3 NEW YORK Administrative Headquarters 54 West 40th St., New York, NY (212) / (800) 2-DAYTOP RESIDENTIAL CENTERS Adolescent Intake & Assessment P. O. Box 214, Rhinebeck, NY (845) Entry & Re-Entry Center 316 Beach 65th Street Far Rockaway, NY (718) Fox Run P. O. Box 831, Rhinebeck, NY (845) Manor House P. O. Box 782, Rhinebeck, NY (845) Meadow Run P. O. Box 214, Rhinebeck, NY (845) Parksville (Pictured Above) P. O. Box 368, Parksville, NY (845) Springwood P. O. Box 633, Rhinebeck, NY (845) Swan Lake P. O. Box 340, Swan Lake, NY (845) William A. Schreyer Youth Center P. O. Box 607, Millbrook, NY (845) AMBULATORY CENTERS Bronx Outreach 16 Westchester Sq., Bronx, NY (718) Brooklyn Outreach 401 State Street, Brooklyn, NY (718) Outpatient & Medical Services 500 Eighth Ave, NY, NY (212) Queens Adult Outreach Merrick Blvd., Jamaica, NY (718) Queens Adolescent Outreach st Ave., Jamaica, NY (718) Rockland Outreach 620 Route 303, Blauvelt, NY (845) Content Message from the President, 4 Daytop Executives, 5 Then & Now A story of a saved life, 6 7 Annual Report : Introduction, 8 10 Overview Nationwide Client Demographics, 11 New York Daytop Sources of Referrals, Treatment Programs Adult Services, Treatment Programs Adolescent Services, New York Population Served, 19 Adult Population Breakdown, Adolescent Population Breakdown, Treatment Outcomes Management System, Treatment Outcomes Adult Residential, Treatment Outcomes Adolescent Residential, California Treatment Programs in California, California Population Served, New Jersey Treatment Programs in New Jersey, 32 4 New Jersey Population Served, Quality Improvement System Quality Improvement Subcommittees, Services Network Health Services Division, Educational and Vocational Services, Special Programs/Staff Development, Daytop Association of Alumni and Friends, 44 Spiritualilty Component, 44 Housing Arrangements, 44 Legal Department, Women s Program, 45 Family Association, 45 Community Assistance and Resources for the Elderly, Administrative Headquarters, 46 Division of Grants and Proposals, 46 Daytop Foundation, 46 Promethean Institute, 46 Public Affairs and Community Relations, Communications/Information Technology Group, 47 Daytop International, 47 Special Issues Prevalence of Smoking, A Research-to-Practice Initiative, Enhancing Services for Families, Report Conclusion, 54 Financial Information, 55 Staten Island Outreach 1915 Forest Ave., S.I., NY (718) Suffolk Outreach 2075 New York Ave. Huntington Station, NY (631) Westchester Outreach 246 Central Park Ave. Hartsdale, NY (914) CALIFORNIA RESIDENTIAL CENTERS East Palo Alto 2560 Pulgas Ave. E. Palo Alto, CA (650) Redwood City 631 Woodside Road, Redwood City, CA (650) San Mateo Group Home 1200 Palm Avenue San Mateo, CA (650) NEW JERSEY RESIDENTIAL CENTER Mendham 80 West Main St., Mendham, NJ (973) AMBULATORY CENTERS New Jersey Screening Unit (Pictured above) 30 Schuyler Place Morristown, NJ (973) Morris County Outreach 320 West Hanover Avenue Parsippany, NJ (973) Sussex County Outreach 19 Hospital Road. Franklin, NJ (973) Hunterdon Outreach Route 12 Country Complex Building #2 Flemington, NJ (908) PENNSYLVANIA Promethean Institute P. O. Box 849, Milford, PA (570) Content 3
4 Footprints of a 40 Year Journey Monsignor William B. O Brien Founder & President It was far from a banner year ! Birmingham became a byword for police brutality visited upon those civil rights marchers while Dallas sent tremors across a grieving Nation. Interestingly, America's leading ballad that year was: "Call Me Irresponsible." While on the youth frontier in 1963, 'dropping out' became the order of the day. Dr. Timothy Leary was roundly championing that option. The resultant ambivalence among parents and, more critically, on the part of public authorities, contributed to widespread community paralysis. Kids found themselves spinning through courts to jail cells and back to drug infested streets in alarming numbers. Medical 'experts' conceded failure at Riverside Hospital, Manhattan General, Article IX on Ward's Island as well as at Lexington and Fort Worth Federal Hospitals. Raging panic and despair prevailed. Then on October 1, 1963, Daytop opened its doors in Tottenville, Staten Island amid a hostile, violent reception. A Congressional Committee Hearing soon after lent needed validity, hailing "This courageous miracle." Hope and recovery were born for New York, the Nation and for 72 nations of the world. Miracles do happen! Hope and recovery were born for New York, the Nation and for 72 nations of the world. Miracles do happen! A 40th Anniversary, while providing a platform for measuring incredible achievement, challenges us to remain alert, concerned and sufficiently flexible in fashioning "the family healing approach" for new frontiers. Is it really necessary to incarcerate two million young Americans each year? Happy Anniversary to the finest group of professionals across the Nation - Daytop's gifted Staff! Sincerely, (Msgr.) William B. O'Brien
5 Daytop Officers Officers Board Members Daytop Incorporated Chairman Frank Prudente Vice Chairman Joseph M. Fitzpatrick, Esq. Secretary Charles J. Rappaport, Esq. Treasurer Walter J. Cook Daytop Foundation Chairman Richard P. Phelan Vice Chairman Vincent F. Pitta, Esq. Secretary Robert J. Del Tufo Treasurer Ethan C. Eldon Executive Vice President Brian Madden Senior Vice President/ Treatment Services Charles Devlin Senior Vice President/ Operations Yasser Hijazi Senior Vice President/ Special Programs Patricia Zingale Senior Vice President/ Legal Affairs Steven Winston, Esq. Vice President/ California & New Jersey Joseph Hennen Vice President/ Chief Financial Officer Thomas McCulloch Daytop International Chairman John P. Curran Secretary Michael R. Long Treasurer Hon. Thomas B. Galligan Photo: Daytop Headquarters in New York, NY Daytop Officers 5
