Staff Report

MEMORANDUM

TO:                  City Council

FROM:            David J. Deutsch, City Manager

SUBJECT:       Youth & Family Services

DATE:             March 18, 2009

Mission

The Bowie Youth & Family Services Division’s mission is to provide community-based mental health services for the families of the Bowie community, to improve understanding and communication between parents and youth, to prevent youth from entering the formal juvenile justice system, and to increase the safety of our community through drug and alcohol prevention activities. We are dedicated to providing excellent professional services and innovative programming in order to help and support those citizens who are experiencing emotional difficulties and family stress.

Overview

Bowie Youth & Family Services provides a wide variety of services aimed at creating healthy families and functioning youth.   Families with a troubled child up to the age of 18 can seek family therapy for many reasons including, but not limited to, school failure, family conflict, separation and divorce, child abuse and neglect, suicidal concerns, illegal behavior and other behavioral problems.  Our agency conducts parenting classes and groups offered to help parents and children cope with problems such as ADHD, divorce, lack of social skills and problems of teenage life.  Outreach programs include coordination of the Bowie Prevention Network (BPN), administration of a Teen Mentoring Program at Bowie High School, and administration of a Teen Job Bank.  BYFS has developed and is participating in a screening program at Bowie High School to identify teens with drug and alcohol problems and offers other programs in Bowie schools.  

Youth Services Bureau History and Relationship to the Maryland Association of Youth Services Bureaus (MAYSB)

Youth Services has been a division of the government of the City of Bowie for more than thirty-five years. In 1971 a national movement was spearheaded by the U.S. Department of Health, Education, and Welfare to help youth and their families find appropriate settings to come together to work on problems that had surfaced.  At that time the Bowie Involvement Program for Parents and Youth (BIPPY), run by Carolyn Rogers, opened a drug and alcohol abuse program funded, in part, by a three year grant from the Department of Justice’s Law Enforcement Assistance Administration.  This program was eventually housed within City Hall.  In 1973 the sixteen existing Youth Services Bureaus met to begin the formation of the Maryland Association of Youth Services Bureaus (MAYSB).  At the beginning of FY74, the first five of these Bureaus, including Bowie, began receiving State of Maryland funds. MAYSB members have worked together since that time to develop standards for service delivery, develop standards of reporting, support pertinent legislation, serve on state advisory boards and advocate for children and families in Maryland. Presently there are 19 Youth Services Bureau members.

Staffing

Youth & Family Services employs 7 full-time and 5 part-time staff that equal 9.6 FTE’s. The following paragraphs detail the positions and the services provided by each.

Director
The Director is a clinical professional counselor.  The responsibilities for management of the Youth & Family Services Bureau are as follows:

• Defines and administers program policies and program direction
• Develops programs, assigning tasks, hiring staff, providing supervision, and evaluating performance
• Attends to client crises, concerns, and special issues via direct contact, telephone and consultation
• Identifies service gaps and initiating services and/or programs to fill those gaps
• Prepares statistical reports for the county, state, city, and grantors
• Meets with community leaders, school personnel and others to discuss potential or current programming
• Advocates as an officer of the Maryland Association of Youth Services Bureaus for continuing financial support from legislators in Annapolis.

Clinical Staff

Our clinical Family Counselors all have master’s degrees and post-graduate training. 

Clinical Supervisor
The Clinical Supervisor is a clinical social worker.  The responsibilities for Clinical Supervisor are as follows:

• Assists in the day-to-day administration of agency programs
• Provides clinical supervision of family counselors
• Monitors progress of staff counselors’ family therapy cases through live supervision, case consultation and general casework
• Reviews therapy case files for compliance with legal requirements
• Coordinates in-service training programs
• Performs duties of a Family Counselor – providing individual, family, and group counseling, crisis counseling and referral services
• Leads psycho-educational groups for adults and teens
• Provides training for graduate interns.

Family Counselors (4 full-time, 2 part-time)
All six Family Counselors are master’s level clinicians. One is a clinical social worker.  Four are marriage and family therapists and one is a clinical professional counselor.  Each carries a formal caseload of family therapy clients, providing counseling concerning personal and social problems of children, adolescents and their parents.  Counselors coordinate efforts with other mental health and school professionals to provide the best possible treatment for families.   Counselors rotate crisis coverage for citizens who seek immediate help. They conduct intake interviews with families seeking services.   Counselors lead psycho-social groups for parents and children. They make presentations to community groups.  Some are responsible for ongoing supervision of graduate interns.

