The struggle for treatment integrity in a "dis-integrated" service delivery system.

Abstract

QUALITY ... Quality is never an accident; it is always the result of high intention, sincere effort, intelligent direction and skilful execution; it represents the wise choice of many alternatives. Anonymous Abstract The purpose of this chapter is to describe an innovative family preservation program for delinquents, which exemplifies effective correctional treatment: Community Support Services of the St Lawrence Youth Association in Ontario Canada. Over 7 years, the program utilized the Teaching-Family Models (see Chapter 7 by Dean Fixsen, Karen Blase, Gary Timbers and Montrose Wolf in this book) integrated clinical, administrative, evaluation and supervision systems to ensure quality and treatment integrity. These systems will be delineated, along with some of the challenges of implementing an integrated treatment within a fragmented children's' services delivery system. The intention is to do so from a multilevel systems perspective (Bernfeld, Blase & Fixsen, 1990), in which four levels of analyses are used to examine the delivery of human services: client, program, agency and societal. Finally, suggestions are made for contextual supports for innovative programs, so as to foster their effectiveness, longevity and key role as catalysts for systemic change in children's services. Keywords: family preservation, delinquents, corrective treatment, Teaching Family Models, integrated treatment, contextual supports, children's services. EMPIRICAL FOUNDATIONS Community Support Services of the St Lawrence Youth Association was specifically developed in 1988 to offer intensive, short-term and flexible support to 12-15-year-old young offenders (juvenile delinquents) who are at of being placed in more restrictive residential settings, such as closed or secure custody. The aim was to start with the treatment orientation and procedures used by Alberta Family Support Services (Olivier, Oostenbrink, Benoit, Blase & Fixsen, 1992) with mostly child welfare clientele, and adapt them for use with young offenders. Thus, the two programs shared the same broad goal of integrating the well-researched treatment methods of the Teaching-Family Model (see Chapter 7) with the service delivery strategies of the Homebuilders Model (Whittaker, Kinney, Tracy & Booth, 1990), an exemplary family preservation program. Other literature supporting the development of the Community Support Services model include: * Clinically appropriate treatment, as defined in meta-analytic literature reviews (e.g. Gendreau, 1996; Chapter 2 by James McGuire and Chapter 4 by Friedrich Losel, both in this book), includes behavioral systems family therapy, intensive structured skill training and structured one-on-one paraprofessional programs. * Andrews, Leschied and Hoge's (1992) review identified a number of key risk factors for delinquency, which establish appropriate targets for treatment, including: cognitions (antisocial attitudes and values), family factors (low levels of affection/cohesiveness and supervision/monitoring, poor discipline, and neglect and abuse) and peer influences (association with antisocial companions and isolation from non-criminal peers). * Patterson, Reid and Dishion (1993) provided detailed empirical support for their developmental model of antisocial or coercive behavior, in which parents are key to the early training for antisocial behavior. As well, their research targeted the teaching of appropriate family management skills as essential to rehabilitating delinquents. * Christensen and Jacobson (1994) reviewed research on psychological treatment delivered by paraprofessionals and concluded that paraprofessionals are usually as effective as professionals. Given that the need for mental health services exceeds the supply of professionals and the costs savings afforded by paraprofessionals, they concluded that services delivered by non-professional therapists merit wider use and further research. …