6 DAYTOP The Begi ning MY NAME IS JACK. MY JOURNEY BEGAN IN 1972, THIRTY ONE YEARS AGO. There was alcoholism in my family. In school I was very restless, and early on was labeled a troublemaker, somebody who's never going to make it. I figured then I'd become the best troublemaker I could be, and be good at something. In my neighborhood it was taken for granted you would go to high school, join the service, and when you came out you became a cop or fireman, worked for the phone company or Con Edison, and put in your years. Well, I got as far as joining the service. I really didn't care if I lived or died. I was depressed, lonely, it just felt like the ultimate failure in the world. There was no hope. 6 Then & Now I always felt unique, different, that I didn't fit in. Drugs and alcohol took away the pain, the misery. I tried to get off heroin, and in those days they put you on methadone. I was on an enormous amount of methadone, and I was addicted to barbiturates. There was no place I could go. I couldn't go home, I didn't have any friends left, nobody wanted to have anything to do with me. I can remember walking down the street and people I had known all my life saw me coming and crossed the street. I had no idea I was going to make it to 27 years old, much less the 57 years old I am today, and I didn't care, it really didn't matter to me. Life and death meant nothing at that point. In fact, dying was an alternative, a way out. Out of fear and survival, I went to Daytop. And I really didn't know what it was. When I went up to Swan Lake it was New Year's. In this big room full of people, everybody started to hug each other. I was scared to death. No way was I going to hug people, especially not another guy. I was back to feeling awkward, apart, and that I didn't belong. But I stuck it out. I just kept showing up, being there. I truly had no place to go. I guess the biggest thing that kept me there was that I started to identify with people. To see people who felt even worse than I did, who had done things worse, and that I wasn't unique, it wasn't in the genes or something. Counter Clockwise: High School year book picture; Jack(left front) with fellow Daytopians; wedding day; on vacation with family in Italy.
7 N w F rty years later I AM WHO I AM TODAY BECAUSE DAYTOP GAVE ME THE TOOLS TO NOT QUIT. "I think then, I began to get hope, that maybe I can put a life together. I started to see guys who had been at Daytop a while moving forward, and I started to think, "If they can do it, why can't I?" That was the beginning of when I started to change. Daytop helped me form a concept of what character was. Honesty, responsibility, confronting your feelings, all the things that were foreign to me. The sensitivity, the love and concern, finally got through to me. And somewhere along the line I began to take responsibility for my life. I saw hope. Top-Bottom: Jack Leonard now; meeting with a client; with one of his employees. I was working in New Jersey when I met my wife. I looked at this woman, and I just knew she was a gift for my life. When we got married, we didn't have a penny. I wanted to open up a business in the town where we live. I would work hours a day. I remember one time, my wife and I had plans to go out, and this opportunity came up to meet with a client. I took a piece of paper and drew a stick figure of a house on a hill, with two kids and a dog, overlooking the water. I wrote that this was what I was working for. I was driven by something I never had before, a drive to be somebody, to be successful, to be able to support a wife and to have kids and to have a home. A few years ago my wife pulled out this little piece of paper. We have the house on the hill, by the water, two kids. I really believe that if you have an image in your mind of what's important to you, if you just keep it, and are willing to make sacrifices, you'll get there. Whenever I can, I reach out to people, kids especially, and use my past to help them stop or prevent them ever using drugs. My wife and I are very involved in our community and our church. Today my business is successful. I'm a Chartered Financial Consultant, and help people plan their insurance and investments and they trust me with that. It wasn't easy, but Daytop gave me the tools to not quit, be honest, confront the things that bother me, and that's probably been the key for where I am today. Here I am today, people are trusting me with their hopes, dreams, and assets. I value that, I wouldn't compromise that in a heart beat. Then & Now 7
8 Annual nnual Report Report Daytop is a Therapeutic Community for individuals with substance abuse and addiction problems. For the past 40 years, Daytop has helped people who have realized that they can t do it alone. This annual report presents the reader with information about the population Daytop has served in its diverse treatment programs during the fiscal year It details demographic, drug history, psychosocial, and vocational information for individuals who received services in Daytop s treatment programs in New York State, California, and New Jersey from July 1, 2002, through June 30, In addition, the report presents information about retention rates as well as admission and discharge patterns for clients in residential and outpatient modalities in all Daytop centers. A large majority of Daytop clients are referred to treatment by the Criminal Justice System. It is often questioned if clients entering treatment under such massive pressure as a potential prison sentence are motivated enough to benefit from treatment as much as their voluntary peers. In order to explore this issue, this annual report presents results from Daytop s Outcomes Management System (OMS), comparing progress in treatment, craving, client satisfaction and other variables in clients with pressuring legal involvement and those who do not currently have any legal involvement. The reader will also find information about the variety of programs that are entailed in Daytop s continuum of care as well as special issues relevant to the field of substance abuse treatment as observed through the Daytop lens. Finally, this annual report outlines Daytop s extensive quality improvement system, and the range of supportive services and functions that complete the Daytop continuum of care. You Can t Do It Alone Daytop is a Therapeutic Community for individuals with substance abuse and addiction problems. For the past 40 years, Daytop has helped people who have realized that they can t do it alone that they cannot build a drug-free, contented life without the support, encouragement and challenge of a community of like-minded human beings. Daytop offers the compassionate environment that fosters crucial aspects of long-term recovery: the desire and ability to help himself or herself, the courage to face one s personal truth, and to take responsibility for one s own life. 8 Annual Report The roots of Daytop go back to 1963, when a small group of pioneers started Daytop Lodge to provide addiction treatment for individuals on probation in NYC. From these early beginnings, Daytop has grown and developed to epitomize the highly effective Therapeutic