Outreach Staff

Prevention Coordinator
The Prevention Coordinator is responsible for providing outreach and network services to the community through alcohol and drug use prevention activities and educational programs in schools, community centers, houses of worship, businesses and community organizations.  The Coordinator provides leadership in assessing the needs of youth in the community.  She works with local, county and state agencies to access resources and information necessary to insure a comprehensive and multi‑disciplinary approach toward the issues of substance abuse prevention and community health.  She supervises a contractual Volunteer Coordinator who administers the Teen Mentoring Program.

Administrative Staff

Administrative Office Associate II
The Administrative Office Associate is responsible for the coordination of all administrative and clerical functions of the department.   This includes establishing and maintaining the filing and record-keeping system of the office.  Client files are confidential medical records subject to statutory regulations and must be maintained correctly.  She is responsible for all other administrative tasks. She is the liaison between Youth Services and other City offices.  She assists the Director, the Clinical Supervisor, six Counselors, the Prevention Coordinator, the Volunteer Coordinator, and interns. She is responsible at the same time for interacting with the public during all her working hours.  She supervises the two Office Associates. They work in the evening as receptionists and oversee children in the waiting room.  One of them works an additional 15 hours each week to help with assigned administrative tasks.

 Services Provided

Counseling
 
Family counseling is a form of therapy that usually involves all members of a family in treatment.  According to the underlying principle, when a child is experiencing difficulties, the whole family is involved in the problem and parents are crucially important in finding and implementing solutions.  The family is seen as a system in which the actions of any member of the system influence and change other members.  Therefore, the therapy includes not only the troubled child, but also parents, siblings and even grandparents, if needed.  When parents become more effective in disciplining and more supportive and understanding, child behavior is likely to improve. 

Families seek services for many reasons.  The majority of cases seen involve issues such as family conflict, sibling conflict, behavioral problems, school problems and separation and divorce.  Other cases address a wide range of problems including, but not limited to, child abuse or neglect, sexual abuse, substance abuse, attention deficit disorder, learning difficulties, emotional disturbances, suicidal dangers, anxiety, depression, runaways, truancy, suspensions, delinquency, violence and cruelty to animals.
 
Counseling also enhances family safety.  If a therapist suspects that a client is or has been the victim of physical or sexual abuse, the therapist is required to make a report to Child Protective Services.  Following the report, BYFS counselors work with Child Protective Services’ social workers to foster change and safety in the family.

Families are referred to us from schools, other community agencies, the Maryland Department of Juvenile Services, the Prince George’s County Department of Social Services, and other Bowie residents who have used our services.  Some of our families are ordered by the court to attend counseling.  

When a family member calls for help, a crisis counselor conducts an intake interview of about twenty minutes. The family is then placed on a waiting list that usually averages about eight weeks.  When a counselor has space, the family is offered an appointment to begin counseling. Families usually meet with counselors weekly for one hour sessions for an average duration of nine months. Therapeutic goals are established and therapy begins.  Duration of treatment varies according to the needs of each family. In exit surveys in 2008 at the end of treatment, 99% of clients rated the quality of service they had received as excellent or good. 

The following vignettes are fictionalized composites of the types of cases treated.  Confidentiality prevents sharing specific details of current and past cases.

Example 1
A recently divorced mother of two children aged 11 and 6 was laid off from her job as a receptionist at a law firm.  She was currently paying for insurance through COBRA, but was about to give up insurance because she could not afford to continue her payments.  She was able to find part-time work as a cashier in a supermarket, but received no benefits.  There was severe conflict between the two children, often leading to loud arguments and physical fights. The 6 year-old was wetting his bed at night.  Mom would withdraw into her room and leave the children to fend for themselves. The counselor referred Mom for a psychiatric consultation regarding her depression before she ended her insurance.  She informed Mom of state resources for insurance for her children.  The therapist helped Mom learn skills to handle sibling conflict.  She worked with Mom to help her find support from extended family and friends.  She coached Mom to find individual time to spend with each child in an accepting and non-critical way.  As Mom improved her skills in listening and understanding her children, the children became more receptive to her suggestions.  The bedwetting ceased. As Mom learned effective discipline techniques, child behavior improved.  As Mom began to feel more competent in her parenting, her coping improved and she began to be able to better balance her parenting and her work obligations.  She was able to increase her cashier hours and will start working full time next month.
   
