Community Mental Health Journal
Volume2, Number 4, Winter, 1966
MOBILIZATION OF COMMUNITY RESOURCES IN THE OUTPATIENT TREATMENT OF ADOLESCENT DELINQUENT BOYS: A CASE REPORT MILTON F. SHORE, PH.D., AND JOSEPH L. MASSIMO, ED.D.*
Strategies for working with community groups must be developed if the principles of community mental health are to be put into practice. An experimental outpatient treatment program for adolescent delinquents that required the cooperation of two community groups, the school and businessmen, necessitated the development of certain procedures for mobilizing the groups around the implementation of treatment. The success of the program serves to highlight certain principles of working with community members.
One result of the recent theoretical focus on the role of the community in the prevention, treatment, and rehabilitation of mentally disordered individuals has been a growing interest in the development of strategies and techniques for the mobilization of community resources to improve the mental health of its members. Two approaches to the development of a strategy for community intervention are possible. One is to evolve an overall plan of intervention from an understanding of the community and its service structure, from which develop large-scale techniques of intervention, such as mental health education, community planning, and interagency conferences. A second approach is to attempt to mobilize those resources in the community necessary for the implementation of a specific program. While the first approach is often best evaluated by largescale measures, the second is frequently
*Dr. Shore, a child clinical psychologist, is Clinical Psychologist at the Mental Health Study Center, National Institute of Mental Health, Adelphi, Maryland. Dr. Massimo, a school psychologist, is Chief Psychologist, Newton (Massachusetts) Public Schools, and Administrative Manager, Newtor~-Baker Project, Judge Baker Guidance Center, Newton, Massachusetts. Dr. Massimo carried out the program described here.
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THE COMMUNITYMENTAL HEALTHJOURNAL
best studied through a case study approach. The purpose of this paper is to present a case study of how specific community resources were mobilized to assist in the carrying out of a successful experimental, outpatient treatment program for adolescent delinquent boys. From the success of this program, there are certain general principles of working with community members that are highlighted. The program that was planned was an experimental, vocationally oriented psychotherapy program described in detail in Massimo and Shore (1963). The goals were very specific. Since adolescent boys with a chronic history of antisocial behavior have usually been very difficult to treat, it was believed that perhaps an innovative individual approach of a flexible kind made available within 24 hours of the time the boy either left or was suspended from school would perhaps be successful. The essential component of this approach involved offering the boy an opportunity for employment. The belief was that employment would provide an entr6 for remedial education and psychotherapy, both of which are needed by the delinquent adolescent but which are both characteristically rejected by him as unrelated to his needs. In order to carry out this program, it was necessary to gain the cooperation of two community groups: the school and businessmen. THE SCHOOL Two groups in the high schools were important in the program: the vocational guidance counselors and the attendance ofricers. Prior to contacting these two groups, the therapist notified the guidance director and superintendents of his affiliation with a responsible treatment agency and his desire to work with those boys who had left school. This short and often informal contact was adequate for their acceptance and permission to contact and work with the counselors and attendance officers. The program was explained to the vocational guidance counselors, who were told that the therapist would not be competing with them for available jobs or for vocational guidance services. The fact that the boys helped
would be those who had left school made it easier to see the service as separate from the usual school services. Communication was encouraged by suggesting that the counselors contact the therapist if there were any problems. No such formal contacts occurred. The person in the school who was most important in initiating contact with the boy was the attendance officer. He was the first one to know when a boy left or was suspended from school. The therapist personally contacted each attendance officer to explain the experimental program. The importance of the immediacy of the contact was stressed, and the officer was requested to give the therapist the boy's name, address, and telephone number as soon as he knew the boy had dropped out of school because of antisocial behavior. Although the responsibility for a boy who had left school was legally that of the attendance officer,* the latter was willing, even eager, to have someone take over the assistance of these youths. The therapist also made clear that he would not ask the school for any special requests or considerations. (He realized how difficult these boys were for the school to handle and how often the school felt a sense of relief when a boy dropped out.) Other than giving him identifying data, the school's only responsibility to the therapist was to provide him with records for carrying out the study. Informal contacts with the attendance officers kept them up to date with the boys in the program. EMPLOYERS Most important in the vocationally oriented treatment program, of course, was gaining the cooperation of businessmen in order, first, to collect a pool of employment possibilities and, second, to aid the employ. ers in the handling of the boys. It was always clear that the role of employment in the program was not to set up a therapeutic community with the employer as an enlightened, therapeutically oriented boss. Rather, *The school has legal responsibility for the boy after he leaves school unless the parents agree in writing to assume this responsibility.However,this responsibility ends when the boy becomes 16 years of age.