9 Community treatment approach, and is regarded as a leader in ongoing innovative treatment responses to ever-shifting political, legal, economic, cultural, and attitudinal influences. Forty years after opening its first treatment center on Staten Island, NY, Daytop now operates twenty-seven facilities in three states, providing an expansive continuum of care in New York, New Jersey, and California through a network of fourteen residential centers and thirteen ambulatory (outpatient) centers. Daytop operates two additional sites an Administrative Headquarter and its Annex in New York City and a training site in Pennsylvania. Daytop s New York residential programs are located in Manhattan, Queens, Sullivan, and Dutchess counties; ambulatory services are delivered in the five boroughs of New York City as well as Suffolk, Rockland, and Westchester counties. Daytop New Jersey provides residential services in Mendham and ambulatory services in Parsippany, Newton, and, since April 2003, in Flemington. Daytop California provides residential services in Redwood City, East Palo Alto and San Mateo. The Therapeutic Community Model The Therapeutic Community (TC) model has been shown to be an effective method to address the complex issues that determine chronic substance abuse. The TC perspective conceptualizes substance abuse as a form of deviant behavior that reflects impaired personality development and/or chronic deficits in social, educational and economic skills. Accordingly, the model aims at treating and developing the whole person, rather than addressing substance abuse issues alone. Based on the premise that You can t do it alone, the TC model views the community of peers as the central agent for change in the individual. It is the influence of peers within a hierarchical structure and treatment stages, that allows clients to accept and fulfill increasing personal and social responsibility. Mediated through a variety of group processes, clients take a highly outspoken role in one another s treatment, expressing feedback, confronting, and supporting each other with the goal of modifying attitudes, perceptions, and behaviors associated with drug use. Typical TC program completion criteria include total abstinence from drugs, stable employment and living arrangements, a demonstrated ability to cope with everyday life demands and responsibilities, an understanding of relapse prevention, and demonstrated ability to participate and comply with an aftercare treatment plan. The Daytop Continuum of Care Over the past 40 years, Daytop expanded and enhanced the TC model through a variety of specialized programs and comprehensive services. Daytop now offers a continuum of care on behalf of its adult and adolescent clients. Adults and adolescents receive services in ambulatory settings and in three residential treatment tracks: Shortterm (1-3 months); Intermediate-term (6-9 months); and Long-term (9-12 months). Daytop s adjunctive Services Network addresses many clients co-existing bio-psycho-social needs in accordance with the agency s commitment to treating the whole person. Recent scientific evidence now supports this commitment, suggesting that the recovery process is often exacerbated or undermined by non drug-related issues. Daytop is based on the premise that You can t do it alone. This TC model views the community of peers as the central agent for change in the individual. Annual Report 9
10 Clients have access to the level of care appropriate for each individual within one agency. The continuum of care translates to services that are comprehensive and coordinated to meet each client s needs with the appropriate level of treatment support. From the point of referral and admission to a client s eventual discharge, treatment is responsive to each individual s strengths and needs, and the evolving change process. Clients have access to the level of care appropriate for each individual within one agency, avoiding referral procedures and disruption of the individual s treatment process. The continuum of care is reflected in the flowchart below. Daytop s exhaustive screening and referral process establishes the most appropriate level of care for each client s rehabilitative needs. Prescreening may be performed centrally in an intake unit as well as in hospitals, detoxification units, courts, shelters, and correctional facilities. The pre-screening process evaluates potential clients medical, psychological, educational, vocational, and legal status to ensure that Daytop will be able to provide each client with comprehensive services, and that the client is fully able to participate in the treatment process. The clinical recommendation that emerges from this process indicates a client s required level of care (Short-, Intermediate-, or Long-term residential treatment, ambulatory treatment, or inter-agency placement) as well as specific adjunctive services from which she or he may benefit; this recommendation is the precursor of the comprehensive inter-disciplinary treatment plan. Short-Term Residential Treatment REFERRAL Outpatient Services ENTRY UNIT Upstate Long-Term Residential Treatment Re-Entry Completion Aftercare Graduation 10 Annual Report
