Family therapy is a low-cost and effective substitute for juvenile offenders, advocates say

Alexandra was 9 the first time she saw her father rape her mother. It was a trauma that became the norm in her life for six years before her father was sent to prison for gang-related charges. After attempting suicide at 12, she was hospitalized for psychiatric care and was molested by a staff member there. Once she returned to her mother’s care at 13, the family struggled financially and ended up in a shelter. Alexandra fell behind in school, drank alcohol and smoked marijuana, got into physical altercations and hung out with a gang.

At 17, she became a mother to a little girl. Two months after the birth of her child, after being arrested for robbery, she was referred to the New York Foundling’s Families Rising Program, which provides counseling services as an alternative to incarceration. Founded in 1869 as a home for abandoned children, the New York Foundling provides resources for underserved children and adults to rebuild their lives.

The family intervention program follows the Functional Family Therapy model, which advocates and trains social workers on ways other than incarceration to redirect and rehabilitate wayward youth. These programs mostly look for root problems in the family dynamic that foster bad behavior, usually through family therapy sessions. This approach was developed in the 1970s by psychologist James F. Alexander and now influences public and private programs across the United States and in other Western countries, including Canada and Australia.

Alexandra’s story, which was related to this reporter by New York Foundling officials, is an example of how the Functional Family Therapy model can succeed. Five years ago — before the program was implemented in New York — Alexandra would have ended up in prison, likely for a long stint because of her gang affiliations. Her child would have been placed in foster care. The annual cost of incarceration per inmate at Riker’s Island was $168,000 in 2012, according to a report issued by the New York City Independent Budget Office. The cost for Alexandra’s treatment in a Functional Family Therapy program was $8,500.

Sylvia Rowlands, senior vice president for evidenced-based programs at the New York Foundling, said these programs usually involve a therapist and consultant that work with the family to set goals. “They’ll look at the referral behaviors that caused the youth to be in the situation they were in.”

Treatment is generally home-based. “We don’t have to worry about the family not showing up or missed sessions,” Rowlands explained.

There are typically two or three sessions a week and the goal is to complete the program within six months.

While advocates point to billions of dollars in savings, not all government officials have embraced these programs. Pam Hawkins, a senior associate with the California Institute for Behavioral Health Solutions Child and Family Services Unit, said elected officials must be better educated on the most effective way to approach juvenile crime. There is plenty of evidence Functional Family Therapy programs reduce recidivism, and set wayward youth on a path toward productivity in society, she said.

“The research is proven that you’re going to get a better outcome,” she said.

Then there is the problem of funding. Some programs receive federal grants, others receive money from private foundations. Often they must piece together dollars from a variety of sources. If they are lucky, they can get Medicaid reimbursement.

Rowlands said that from her experience the main barriers for adopting these programs are: lack of awareness, lack of understanding and cost. Individuals “who have been doing this work for a long time and have created a [professional reputation] where they’re experts in what they’re doing … have to go back to being students” when a new model is adopted, which might deter them from newer programs, Rowlands said.

According to “Juvenile Crime, Juvenile Justice,” a 2001 report by the National Academies of Sciences, Engineering, and Medicine, when the juvenile justice system was established in the United States, the goal was to encourage rehabilitation by diverting youthful offenders from the harsh punishments of criminal courts.

Proceedings were informal and emphasized treating the child or adolescent as a person needing assistance. That changed in the 1980s. Surging crime, especially among minority youth, prompted a dramatic shift in the way authorities handled crimes committed by juveniles, according to the Center on Juvenile and Criminal Justice. Now, many politicians and other officials have begun to examine the financial cost and societal toll of locking up nonviolent youthful offenders.

Today, the United States incarcerates youths aged 12 to 17 at a rate five times that of any developed country, costing taxpayers more than $5 billion annually, according to Blueprints, an organization affiliated with the Institute for Behavior Science at the University of Colorado that certifies Functional Family Therapy programs. Three quarters of youth offenders are rearrested within three years of being released from prison, according to studies conducted by Blueprints.

On any day, approximately 54,000 juvenile offenders are held in lockups, often called residential placement, according to the Campaign for Youth Justice, a national organization dedicated to ending the incarceration of youth offenders in the adult prison system.

Rowlands said youth incarceration differs across states. “When we talk about juvenile placement, we’re usually talking about kids who are put in large residential programs where the doors are locked. They don’t usually have bars but it is incarceration.”

In October, California Gov. Jerry Brown signed 11 criminal justice bills, eight of which directly affect the juvenile justice system. Starting Jan. 1, minors convicted of felonies may petition courts to have their records sealed. Previously, if a minor convicted of a felony violated probation, their record was ineligible to be cleared. Juveniles sentenced to life in prison will have a chance at parole after 25 years and fees imposed on families with incarcerated minors will be limited.

Catherine Boatwright, a therapist who co-supervises Families Rising clinicians, said, “It’s a positive move to begin to reform this but disappointing that juveniles still need to petition the court to even have the opportunity to seal their records.”

Having to petition “just prolongs the process, costs more taxpayer dollars, can still be denied and feels less focused on rehabilitation,” Boatwright said.

Once juveniles are released, the process for reintegrating youths into society “fails to adequately prepare them for an independent, self-sufficient lifestyle outside of a correctional institution,” according to the Center on Juvenile and Criminal Justice, a nonprofit organization based in San Francisco that works to reduce youth incarceration.

Los Angeles has the largest implementation of a Functional Family Therapy program in the state, Hawkins said, “We started out with just a few sites who had interest, and we offset some of the costs with the grant funding that we had.”

The treatment plan is generally home-based and Rowlands defines “sites” as the location of an agency that has the contract to provide Functional Family Therapy programs.

According to Blueprints, Functional Family Therapy should be implemented with a team of three to eight master’s level therapists with oversight by a licensed clinical therapist. Smaller counties, and especially in rural areas, do not have enough staff to run them. There must be “a team approach,” Hawkins said. “It can’t just be one person doing it.”

Stephen Phillippi, chair of behavioral and community health sciences at the Louisiana State University School of Public Health, has been working to bring more counseling programs into the juvenile justice system. Phillippi said lack of funding and a lack of understanding of a community’s needs are the biggest barriers to these programs.

Less than 10 percent of at-risk families in the United States have access to Blueprints-certified programs, he said. At-risk families are defined as those whose members have already had a brush with the criminal justice system. Then there is the problem of providing a broad spectrum of therapy options to address each youth’s problems.

“One size does not fit all,” Phillippi said. “You have to match the kid’s risk and needs with the practice.”

In New York, the child welfare agency was on the brink of fully removing Alexandra’s infant from her care. After she enrolled in Functional Family Therapy, the family court judge allowed Alexandra’s mother to step in as a temporary kinship foster caregiver, according to the New York Foundling. By the time she graduated from the program in May 2016, Alexandra had regained primary custody of her child.

“We know we have reached the treatment goals when we reach the target we have set for each [referral] behavior,” Rowlands said. “We don’t look for perfection. We look for what will prevent this youth from coming back into the program.”

Alexandra had previously not succeeded in other programs, but Functional Family Therapy gave her family a new understanding of one another and their past motivated them to learn new ways to function as a family, according to New York Foundling representatives. Now, she is finishing her GED at a program that offers services for young mothers, and would like to study to be a therapist working with at-risk youth or women affected by domestic violence.