Among adolescents, admission to residential treatment facilities in New York State is reserved for those who have severe emotional and behavioral problems, including antisocial and self-destructive behaviors that require virtually constant supervision. Such facilities are usually the only placement less restrictive than incarceration or total institutionalization. All potential referrals to residential treatment facilities are screened for need by a state-mandated preadmission certification committee, which is the only final referral source for admissions.
In 1991, the August Aichhorn Center for Adolescent Residential Care opened a residential treatment facility in Manhattan that provides an extensive array of services to its adolescent residents. The center's policy is to accept all referred youths who are 12 to 16 years of age, and who have been certified by the New York City preadmission certification committee, without further screening except for Medicaid-required documentation.
Residents almost invariably have been placed in a large number of institutional settings before admission. There are no exclusion criteria and no bases for administrative discharge or transfer to another facility. The program was designed and is operated as a last-resort placement for adolescents who cannot be managed anywhere else.
The facility is located in a specially designed six-floor brownstone in a residential neighborhood. It accommodates 32 residents in four living units—three with eight single bedrooms and one with four doubles—and it includes school, recreational, clinical, administrative, and support space. The design and operation of the facility, along with the staffing pattern of about 86 full-time equivalents, including 46 child care workers, permits continual, intensive supervision.
Living units are intended to be the residents' homes. The unit leader is a parent substitute and is responsible for all aspects of daily life for the residents and for supervision of the unit's child care staff. The facility's clinical staff—therapists, teachers, and others—are consultants to the unit leader. This system is modeled on a community living arrangement, in which outside professionals may advise the family, but final decisions are made by the parent.
Although it is sometimes necessary to hold children who become agitated, the facility has no seclusion or special care rooms, and mechanical restraints are not used. The center's small size and urban location afford ample opportunity for supervised or independent access to the city's multiple mainstream educational, recreational, and cultural resources as well as for participation in ordinary daily activities such as shopping. Well-stabilized residents may begin attending public high school part-time, and eventually attend full-time.
One of the justifications for such intensive services is the hope of keeping these youths out of the criminal justice system, but little is known about the impact of care in a residential treatment facility on this outcome. In 1997, with support from the Child Welfare Fund of New York, the center initiated a prospective longitudinal study of this question among all of the discharged residents at that time—a total of 52 persons. These former residents had been in the center for periods ranging from three months to four years.
Because of the highly selected nature of this population, comparison with general norms of achievement would have little meaning. Therefore, we included a control group of 52 adolescents who had also been referred to the August Aichhorn Center but who did not actually enter the facility for reasons unrelated to their diagnosis or to admission policies and procedures, such as a lack of a bed at the center at the time.
We looked at arrests that occurred at any time after the study subjects' 18th birthdays by submitting the names and birth dates of all 104 subjects to the New York State Office of Court Administration (OCA) and requesting a computerized check of adult criminal court records for all 13 downstate New York counties. At the time of the inquiry, the average age of both groups was 21.5 years; the mean time since discharge for the "alumni" group was 55.4 months.
OCA reported that 51 of 104 subjects had an adult arrest record. However, even after one discharged youth who was readmitted to the center was excluded from the analysis, the proportion of alumni with arrests (20 of 51, or 39 percent) was significantly smaller than the proportion in the control group (31 of 52, or 60 percent; χ2= 4.28, df=1, p<.05).
This early finding suggests that the August Aichhorn Center's residential treatment program may serve to reduce the high rate of adult criminal convictions among high-risk youths with severe emotional and behavioral problems.
Dr. Horowitz is a researcher with Child Welfare Research in New York City. Dr. Pawel is executive director of the August Aichhorn Center for Adolescent Residential Care and assistant professor of psychiatry at the College of Physicians and Surgeons of Columbia University. Ms. O'Connor is quality improvement coordinator at the August Aichhorn Center. Send correspondence to Dr. Pawel, August Aichhorn Center, 23 West 106th Street, New York, New York 10025 (e-mail, firstname.lastname@example.org).