11 ODaytop served a total of 8,960 clients in its nationwide residential and ambulatory (outpatient) treatment network during the fiscal year. A further estimated 2,000 family members received support through family programs. verview Of all clients treated, 6,757 (75%) were 21 years or older and the remaining 2,203 clients (25%) were under 21 years old. About one third of clients received substance abuse treatment in Daytop s residential facilities in California, New Jersey, and New York State, which offer Short-Term, Intermediate Term, and Long-Term residential treatment. All other clients were admitted to ambulatory facilities in these three states. The basic demographics of this year s nationwide client population are presented in Chart 1. Following this overview, this report describes the variety of Daytop programs and their accomplishments in the fiscal year , and breaks down client characteristics, including admission and discharge types, for each state. In addition, treatment outcome results are reported by the Daytop New York Outcomes Management System (OMS). Differences between this fiscal year and last year s breakdown will be noted where applicable. Nationwide Client Demographics Gender: Nationwide, 7,407 men (83%) and 1,553 women (17%) were treated in Daytop programs. However, the proportions vary by state: in California, 33% of all clients were female; in New Jersey, 31% of clients were women. New York, with the largest program capacity, served 16% women. The rate of women served remained stable from last year s rate. Both sexes have access to gender-specific services. Ethnicity: Daytop embraces diversity through programs that continue to be ethnically and culturally heterogeneous. Close to half of the overall client population is African-American, while Latino/a and white clients each represent a bout a quarter of the population, respectively. (Chart 1) These overall rates are virtually unchanged from last year s report. However, ethnic distribution varies by state, with New York programs serving a majority of African-American clients (49%), while New Jersey and California programs serve a larger proportion of white clients (79% and 53%, respectively). 25% Latino/a 26% White 3% Other 46% African American Ethnicity-Nationwide Average 1 2 Criminal Justice System (CJS) Mandate: Two-thirds of Daytop s clients (66%) come to treatment as referrals from the Criminal Justice system. Other referral sources include detoxification units, ambulatory treatment centers, family members, employers, and Social Service agencies. Drug Use History: Basically unchanged from last year s report, drug use centers on cannabis as both clients most common primary drug as well as their most frequent additional drug, even though it lost 2% in primary and 1% in general drug use. Alcohol is the second most reported generally used drug by Daytop clients and gained 2% as primary drug compared to last year s rate of 12% (Chart 2) Drug Use History Nationwide (%) Heroin Cocaine Crack Cannabis Alcohol Primary Use General Use Overview 11
12 New ew York York Daytop Sources Of Referrals On the following pages, Daytop s treatment programs in the State of New York will be presented. This includes an overview of the main sources of client referrals, a detailed description of treatment programs offered to adults and adolescents, program accomplishments, an overview of the client population served as well as outcome results achieved during the fiscal year Clients come to Daytop from many sources. During the fiscal year about 12% of clients were self-referred, 8% were referred by family or friends, 5% by a Social Service agency, and 10% were referred by other sources such as schools, employers, detoxification centers, etc. The largest referral source, however, was the Criminal Justice System (CJS) with 65% of referrals in New York State. Over the 1990s, a growing number of clients reported some kind of recent involvement with the CJS, and are increasingly referred to Daytop by the CJS, as demonstrated by Chart 3. Daytop holds several contracts with the Criminal Justice system, which are aimed at diverting non-violent drug offenders away from the legal system and offering them the alternative of drug treatment to a prison sentence, or post-incarceration Aftercare. Differences exist in each contract s approach to the targeted offender population and the strategy of diversion or recidivism reduction. Some of the main Criminal Justice programs that Daytop participates in are outlined below. Drug Treatment Alternatives to Prison (DTAP): The Drug Treatment Alternatives to Prison (DTAP) program operates throughout New York State. DTAP s goal is rehabilitating individuals with addictions instead of imprisoning them. Begun in 1990 through a close collaboration with the Kings County District Attorney s office, DTAP was co-designed using a balance of treatment and law enforcement to facilitate internal and external motivations that are often essential in the rehabilitation of people with addictions. Since then, DTAP has expanded to other counties CJS-Referred & Involved Clients (%) CJS-involved 12 New York CJS-referred DTAP clients are non-violent offenders whose main external motivator is an increased likelihood of imprisonment if they do not complete treatment. Clients are required to plead guilty to a felony charge prior to admission, and this increased certainty of punishment in the case of noncompliance with treatment, or pardon with compliance to treatment, has shown a positive effect on client retention and treatment outcome. DTAP evaluators report that recidivism and drug relapse rates are drastically reduced in clients referred through DTAP compared to individuals incarcerated without treatment. Also, while 64% of clients are unemployed at the time of their admission, 86% of DTAP clients who complete treatment are either employed or in school at the time of their exit interviews. In terms of efficiency, the DTAP system has estimated that $1 spent on treatment saves approximately $13 in correctional (prison) expenses. Above: Daytop clients in a morning meeting at the Swan Lake residential facility.