Example 2
A single mother sought our help because of problems with her fifteen year-old daughter’s behavior. The daughter was inattentive, aggressive and expressing suicidal thoughts.  The aggressive behavior was so serious that her daughter had been expelled from her high school.  The family had initially been seen by a private provider, but insurance benefits had run out and the family could no longer afford the fee of $100.00 per session.  The BYFS therapist assessed the girl for current suicidality and depression. The counselor and the girl negotiated a suicide prevention contract in which the girl promised to tell a trusted adult if the suicidal thoughts recurred.  The counselor referred her for a psychiatric evaluation and the psychiatrist prescribed anti-depressant medication. The therapist   worked with mother and daughter together to help the daughter learn and practice how to express her feelings verbally and to develop better coping strategies for dealing with anger and frustration. Mom was able to increase structure in the household by setting more consistent rules and routines. She was also helped to find ways to connect with her daughter without constant criticism and anger. The daughter’s suicidal thoughts subsided. After 15 sessions, the daughter is functioning in a new school. Her relationship with her mother has improved. The family will soon end counseling.

Example 3
A mother and step-father contacted our agency because of her son’s newly-discovered drug abuse.  Mom was extremely upset because she came from a family in which her father and uncle were alcoholics.  She had also had an alcohol problem, but with the help of AA, she had been clean for eight years.  Step-dad was fed up with the boy’s behavior. There were frequent angry outbursts between them.  Mom would interfere in her son’s defense when step-dad attempted to discipline him. This increased conflict in the marriage.  The BYFS counselor worked with the couple to highlight their common concerns about their son and to help them stop undermining each other.  Step-dad worked on anger management.  Mom worked on stopping her enabling behavior.  Both were helped to learn how to set limits.  The counselor worked with the parents to help them with the process of getting the son admitted to an inpatient substance abuse program. Following the inpatient treatment the family continued at BYFS for six months.  The boy is substance-free. The family continues to work on parenting and family relationships.

Example 4
The parents are divorcing, and so conflicted that they cannot communicate enough to coordinate care for their two children.  The children have been subjected to ongoing verbal and emotional violence between the parents for several years. The 13 year-old daughter is failing three classes and shows signs of depression. The 5 year-old son is having nightmares and insists on sleeping with his mother.  The school counselor recommended that the family apply for services at BYFS. The parents attend sessions separately because they are so angry with each other that they are unable to be together in the same room with their children without arguing intensely with each other. The counselor has challenged them to protect their children from marital and parental conflict.  The counselor is working with both parents on anger management skills. She has advised them to cease talking about the other parent to the children.  The counselor is coaching parents to find ways of making any necessary arrangements for the children without angry outbursts. The parents are still reactive and have difficulty applying new skills even with frequent reminders from the counselor about how damaging such outbursts are for their children  Ongoing therapy is focusing on preventing escalation of the conflicts and on helping parents to understand the needs of their children as they go through this intense phase of their divorce.

Example 5
A single parent with limited resources was raised in an abusive family environment and does not have the skills to use discipline to teach, rather than punish or shame.  Under stress she gets rageful, calls her 14 year-old daughter names and says hurtful things.  She is very angry with her child and finds herself wishing that she had never given birth to her.  The child is struggling in school and engaging in risky behavior.  She is finding friends who are older than she is.  She skips school and often does not come home when expected.  She has run away several times.  The counselor is holding individual sessions addressing Mom’s childhood history of sexual abuse.  She is helping Mom to increase her self-esteem, to recognize her strengths and to connect in a better way with her daughter.  Since Mom had no models of good parenting when she was growing up, the counselor is teaching her listening, nurturing and discipline skills. The counselor coaches Mom to use these new skills in session.  The counselor has referred the daughter to the Teen Mentoring Program to provide a healthy relationship with a functioning adult as Mom struggles to make the changes she needs to become a better parent.      

Suicide Prevention and Crisis Intervention

 Suicide prevention and interventions at times of crises are necessary, both with formal family therapy clients and with citizens who call for immediate help.  A Family Counselor is on crisis duty daily between the hours of 10:00 a.m. and 5:00 p.m. This counselor handles crisis calls and intake interviews in addition to her regular client obligations. 

If an active Youth Services’ client is suicidal, the counselor does an assessment.  If necessary, the counselor refers the client for hospitalization.  On rare occasions, the counselor must work with other professionals and the courts to facilitate involuntary hospitalization. During the period of hospitalization, counselors consult with the psychiatric staff, work with the rest of the family and participate in post-hospital planning. If the risk of suicide is not seen as imminent, a prevention protocol is followed including the writing and signing of a suicide prevention contract that commits the client to call trusted individuals in the case of recurring suicidal thoughts.  Parents are instructed to secure all possible weapons and harmful substances. Parents are coached to work with a suicidal child, to assure the child of their love and to let their child know how much they need the child to stay alive.  In FY 2008, BYFS counselors were involved in 19 suicide prevention interventions.  In the first half of FY 2009 they were involved in 14.  These interventions were successful.  There have been no suicides of BYFS clients in the last 20 years.  There is no data before that time.

