An Overwhelming Task

I’m supposed to be writing a timeline/brief for a multi-agency symposium regarding service provision to dual-jurisdiction youth and “where the system(s) fail.” I’m not.

Where does one start with such a project? Especially without pointing fingers, laying blame, or making excuses? To approach case management form a “systems” view is to analyze how we’ve intruded into people’s lives, offering “intervention” and often setting up an already dysfunctional and barely cohesive family to publicly fail.

What are the tools I have available for intervention? Well, I have motivational interviewing, which is supposed to allow me to gather the most information from my meetings with the smallest amount of effort, teaching, or criticism. Information gathered in this way is inherently suspect, as there is no guarantee that the interviewee is telling the truth, revealing ALL information requested, or has an adequate understanding of his/her own needs. Information gathered this way is touted to allow the client to explore his or her own ambivalence toward change, in order to facilitate intrinsic motivation to mediate their own behavior. Sounds good, right? And it would be – in an ideal population.

I have Evidence-Based Practice, which is a research-based approach to what works and what doesn’t work in systems ranging from the medical field to social services to law enforcement. Using information gathered from the motivational interviewing processes, I can assess a client for needs and risk, and then match services to the needs and to the risk factor. Of course, I would also want to match services based on responsivity as well – offer intervention in the native language, in accordance with certain special physical or mental health needs, or based on financial viability or transportation costs. Evidence-based practice shows us that “appropriate treatment” (treatment that matches risk, needs, and responsivity) works. Again, we have to assume that the information gathered is accurate and comprehensive, that families have been honest about their needs, that my assessment of the risks is objective and fair, and that I have enough experience, intuition, and creativity (not to mention time) to ensure that I am not over-servicing nor underservicing the client. Because over-servicing makes things worse. And under-servicing makes things worse. Duplication in services makes things worse.

I have traditional tools, such as intensive supervision, punitive sanctions, removal from the home/community, and Fourth Amendment waivers. These “traditional” tools, believe it or not, increase recidivism (depending on how recidivism is measured), and are therefore commonly held, from a multi-systemic point of view, to fit into the category of what doesn’t work. Do we rely heavily on these traditional tools? You bet.

So where, exactly, does the system fail these kids and their families? The case being reviewed in this symposium has been a dual-jurisdiction kid since he was ten years old. His mother is a methamphetamine user who has been “in recovery” for four years. His father has a new family and can’t be bothered with his mentally-ill and understandably angry firstborn. The kid has been in foster care, juvenile hall, residential treatment, day treatment, and special education. Despite comprehensive services, he continues to commit crimes, generally crimes of opportunity and impulse. Despite intensive supervision, he continues to fail academically and demonstrate habitual truancy. Despite punitive intervention, including custodial sanctions, he continues to abuse controlled substances and has stated that he is not interested in ceasing his drug use. Despite psychological services and psychotropic medication, the youth has failed to respond to cognitive behavioral restructuring and continues to hurt people without thought or remorse.

And now I am tasked with positing a theory about where the multi-systemic approach has failed.

:::::sigh:::::

I will have to come back to this question at a later date. I am overwhelmed at the moment.