13 Willard Program: Daytop maintains a contract with the Department of Corrections Willard Drug Treatment Facility for aftercare drug treatment. Eligible non-violent offenders go to Willard for three months, before being referred to Daytop for six months of intermediate-term residential treatment at our Meadow Run facility, and six months of outpatient Aftercare services. Treatment Alternative To Street Crime (TASC): Treatment Alternatives to Street Crime is a New York City (NYC-TASC) program that acts as a bridge between the Criminal Justice system and the treatment community. NYC-TASC works to divert substance abusing, nonviolent prison and jail bound offenders into treatment in lieu of incarceration. The program also partners with the District Attorney s Office in four counties, providing screening, assessment and case management services for the District Attorney s Drug Treatment Alternative-to-Prison (DTAP) programs. Drug Courts: Drug Courts, or Treatment Courts, provide direct supervision by a judge of clients in treatment. Treatment courts are diversion programs. They require clients to report to the judge regularly as a way to monitor progress in treatment. Judges can sanction clients immediately for lack of progress or non-compliance. Outpatient Criminal Justice Services (OCJS): Clients referred by the Criminal Justice system now comprise a significant portion of the adult outpatient population, and Daytop maintains contracts with Federal, State and City Criminal Justice agencies. Ambulatory Criminal Justice treatment (also known as recidivism reduction treatment) often includes clients who have completed a period of incarceration and are now mandated to treatment as a function of post-incarceration legal supervision (parole). Treatment Program Adult Residential Twenty-four hour residential treatment is recommended when adults are deemed socially and occupationally dysfunctional due to their substance abuse or dependence. Once residential treatment is indicated, clients begin a residential-to-outpatient treatment continuum that includes an Assessment and Referral (Entry) phase, a Core treatment phase, and a residential Re-entry phase that steps down to an outpatient Aftercare phase. This treatment continuum, including the three Core Treatment options (Long-term, Intermediate-term, and Short-term), is presented in the flowchart on page 10. Right: Adult graduate of one of our New York residential programs. Residential Assessment & Referral (Entry): When the pre-screening process indicates the need for Long-term residential treatment, newly admitted adult clients start their recovery process in the 14-day Assessment and Referral Unit located in Queens, NY. Here, all clinical assessments and interviews, and results of vocational/educational test batteries are combined to yield an individualized, comprehensive inter-disciplinary treatment plan. This plan, created with the client s participation, identifies strengths, needs, individual treatment goals and objectives as well as the discharge plan to be pursued during the Core treatment phase. Clients meeting criteria for Intermediate-term or Short-term Core treatment enter those facilities directly. Their treatment plan is based on comprehensive on-site assessments. New York 13
14 Long-Term Residential Treatment: The planned duration of Longterm Core treatment is 9 to 12 months and consists of structured treatment every day of the week. Clients participate in a tailored therapeutic structure of general meetings, one-to-one counseling sessions, encounter groups, marathon groups, vocational/educational training, topical seminars, and educational workshops. Clients develop maturity and responsibility through positive peer pressure within a therapeutic milieu and are awarded privileges over time by client peers and clinical staff. Progress is regularly reviewed. Once treatment goals are completed, clients proceed to the residential Re-entry phase or discharge to Aftercare in an outpatient facility. Intermediate-Length Treatment: Intermediate-term treatment is planned for six months. The New York adult track hosts select forensic programs, including clients from Drug Treatment Alternatives to Prison (DTAP), Treatment Alternatives to Street Crime (TASC), Willard, Parole, and Probation. Clients develop maturity and responsibility through positive peer pressure within a therapeutic milieu. Short-Term Treatment: Short-term treatment may take one to three months for clients with less functional impairment than those in the lengthier Core treatment tracks. Upon completion, clients are referred to an outpatient facility for Aftercare, schooling, and support services. Residential Re-entry: Clients in Long-term Core treatment who need further vocational/educational, housing, or job placement remediation end their treatment in a residential Re-entry unit. The goal of this treatment phase is to re-integrate clients with their communities while providing treatment support in a less structured environment than the Core treatment milieu. During this phase, clients secure work, manage their own finances, and find housing. Clients attaining these goals are considered successful Long-term treatment completions. Aftercare: Adult clients completing residential treatment may subsequently attend outpatient Aftercare. Aftercare services include relapse prevention support and puts emphasis on re-adjustment issues. Accomplishments Adult Residential In times of budgetary constraints, much organizational effort goes into securing treatment slots and broadening client access. Daytop s Intermediate-term Meadow Run and the Short-term Manor House residential centers in Dutchess County provide contracted services for select clients from specific sub-populations within the criminal justice system. The Meadow Run center continued to provide services for clients from the Department of Prisons Willard Extended Treatment Program and received an additional contract to service Willard referrals. Meadow Run clients who were participants of the Willard Extended Treatment program were officially recognized at a ceremony in Manhattan. The Manor House was awarded another contract from the Eastern and Southern Districts of New York for Probation and Parole referrals. 14 New York All adult residential facilities have designed and implemented quality improvement measures that are specific to their program needs as indicated in by their outcomes evaluation results. Several facilities have initiated intensified programming for women, who appear to experience more emotional and social distress and have unstable retention Left: Adult graduates congratulating each other over their accomplishment.