The counselor on crisis duty takes phone calls from citizens and sees clients who walk into the office with many different kinds of concerns.  If there is a threat of suicide, callers or walk-ins are referred to hospital emergency rooms or for psychiatric evaluations and are given suicide prevention instruction regarding weapons or harmful substances. The crisis counselor makes follow-up calls to be sure that referrals and recommendations have been followed.  Other types of calls might involve a mother who is unable to cope and wants her child to leave the house and live somewhere else.  A parent may call for help with a child who is out of control and is using drugs or alcohol. People call with concerns about economic stress.  The crisis counselor will provide informal counseling during the phone call or with a walk-in citizen.  The counselor will help develop coping strategies.  She will share information about community resources.  The counselor may do a formal intake interview and place the family on our waiting list for services.    

Information and Referral

Bowie Youth & Family Services provides a gateway for Bowie residents to other city, county and state services.  The office maintains a detailed resource file of community and county services.  Many of the calls received are requests for information of many kinds.  Callers are referred to tutoring centers, food banks, day care providers and other sources of help.

Teen Job Bank

Bowie citizens can hire teens for occasional lawn and yard work, babysitting, odd jobs, etc.  BYFS maintains a list of teens interested in working.  Citizens can call for names of teens and then contact the teen directly to arrange the details of hiring. There are 123 teens currently on the list.  So far in FY 09 there have been 50 requests for names. There has been a 98% satisfaction rating in our follow-up surveys of citizens through January 2009.

Groups

Counselors develop the curricula, screen applicants and lead the following psycho-social groups that are offered several times a year.  There is a fee of $40 or $50 dollars per family for attending a group.  The $50 fee applies when there are concurrent groups for children and parents in the same program.  Fees cover materials and non payroll expenses. Occasional one-time lectures are offered without fee on topics such as motivating and encouraging children, or tools for helping children with ADHD.  So far in FY 09, 93 people have participated in groups or attended lectures. Ninety-four percent (94%) of these are Bowie City residents.

“My Family and Me” Separation/Divorce Group - Two simultaneous groups help parents and their children ages 6 ½ -11 learn to cope with the stress of the separation/ divorce process.

Girls Count! - An ongoing group for high school teen girls focuses on helping girls find their inner strengths as they cope with pressures of being female in today’s world.   

Active Parenting - An interactive 7-week parenting class focuses on discipline, communication, anger management and family enrichment to help parents learn practical skills to develop cooperation, self-esteem and responsibility in their children.

Attention Deficit Disorder Education – In two simultaneous groups, adults learn about ADHD, find new ways to help their children and gain understanding about  how the disorder in a child affects the whole family.  The children’s group (ages 8 – 10) focuses on improving social skills. 

Social Skills for Elementary Aged Children - A small interactive group for 4th and 5th graders helps them navigate the sometimes complex skill required for developing positive relationships.    Group leaders also work with the parents, explaining the group goals and involving parents in homework assignments for the children. 

Graduate Intern Training

Giving back to the therapeutic community by offering an internship program is universally practiced within the counseling field. Bowie Youth & Family Services is proud to have a program that is recognized by local universities and sought by students for master’s level training experience in the counseling profession. Each year two to four unpaid interns are selected from a pool of applicants from such as Bowie State University, University of Maryland College Park, Towson State, George Washington University, Argosy University and Loyola College. The students are trained and supervised by Family Counselors who lead weekly didactic sessions and provide live supervision of the interns’ clinical sessions. 

Community Outreach

Bowie Youth & Family Services places a high priority on prevention strategies for the health of young people and their families in the Bowie community.  In keeping with best practices in prevention, the work of the Prevention Coordinator includes community building and outreach, prevention education for youth and their parents, asset building, alternative activities and youth engagement projects.   Speaking at venues such as the Parent Teacher Student Organization (PTSO) meetings, student club meetings such as Future Teachers of America, and sponsoring programs such as Red Ribbon Week (substance abuse prevention in the schools) and Project Save (reading/literacy program in the elementary schools), the prevention message is broadcast throughout the student body. 

In addition, a large coalition of Bowie residents has joined in these prevention efforts through the Bowie Prevention Network.  This consortium of individuals has been ongoing and growing since 2001. Originally named the Community Prevention Network, this group of over 300 individuals is dedicated to creating ways for the youth that reside in Bowie to have safe and drug/alcohol free activities and venues in order to help them grow into productive citizens. Coming from diverse backgrounds and interests, they continue to share their ideas and concerns through emails and meetings.   

