revolutionizing the child welfare system. “I’ve always tried to take a more progressive view of how we can work with families,” says Guyet. “But the parents have more direct knowledge about their community, clients and cultures. On a regular basis, they point something out new.”

Guyet oversees the Administration for Children’s Services Parent Advisory Workgroup, whose members meet regularly with ACS Commissioner John Mattingly to discuss issues relevant to birth parents. Now the group is looking into the possibility of securing subsidized guardianship in New York City so that relatives can help a struggling family without going through the foster care system.

Lynne Miller, a paid parent advocate at Seaman’s Society, says that if birth parents can talk to someone who has been through what they are coping with, they will be less likely to act out their anger and frustration and more likely to cooperate with the demands of the court and the city government. “They’d probably be more willing to admit they had problems, and more open to getting help,” she says.

Miller says that almost half of the new birth parents she works with are in denial about why their kids are in care. “They like to place blame anywhere and everywhere except on their own shoulders,” she says. “It’s hard enough to admit to yourself that you might have done something wrong, never mind admit it to strangers who are now controlling your life.”

Miller helps the parents work through their resistance by letting them talk and vent all they want. But she also lets them know that it is possible for them to get their kids back and uses her own experience of getting her son out of foster care as proof.

When the time comes, she talks to the parent about how difficult it can be for a child to return home. A child coming out of foster care usually has lots of anger and resentment to work through, says Miller, and many need therapy. After the kids of Miller’s parents return home, she stays in touch, offering to visit or talk. Sometimes she volunteers to look after the kids when the parents need a “little breathing space,” or feel overwhelmed.

And she encourages the adults to do what feels counterintuitive to most parents with kids in care: stay in touch with their child’s former foster parents. “Foster parents aren’t the enemy,” she tells the parents she works with. “They can be more like the Red Cross.”

For many parent advocates, working for the foster care system that once took their children from them requires a big adjustment. But for Miller, the difficult memories from when she was a client of Administration for Children’s Services fueled her passion for her job as an advocate. “The way I see it,” she says, “my job is to help parents see the agency and the foster parents as supports, and to help the agency and the foster parents see the birth parents’ strengths, too.”

Timmons agrees. “ACS is starting to develop a relationship with parents and to understand our perspective,” she says. “I see the very beginnings of a change here.”

This article is adapted from stories in Rise, a magazine by and for parents involved in the child welfare system, which is published by our partner, Youth Communication. Read stories from Rise at www.risemagazine.org.

Amy Cooper sits in a circle with seven pregnant women and one new mother demonstrating the techniques of infant massage. Massage, she explains, can be a valuable tool to help a newborn deal with tension and stress, sleep more and cry less, and connect with a mother in a physical way.

One woman seems surprised and slightly nervous about the idea that babies liked to be touched.

"Some of us have negative experiences with touch, like if it was used to punish us," Cooper says. "For moms who haven't had good experiences, baby massage can be a positive way to respond to your baby when he or she is upset. Rather than neglecting or hurting your baby, you can massage.”

The women in the group understand: They are all teenagers, all live in foster care, and most have experienced abuse and neglect themselves.

Cooper’s class at Inwood House, a group home for pregnant and teenage mothers, is one of a handful of initiatives in New York City that aim to stop generational cycles of abuse by working with young moms. Like the massage class, many of these programs focus on educating mothers living in foster care.

HELPING CHILDREN WITH CHILDREN

Although teenage pregnancy has decreased significantly in the last 10 years, it remains common for girls in foster care. By age 19, nearly half of all girls in foster care have been pregnant, and 31 percent have had a child. (Nationwide, 12.2 percent of girls have had a child by age 19.)

The national Nurse-Family Partnership has long helped low-income, first-time mothers learn to parent. In October, it started a special project in New York City to recruit girls who are in foster care, homeless, or coming out of jail from Rikers Island. The program works with the youth development programs at the Administration for Children’s Services and at foster care agencies to reach the teen parents.

“We’re targeting them because these moms are more vulnerable,” says Julia Carter, a supervisor of the program. “They have all the questions any new mother would have, but less support.”

Each expectant mom in the Nurse-Family Partnership is assigned a nurse, who visits with the mother while she's still pregnant. The nurse helps the mom get prenatal care and tries to help her cut down on unhealthy habits like smoking. Later, the nurse teaches the mother how to care for her baby, helps her to who her child is, and how they can form a relationship.

A SAFE PLACE TO BE A MOM

But the partnership does not reach every young mother who needs help. When a young mom named Melanie (not her real name), started feeling like her two-year-old son was too much to handle, she thought she would have to give him up. As a single mother living in a homeless shelter, she didn't believe that she was able to take care of her toddler.

So Melanie was relieved when her shelter sent her to the New York Foundling’s Crisis Nursery, an organization dedicated to “saving, preserving, and building families” that dates back to 1869.

The lower Manhattan nursery -- which offers up to three weeks of free childcare to parents facing a crisis, emergency cash and goods, and counseling -- found out that Melanie was a victim of domestic violence and feared she couldn't keep her son safe.

The Crisis Nursery helped Melanie obtain an order of protection against her abuser. They also gave her counseling on domestic violence, and connected her to a support program in her own community. Melanie is now living with her child and continues to stay in contact with the organization.

"She feels more capable of meeting her son's needs," said Victoria Peña, the director of the Crisis Nursery. "And she knows she can always count on us for support."

Peña says that facing a crisis without support can be more than even the most well-meaning parent can handle. And too often, such events send some children into foster care. By caring for the parent as well as the child, the Crisis Nursery hopes to make the family safer now and in the future – and enable the children to remain with their parent.

"If we had programs like this in the outer boroughs abuse rates would drop and neglect would drop,” says New York Foundling Director Bill Baccaglini.

But not all young moms agree. Some worry that accepting services will make their kids more likely – not less -- to get caught up in the city’s children’s services system. Young moms who have been in care themselves or have had negative experiences with city agencies can also find it hard to trust outsiders offering them services, especially ones connected to foster care. Because the Crises Nursery gets funding from the Administration for Children’s Services and must report evidence of physical abuse, for instance, some mothers fear that their children may be taken away from them.

But the program’s organizes say they work to win the trust of the young mothers with histories of foster care. Then, the organizers say, the real work begins. One of the main challenges is teaching a young mother who had been abused or neglected how to communicate and bond with her baby in healthy ways.

“The hardest thing for any new parent is realizing that this little baby is a person with its own personality,” says Carter of the Nurse-Family Partnership Program. “As new parents, you have to learn to work with that personality so that you can communicate and understand what your baby needs from you. I think when things go wrong is when there's no communication.”

THE POWER OF COMMUNICATION

When Cooper teaches infant massage to the soon-to-be-mothers at Inwood House -- demonstrating on a seven-month-old named Madison -- she explains that babies communicate with their mothers and the environment through body language.

"Some of us get disappointed when we're looking at our baby and he or she looks away,” Cooper says. “It's not that they're rejecting you, but they're saying 'that was a lot to take in, give me a moment.’”

Toward the end of her massage, Madison gets restless and begins giggling. She squirms while her mom tries to massage her face, and her mom has to stop.

"That's OK," Cooper says, explaining that massage is simply a way of connecting and relaxing, and every baby has her own limits. "She's showing you she's had enough."

This article by Natasha Santos and La Quesha Barner both writers at Represent, a magazine written by and for teens in foster care, is adapted from the pages of our partner Youth Communication. Additional reporting by Sasha Chavkin.