15 patterns. Interventions include more women s groups, women s encounter groups, earlier facilitation of child visitation, and the women s deliberate assignment to female clinical staff. High early attrition rates among both men and women have been responded to with intensified orientation groups and younger-member groups. Other intensified groups include anger management and men s issues. Special attention has been paid to the inclusion of families and loved ones into a client s treatment. In addition, the social work and clinical staff in the adult Re-entry unit developed a five-part series of groups that explore the impact that fathers have on their sons. Female and male clients discuss how the image that fathers portray to their sons affects them and how families are challenged by societal and familial roles and expectations. Giving back to the community has always been an important aspect of TC treatment. Staff development is an on-going demand in order to keep up with changing client populations and external requirements, and improve the quality of services. A large group of adult residential staff members received a three-day training in psychodrama under a Temporary Assistance for Needy Families grant awarded to Daytop during the year. Giving back to the community has always been an important aspect of TC treatment. Adult clients participated in various fundraisers and special events, including the AIDS Walk in Valhalla, NY, the AIDS Walk in Central Park in New York City, a Mini-Olympics event at Rockland Community College, the World Federation of Therapeutic Communities Global Run, and the Daytop Alumni Association s annual picnic for Daytop graduates and their loved ones. Daytop is the prototype for substance abuse treatment all over the world, and draws considerable interest from individuals and constituents who are interested in bringing the Daytop concept to their respective communities. From abroad, various international trainees studying the TC model practiced at Daytop stayed at the Promethean Institute in Pennsylvania and visited the adult residential sites to observe the continuum of care concept in practice. Closer to home, a series of three visits took place from constituents from Maine. Law enforcement officials, judges, lawyers, doctors, Native American tribe representatives and others explored the Daytop concept because of their interest in starting a similar program in Maine to address a rapidly growing opiate problem. Locally, Daytop became involved in a project called Road To Recovery, which was developed by the Assistant Commissioner of the New York State Office of Alcoholism Substance Abuse Services (OASAS), for substance abusers arrested for felonies from specific upstate New York counties. Representatives from OASAS and officials from Washington and Warren Counties were impressed with their visits to Daytop during the year. Treatment Program Adult Ambulatory Right: Adult graduate of our residential program. Daytop has a wide-ranging and diverse portfolio of adult outpatient services. During the fiscal year, previously OASAS-licensed Medically Supervised Outpatient Services were converted to Department of Health (DOH) Certified Chemical Dependence Outpatient Services. Statewide, all Non-medically Supervised Outpatient Services were eliminated. NYS OASAS and Department of Health concurrently license all Adult Outpatient Services New York 15
16 including Aftercare and Outpatient Criminal Justice programs. These services are delivered within the framework of the Therapeutic Community (TC) model and offer an integrated regimen of medical, mental health, clinical, and vocational rehabilitation activities. They meld counseling and support from older drug-free peers with a wide array of support services from certified professionals, affording the opportunity for growth and rehabilitation on all levels. Accomplishments Adult Outpatient All Daytop Outreaches were successfully converted to Outpatient Chemical Dependence providers. The Manhattan Outreach continued a positive trend of excellent performance on several measures during the year. The Adult Outpatient and Aftercare components were selected as a Best Practices site by OASAS as part of their Local Community Services efforts. Elements of best practices at the site included skilled, experienced managers, flexible treatment approaches, provision of a wide range of services and rapid engagement of clients into treatment. The Adult Outpatient and Aftercare components were selected as a Best Practices site by OASAS as part of their Local Community Services efforts. The Manhattan Outreach also demonstrated solid teamwork and efficiency by meeting or exceeding all OASAS standards and increasing Medicaid revenue for the third year in a row. New groups offered anger management, twelve-step work, and parenting skills. Additionally, this Outreach successfully implemented a special TANF grant for intensive treatment for clients trying to become independent of Welfare. This highly successful program (47% of clients completed the program) was unfortunately defunded in The Staten Island Outreach implemented a Significant Other Program that provides support to family members, friends and associates who are affected by someone else s alcohol or drug use. Additionally, newly hired staff and construction that occurred during the year will facilitate service provision to adult clients. The Rockland County Outreach has been successfully creating linkages with CJS agencies as well as other community organizations through a wide array of speaking engagements and participation in community forums and other local events that addressed the use and abuse of alcohol and drugs. In addition, ties with the Rockland County Department of Mental Health and its new Director have been strengthened to the benefit of easier access for clients with both substance abuse and mental health treatment needs. Although Outpatient Criminal Justice System programs experienced budget cuts, they continued to be a significant percentage of the overall outpatient population, and several positive developments took place during the past fiscal year: 16 New York Outpatient Criminal Justice Services (OCJS) sustained its contracted 940 client slots this year. Daytop continues to be the largest provider of outpatient services to Criminal Justice clients in New York City, with over 800 active clients at year s end. Growth was seen in some program units, including the Federal Bureau of Prisons program, which is expected to continue to increase over the next few years.