MILTON F. SHORE AND JOSEPH L. MASSIMO
it was to use employment as a reality situation with which the boy had to deal and around which other services (remedial education and psychotherapy) would be offered when needed. The strategy for involving employers in the program was initiated by writing both the governor of the state and the head of the Department of Labor in the state, describing the program in detail. When the program was explained to them, both wrote back expressing interest and encouraging the therapist to undertake the project, with the hope that the necessary cooperation from civic-minded employers would be forthcoming. With the governor and head of the Department of Labor aware of the program, certain influential and respected businessmen were then notified in order to plan a talk before the Chamber of Commerce. A presentation was arranged in which the program was explained, as well as the purpose of employment in helping the boys become useful citizens. Some of the problems that the employer might encounter were emphasized, as well as the civic responsibilities, i.e. the community (especially employers) had to help young people in difficulty so that they would not eventually become an expense to the taxpayer. (One important feature that must be remembered was that the community in which the program was planned was a suburban, middleclass community where social responsibility was seen as a virtue. The ethos of the community certainly contributed to the enthusiastic response to the request for participation in the program.) The businessmen who would be able to hire any of the boys were asked to call the therapist. In order to get a greater variety of jobs, the therapist not only spoke at the Chamber of Commerce but also made personal trips to likely business establishments (such as automobile dealers), asked for the owner, and described the program. Each potential employer was told something of the background of the boys he might hire. Questions regarding insurance, handling of the boys, and salaries were also discussed in detail. Each potential employer was told that it was
331
up to him whether or not he wanted the boy. Under no circumstances was the employer to keep a boy who was not able to maintain the standard required in the company. Within five months a pool of 60 jobs was obtained. Despite their interest, some firms decided not to hire the boy when he arrived to interview for the position. (Once a boy had been hired, none of the firms changed its mind when he arrived for work.) Understanding the anxieties related to being interviewed for a position, the therapist always accompanied the boy to the job interview. In this way the boy was not only prepared for the interview but was able to have the support necessary for handling the frustration of possibly being refused something he wanted--a therapeutic experience in itself. If this happened, the therapist and the boy would discuss the situation, then proceed to look for other employment opportunities. The boy thus had the opportunity to see how one talks to a %oss" and how one searches for other " employment possibilities. The jobs were individually selected on the basis of the boy's ability, training, and personality needs. An arrangement was made whereby the therapist could visit the place of employment about once in every two weeks to find out how the boy was doing. No employer was asked to give special consideration to or keep a boy who was causing trouble or losing money for the firm. (On the other hand, the therapist also protected the boy against any possibility of undue exploitation by an employer.) However, the original agreement with the employer stipulated that if a boy was in trouble, the therapist was to be called so that the situation could be handled with the boy. In two cases where the boys were fired outright because of stealing, the therapist sat down with the boy and the employer to find out what had happened, so he could use it to help the boy. Employment served to make the boy aware of some of his difficulties so that other kinds of assistance became necessary. For example, fellow workers found out that one of the boys could not read. They then used this deficiency in order to scapegoat
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THE COMMUNITYMENTAL HEALTH JOURNAL
the boy. The result: the boy had a fit of rage. The therapist, who knew of this deficiency but felt the boy had to find out its consequences for himself, worked with the boy to develop a special remedial reading program (based on the reading of signs and labels on various products). Also dealt with was the boy's handling of the provocative fellow workers so that his response would not be self-destructive. In treating delinquents, questions frequently come up about contacts with the police. In this program the legal authorities were seen as a reality with which the boys had to deal. The therapist did call the probation or parole officers to inform them of his plan for a boy. The officers expressed great interest and, because of their heavy caseloads, were very willing to let the therapist assume primary responsibility for the boy. The therapist did know some of the policemen socially, and informally he kept them abreast of the boy's progress.
dividual projects where certain strategies have been used can be helpful in testing some of our ideas on working with community groups. Out of the experiences in these projects can then emerge a series of specific principles for gaining community cooperation. Described in this paper was a successful project with adolescent delinquent boys that required the cooperation of two com. munity groups, the school and businessmen. The general principles used in developing a strategy for gaining cooperation of these groups were: (1) the expectations of each party were clear and were developed in a personalized relationship (the role of the personal relationship in arranging the contact should not be underemphasized). (2) The expectations were in line with what the parties were easily able to carry out. The therapist did not expect the employers to function as counselors or therapists. (3) Above all, the relationship between the two parties was based on mutual respect, understanding, and honesty.
SUMMARY There are many ways to mobilize community resources to aid in the rehabilitation of people with mental health problems. In-
REFERENCE MASSIMO,J. L., & SHORE,M. F. The effectivenessof a comprehensive vocationally-oriented psychotherapeutic program for adolescent delinquent boys. Amer. J. Orthomychiat., 1963, 33 : 634-642.