The Teen Mentoring Program, now in its seventh year, grew out of a youth forum held in 2001 by the now named Bowie Prevention Network. The Teen Mentoring Program operates at both the Main and Annex campuses of Bowie High School.  The program has been very successful, noting that the majority of the students and mentors return to the program each year. The mentors and their students meet on a weekly basis throughout the academic year. The students referred for this program are often at risk of failure or dropping out of school. This program helps immensely with these teens.  With the efforts of over seventy adult mentors since the inception of the program, most of the student ‘mentees’ will complete high school or have already completed high school and have gone on to join the ranks of other productive citizens.

The following vignette gives a real example (with changes of names) of how one volunteer mentor can change the direction of a child. This is exceptional news for an investment of one caring adult volunteer patiently engaging Jane over lunch one hour a week for just six months! 

Jane joined the teen mentoring program this past fall at the beginning of her freshman year.  She has been meeting her mentor at least once a week. When we first met Jane she would not speak on the phone, nor look you in the eye to speak. When she did speak her head was down and she barely spoke above a whisper. Through consistent care and weekly meetings with a volunteer mentor Jane is speaking up, lifts her head and speaks in an audible voice that any one can hear.  She has stated that through this program she has learned that she can open up and talk to more people and that it wasn’t that difficult. This is exceptional news for an investment of one caring adult volunteer patiently engaging Jane over lunch one hour a week for just six months! 

Summary

Bowie Youth & Family Services has established itself for more than 35 years as an important institution in the community with extensive relationships with the schools, community organizations and many other agencies.  For City residents who do not have health insurance, we are the only low-cost provider in the City. Other similar services in the county are a considerable distance away. Laurel Youth Services Bureau, College Park Youth Services Bureau, District Heights Youth Services Bureau and Greenbelt Youth Services Bureau are carrying waiting lists up to eight weeks. One of these Bureaus has staff working overtime to accommodate the need. Our services are excellent and our providers highly qualified.  We provide help to families with differing categories of need.  We offer preventive services so that future crises can be avoided. We offer crisis management for families experiencing immediate hardships.

Mental health care in the private sector does not provide the wide range of treatment opportunities that BYFS does.  Insurance often limits the number of treatment sessions. A family can continue treatment at BYFS until problems have been sufficiently addressed. Insurance covers individuals only for diagnoses of mental illnesses and psychological disorders.  If a family is seen in the private sector, one family member must have a diagnosable condition.  Some of our identified clients do have these conditions, but most of our families do not have members with diagnosable disorders.  Most come for family functioning support that would not be reimbursed by medical insurance.   If a family uses insurance in the private sector, copayments vary and sometimes can be quite expensive. BYFS provides help and support for families with relationship difficulties or social/economic stress. These are not covered conditions. This means that BYFS can serve a wider range of clients than can be served by private practitioners.  We are able to focus on family member interaction and, in that way, influence the family’s process to create improvement in the whole family system. For help of the kind we offer, families would often have to pay full fees out-of-pocket. Without BYFS, Bowie residents would be deprived of an affordable source of prevention and early intervention.

In addition, the Family Counselors at BYFS often provide services to our clients that are not available through most private providers.  These services include:  A) coordination of care, in the case that inpatient hospitalization or substance abuse treatment is necessary; B)  advocacy and support for residents who are negotiating the process of applying for special education services through the public school system; C) educational and therapy groups that are difficult to find elsewhere at any cost (including ADHD, Separation/Divorce and Social Skills programs); D) crisis and referral services; and E)  referrals to our Teen Job Bank.

Many of our services are not available to the public anywhere else.  We have a long waiting list, often as long as 2 months, for services, as do other Youth Services Bureaus in the state and those in other Prince George’s County municipalities. In FY 09 BYFS has counseled a total of 361 individuals in formal counseling, which are those families that decided to proceed with longer term counseling exceeding three sessions. Eighty-eight percent (88%) of the formal cases are City of Bowie residents. Another 108 individuals have been counseled informally during this same timeframe.

With the credibility of our status as a City agency and the support of the City, we are able to initiate excellent programming in the schools and to recruit volunteers and other agencies to cooperate in offering services to many of our citizens.  Our biggest challenge is to serve all the citizens who seek services, in a timely manner, with our existing staff and facilities at Bowie City Hall.

Youth Services Presentation (21 pages)