17 OCJS was successful in tapping new funding sources including an increase in Medicaid and self-pay clients. This has aided in sustaining programming and population levels. The Federal Southern District programs were rated excellent on eight different audits during the year. This was an unprecedented recognition by Federal Probation of the quality of Daytop s work. Outpatient Criminal Justice programming expanded in the Bronx with the opening of a new facility at 2614 Halperin Avenue. This new site enables Daytop to more adequately provide services to all clients in the Bronx by alleviating space problems at the Bronx Outreach at Westchester Square. Another successful Criminal Justice program has been the Parole Restoration Project. Daytop received over 200 referrals of releasees from Riker s Island. This population represents a traditionally underserved population. As part of an effort to launch new community initiatives, the Rockland Outreach started criminal justice workshops within the Rockland County Jail. The workshops focus on recidivism reduction and treatment options. The Suffolk Outreach continues to strengthen its relationship with the Suffolk County Drug Court. The Staten Island Drug Court Pilot Program started during the year. In order to take advantage of this local resource, several Staten Island Outreach staff received court passes from the New York City Department of Corrections to gain Legal Assistant status. These staff are now permitted to do initial intake assessments in the Court for candidates who are involved in criminal drug activity. The Judge may then assign these candidates to Daytop for treatment services. Treatment Program Adolescent Residential Adolescent residential treatment requires the regular participation of parents or guardians. Daytop s Core adolescent residential treatment mirrors adult residential treatment in its sequence of phases. Assessment of male adolescents and their referral to Long-term or Intermediate-term treatment is conducted at the 30-day Adolescent Diagnostic Unit; female adolescents receive assessment services at the Millbrook facility. Short-term to Long-term Core treatment options, and an adolescent Re-entry phase are available to adolescents. Like their adult peers, adolescents have access to Aftercare services of varying intensity at Daytop s Outreach centers when they return to their home communities. Despite some fundamental similarities in adult and adolescent treatment approaches, adolescents have particular treatment needs that reflect their developmental level. Right: Adolescent female with a counselor at a women s retreat. Adolescent residential treatment requires the regular participation of parents or guardians since adolescents often anticipate the long-term goal of returning to their families. Accordingly, family therapy receives intensive consideration in order to adequately prepare the adolescents and significant figures in their home environment for the client s return. On the other hand, special efforts are made to prepare those adolescent clients for whom the long-term goal is independent living. Adolescent vocational and educational needs receive special attention in residential and outpatient programs through The Daytop Preparatory School. New York 17
18 Accomplishments Adolescent Residential The program entitled Empowering Families in Recovery, made possible through a Temporary Assistance for Needy Families (TANF) Grant from the State of New York, provided much needed family therapy as well as other services to adolescent clients with troubled family relationships. This program will be extended through June 30, Through this program, the Hudson Valley Psychodrama Institute trained Daytop staff in Psychodrama. For more information on the TANF program, please refer to the Special Issues chapter of this report (pg. 52). All three residential adolescent programs designed and implemented quality improvement strategies that address critical issues identified by the Outcomes Evaluation system. Female adolescents with significant time in treatment will be provided with a transitional group that allows intense preparation for the time after discharge and the coping with any emotional issues arising from the anticipated return to the family and community. Additional measures include stress reduction groups and techniques, intensified vocational counseling, and support for housing needs. Young men in the early phase of treatment will be provided with more clinical attention to the adjustment process and its emotional correlates through more individual sessions with counselors as well as group time. For male adolescents, anger management and anxiety reduction are important goals in treatment, and specialized groups and seminars are provided to foster their development particularly in the latter stages of treatment. All three residential adolescent programs designed and implemented quality improvement strategies. Creative expression and identity formation are particularly relevant for the development of adolescents. Thus, each year, adolescent clients are encouraged to participate in exciting art projects. Adolescent clients attended movement workshops and performances at the Kaatsbaan International Dance Center in Dutchess County. The principals of internationally renowned dance groups conducted the workshops. Adolescents, who often have difficulty communicating their feelings verbally, expressed emotions more easily through dance and processed the experience afterward. In addition, the Daytop Preparatory School put on a play at the Rhinebeck Performing Arts Center entitled, C-za, A Gangsta and a Gentleman. Clients wrote part of the script in the vernacular, which was interwoven with Shakespearean English. Renovations at Fox Run are almost complete and renovations to the kitchens at the Adolescent Diagnostic Unit and Millbrook commenced and are expected to be completed by the end of calendar year Treatment Program Adolescent Ambulatory 18 New York Adolescents from a supportive home environment who have fewer substance abuse and/or behavioral needs may attend Adolescent Day Services at the Daytop Outreach Center closest to their home. The Outreach Center is open to clients six days a week. The teens attend school at the center Monday through Friday and participate in clinical activities from 3 to 5 in the afternoon. They receive a full array of counseling, educational, medical services (as necessary), meals, and recreational/physical educational services. The environment is highly structured and stresses positive peer pressure and role modeling as catalysts for change. Adolescents take on chores around the facility to Left: Bonding at a Father & Son Retreat at the Promethean Institute.