POLICE
Volume2, Number 4, Winter, 1966
MOBILIZATION OF COMMUNITY RESOURCES IN THE OUTPATIENT TREATMENT OF ADOLESCENT DELINQUENT BOYS: A CASE REPORT MILTON F. SHORE, PH.D., AND JOSEPH L. MASSIMO, ED.D.*
Strategies for working with community groups must be developed if the principles of community mental health are to be put into practice. An experimental outpatient treatment program for adolescent delinquents that required the cooperation of two community groups, the school and businessmen, necessitated the development of certain procedures for mobilizing the groups around the implementation of treatment. The success of the program serves to highlight certain principles of working with community members.
One result of the recent theoretical focus on the role of the community in the prevention, treatment, and rehabilitation of mentally disordered individuals has been a growing interest in the development of strategies and techniques for the mobilization of community resources to improve the mental health of its members. Two approaches to the development of a strategy for community intervention are possible. One is to evolve an overall plan of intervention from an understanding of the community and its service structure, from which develop large-scale techniques of intervention, such as mental health education, community planning, and interagency conferences. A second approach is to attempt to mobilize those resources in the community necessary for the implementation of a specific program. While the first approach is often best evaluated by largescale measures, the second is frequently
*Dr. Shore, a child clinical psychologist, is Clinical Psychologist at the Mental Health Study Center, National Institute of Mental Health, Adelphi, Maryland. Dr. Massimo, a school psychologist, is Chief Psychologist, Newton (Massachusetts) Public Schools, and Administrative Manager, Newtor~-Baker Project, Judge Baker Guidance Center, Newton, Massachusetts. Dr. Massimo carried out the program described here.
329
330
THE COMMUNITYMENTAL HEALTHJOURNAL
best studied through a case study approach. The purpose of this paper is to present a case study of how specific community resources were mobilized to assist in the carrying out of a successful experimental, outpatient treatment program for adolescent delinquent boys. From the success of this program, there are certain general principles of working with community members that are highlighted. The program that was planned was an experimental, vocationally oriented psychotherapy program described in detail in Massimo and Shore (1963). The goals were very specific. Since adolescent boys with a chronic history of antisocial behavior have usually been very difficult to treat, it was believed that perhaps an innovative individual approach of a flexible kind made available within 24 hours of the time the boy either left or was suspended from school would perhaps be successful. The essential component of this approach involved offering the boy an opportunity for employment. The belief was that employment would provide an entr6 for remedial education and psychotherapy, both of which are needed by the delinquent adolescent but which are both characteristically rejected by him as unrelated to his needs. In order to carry out this program, it was necessary to gain the cooperation of two community groups: the school and businessmen. THE SCHOOL Two groups in the high schools were important in the program: the vocational guidance counselors and the attendance ofricers. Prior to contacting these two groups, the therapist notified the guidance director and superintendents of his affiliation with a responsible treatment agency and his desire to work with those boys who had left school. This short and often informal contact was adequate for their acceptance and permission to contact and work with the counselors and attendance officers. The program was explained to the vocational guidance counselors, who were told that the therapist would not be competing with them for available jobs or for vocational guidance services. The fact that the boys helped
would be those who had left school made it easier to see the service as separate from the usual school services. Communication was encouraged by suggesting that the counselors contact the therapist if there were any problems. No such formal contacts occurred. The person in the school who was most important in initiating contact with the boy was the attendance officer. He was the first one to know when a boy left or was suspended from school. The therapist personally contacted each attendance officer to explain the experimental program. The importance of the immediacy of the contact was stressed, and the officer was requested to give the therapist the boy's name, address, and telephone number as soon as he knew the boy had dropped out of school because of antisocial behavior. Although the responsibility for a boy who had left school was legally that of the attendance officer,* the latter was willing, even eager, to have someone take over the assistance of these youths. The therapist also made clear that he would not ask the school for any special requests or considerations. (He realized how difficult these boys were for the school to handle and how often the school felt a sense of relief when a boy dropped out.) Other than giving him identifying data, the school's only responsibility to the therapist was to provide him with records for carrying out the study. Informal contacts with the attendance officers kept them up to date with the boys in the program. EMPLOYERS Most important in the vocationally oriented treatment program, of course, was gaining the cooperation of businessmen in order, first, to collect a pool of employment possibilities and, second, to aid the employ. ers in the handling of the boys. It was always clear that the role of employment in the program was not to set up a therapeutic community with the employer as an enlightened, therapeutically oriented boss. Rather, *The school has legal responsibility for the boy after he leaves school unless the parents agree in writing to assume this responsibility.However,this responsibility ends when the boy becomes 16 years of age.