19 foster responsible attitudes. Saturday mornings are set aside for facility responsibilities, sports, and other recreational activities. During the Aftercare phase of adolescent outpatient treatment, clients resume attendance at their local schools, begin college or may enter vocational training. Throughout this phase they continue to participate regularly in groups or other treatment aspects to support them in any readjustment issues they may encounter. Accomplishments Adolescent Outpatient Daytop successfully converted its license to Outpatient Chemical Dependence Services. As described in the Adult Ambulatory segment, Daytop successfully converted its license to Outpatient Chemical Dependence Services. Plans to enhance services to adolescents are currently underway and involve applying for an Outpatient Community Rehabilitation license. Daytop would be the first substance abuse program in New York State to pursue this license, which focuses on enhanced staffing and services for adolescents. Daytop s Rockland Outreach has been working diligently to establish a relationship with the Rockland County Department of Mental Health. This relationship will allow the development of linkages with other county providers and yield additional referrals. The Rockland Outreach continues to extend and strengthen its range of communication with schools, Drug and Family Treatment Court, various foundations and community organizations and with the media. One example of media exposure was with the Clarkstown Cable Network that conducted an interview with Daytop staff on how to help addicted youth. Daytop continues to foster the relationship between the Suffolk Outreach and the Suffolk Coalition to Prevent Alcohol and Drug Dependencies, the Suffolk Community Council and the Suffolk Project for AIDS Resource Coordination (SPARC). In an effort to maintain retention of younger adolescent clients, the Suffolk Outreach developed a Thirty-day Orientation program that reaches out to newer clients at this vulnerable point in their treatment. During the year, major construction commenced in the Suffolk Outreach. This construction entails building three new offices, a new kitchen and bathroom renovations. The Staten Island Outreach Offsite Educational Service Program was recognized as having the highest non-residential attendance record Boroughwide for the school year. The Daytop Outcomes Evaluation System was implemented in the Adolescent outpatient divisions. All clients regularly complete confidential Outcomes Evaluation Protocols throughout treatment. Population Served New York A total of 8,380 clients were served in New York State during the last fiscal year. Of these clients, adult outpatient and residential clients accounted for 79% (N=6,645), and 21% (N=1,735) of all clients were adolescents, up from 18% in the past fiscal year. Charts 4 and 5 represent the modality breakdown for each age group. Compared to the past fiscal year ( ), adult residential admissions increased by 1%, whereas adolescent admissions to residential treatment decreased by 2% in favor of outpatient treatment % Outpatient (N=4137) 38% Residential (N=2508) Adult Population 66% Outpatient (N=1152) 34% Residential (N=583) Adolescent Population New York 19
20 < YEARS Age Groups (%) Charts 6 and 7 present the overall breakdown of age distribution and retention rates in residential and outpatient treatment for the fiscal year Age: In the previous fiscal year, only 3% of adolescent residential clients and 5% of adolescent outpatient clients were under16 years old. This year s numbers have increased by 5% and 7% respectively, while the adolescent age groups of and years have each lost 1% to 2%. This signifies a notable shift in adolescent admissions to a younger population. This trend may be related to the fact noted above, that more adolescents were admitted to outpatient treatment the more likely choice for younger clients. Another change can be observed in the population years old, with an increase of 2% in residential clients, and a decrease of 4% in outpatient clients. Among adults older than 25 years, the distribution has not changed markedly One Three Six Nine MONTH(S) Retention Rates (%) Residential Outpatient Twelve Retention: Chart 7 demonstrates residential and outpatient retention rates, combined for adult and adolescent clients in New York State Daytop programs. These rates apply to all those clients discharged during the fiscal year (N=5,780 total; N=2,165 in residential, and N=3,615 in outpatient treatment). One and three month retention rates are 8% and 3% higher in outpatient than in residential treatment, respectively; however, from the six months retention mark residential retention is higher. In comparison with last year s rates, one and three months retention in residential treatment (73% and 58%, respectively) have improved by 1% each, while in outpatient treatment both nine and twelve months retention have increased by 1%. Population Served Adult Breakdown A total of 6,645 adult clients received treatment during the reporting year, about one-third of them in residential (N=2,508), and twothirds in outpatient treatment (N=4,137). Demographics, identified by treatment modality, are presented below. Gender: Women make up less than one-fifth of the adult population in both residential and outpatient settings. In outpatient treatment, clients who enter treatment through contracts between Daytop and the Criminal Justice system show an even greater male majority with only 10% of these clients being female. These rates are unchanged from the year (Chart 8) Ethnicity: African-American clients represent the majority in adult populations across all programs, but their proportion is particularly high in the outpatient programs. Latino/a clients make up about one quarter of Daytop adult residential and outpatient programs. White clients represent more than one quarter in adult residential treatment, while their proportion in outpatient treatment is significantly lower compared to clients of other ethnicities (Chart 9). Compared to last year s annual report, the ethnic distribution in residential treatment is unchanged, while in outpatient treatment African-American clients lost 2%, while white and Latino/a clients gained 1 and 2%, respectively. 17 Women Men 86 Residential Outpatient Gender - Adult Population (%) 1 Other White Residential Latino/a African- American Outpatient New York Employment Status: Adult clients entering outpatient treatment report more than five times residential clients rate for some kind of Ethnicity - Adult Population (%)