MILTON F. SHORE AND JOSEPH L. MASSIMO
it was to use employment as a reality situation with which the boy had to deal and around which other services (remedial education and psychotherapy) would be offered when needed. The strategy for involving employers in the program was initiated by writing both the governor of the state and the head of the Department of Labor in the state, describing the program in detail. When the program was explained to them, both wrote back expressing interest and encouraging the therapist to undertake the project, with the hope that the necessary cooperation from civic-minded employers would be forthcoming. With the governor and head of the Department of Labor aware of the program, certain influential and respected businessmen were then notified in order to plan a talk before the Chamber of Commerce. A presentation was arranged in which the program was explained, as well as the purpose of employment in helping the boys become useful citizens. Some of the problems that the employer might encounter were emphasized, as well as the civic responsibilities, i.e. the community (especially employers) had to help young people in difficulty so that they would not eventually become an expense to the taxpayer. (One important feature that must be remembered was that the community in which the program was planned was a suburban, middleclass community where social responsibility was seen as a virtue. The ethos of the community certainly contributed to the enthusiastic response to the request for participation in the program.) The businessmen who would be able to hire any of the boys were asked to call the therapist. In order to get a greater variety of jobs, the therapist not only spoke at the Chamber of Commerce but also made personal trips to likely business establishments (such as automobile dealers), asked for the owner, and described the program. Each potential employer was told something of the background of the boys he might hire. Questions regarding insurance, handling of the boys, and salaries were also discussed in detail. Each potential employer was told that it was
331
up to him whether or not he wanted the boy. Under no circumstances was the employer to keep a boy who was not able to maintain the standard required in the company. Within five months a pool of 60 jobs was obtained. Despite their interest, some firms decided not to hire the boy when he arrived to interview for the position. (Once a boy had been hired, none of the firms changed its mind when he arrived for work.) Understanding the anxieties related to being interviewed for a position, the therapist always accompanied the boy to the job interview. In this way the boy was not only prepared for the interview but was able to have the support necessary for handling the frustration of possibly being refused something he wanted--a therapeutic experience in itself. If this happened, the therapist and the boy would discuss the situation, then proceed to look for other employment opportunities. The boy thus had the opportunity to see how one talks to a %oss" and how one searches for other " employment possibilities. The jobs were individually selected on the basis of the boy's ability, training, and personality needs. An arrangement was made whereby the therapist could visit the place of employment about once in every two weeks to find out how the boy was doing. No employer was asked to give special consideration to or keep a boy who was causing trouble or losing money for the firm. (On the other hand, the therapist also protected the boy against any possibility of undue exploitation by an employer.) However, the original agreement with the employer stipulated that if a boy was in trouble, the therapist was to be called so that the situation could be handled with the boy. In two cases where the boys were fired outright because of stealing, the therapist sat down with the boy and the employer to find out what had happened, so he could use it to help the boy. Employment served to make the boy aware of some of his difficulties so that other kinds of assistance became necessary. For example, fellow workers found out that one of the boys could not read. They then used this deficiency in order to scapegoat
332
THE COMMUNITYMENTAL HEALTH JOURNAL
the boy. The result: the boy had a fit of rage. The therapist, who knew of this deficiency but felt the boy had to find out its consequences for himself, worked with the boy to develop a special remedial reading program (based on the reading of signs and labels on various products). Also dealt with was the boy's handling of the provocative fellow workers so that his response would not be self-destructive. In treating delinquents, questions frequently come up about contacts with the police. In this program the legal authorities were seen as a reality with which the boys had to deal. The therapist did call the probation or parole officers to inform them of his plan for a boy. The officers expressed great interest and, because of their heavy caseloads, were very willing to let the therapist assume primary responsibility for the boy. The therapist did know some of the policemen socially, and informally he kept them abreast of the boy's progress.
dividual projects where certain strategies have been used can be helpful in testing some of our ideas on working with community groups. Out of the experiences in these projects can then emerge a series of specific principles for gaining community cooperation. Described in this paper was a successful project with adolescent delinquent boys that required the cooperation of two com. munity groups, the school and businessmen. The general principles used in developing a strategy for gaining cooperation of these groups were: (1) the expectations of each party were clear and were developed in a personalized relationship (the role of the personal relationship in arranging the contact should not be underemphasized). (2) The expectations were in line with what the parties were easily able to carry out. The therapist did not expect the employers to function as counselors or therapists. (3) Above all, the relationship between the two parties was based on mutual respect, understanding, and honesty.
SUMMARY There are many ways to mobilize community resources to aid in the rehabilitation of people with mental health problems. In-
REFERENCE MASSIMO,J. L., & SHORE,M. F. The effectivenessof a comprehensive vocationally-oriented psychotherapeutic program for adolescent delinquent boys. Amer. J. Orthomychiat., 1963, 33 : 634-642.
POLICE
