breakdayton.org beginning July 2010.
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Daybreak, Inc.
Agency Service Plan
Fiscal 2010-2011
5122-26-09
Daybreak's mission is: To eliminate youth homelessness in the
Daybreak's provides age appropriate housing programs with comprehensive supportive services including outreach, prevention, education, hotline, selected mental health services, information and referral and other supportive services for teens and youth who runaway, are pushed out of their homes, are at risk of abuse or neglect, are homeless or at immediate risk of homelessness. The purpose is to break the cycle of homelessness and to ensure that teens and youth receive developmentally appropriate services to address their specific needs.
2. Contribution to a System of Care for Children/Adolescents
While Daybreak began as an emergency shelter in 1975, it has since adopted 3 strategies to reach its goal of eliminating youth homelessness in the
Profile of Homeless Youth: The National Alliance to End Homelessness (NAEH) estimates that 5 to 7.7 percent of youth experience homelessness each year. Nationally, homeless youth typically flee homes that are experiencing family breakdown. Nearly half have suffered physical abuse and up to 35% experience sexual abuse before they run away or are pushed out. Many are coming from homes that are overcrowded, substandard or where the family is experiencing poverty, mental health issues, crime, domestic violence and underemployment. According to NAEH, the "most common endangerment component of runaway and expelled youth is physical or sexual abuse in the home the year prior to the episode of homelessness."
Locally, Daybreak, the regional homeless youth organization conducted a retrospective survey of a sample of youth in the transitional housing program and found that 54% have suffered parental abuse and 20% had reported sexual abuse in their home. Forty two percent had been had a psychiatric hospitalization at least once during their childhood –usually for a suicide attempt. The poor family functioning, diminished sense of belonging, and lack of hope often leads to risk-taking behaviors and mental health difficulties. In a survey of all youth staying at Daybreak for a six month period in 2008, 75% reported moderate to high substance abuse and 65% reported that one or more of their parents was an addict or alcoholic. These statistics are particularly alarming because they indicate that runaway, pushed-out, and homeless youth served by Daybreak are especially likely to have a deficit in the protective factors that they will need to draw on to be an effective parent and to build a stable family.
Pregnancy in the Homeless: While teenage pregnancy in the nation overall is on the decline, many cities report that it is on the rise within the homeless population. Greene and Ringwalt, (Journal of Adolescent Health, 1998) reported a study in which they compared estimates of the prevalence of pregnancy among runaway and homeless youth between the ages of 14 and 17 years in various settings with each other and with youth in the general population. They utilized three surveys of youth: (a) the first nationally representative survey of runaway and homeless youth residing in federally and non-federally funded shelters, (b) a multi-city survey of street youth, and (c) a nationally representative household survey of youth with and without recent runaway and homeless experiences. They found that youth living on the streets had the highest lifetime rates of pregnancy (48%), followed by youth residing in shelters (33%) and household youth (<10%). Their conclusions were that: "Shelter and street youth were at much greater risk of having ever been pregnant than were youth in households, regardless of whether they had recent runaway or homeless experiences. Such youth need comprehensive services, including pregnancy prevention, family planning, and prenatal and parenting services."
Furthermore, there is a clear link between homelessness and early pregnancy in our own region. The Midwest Longitudinal Study of Homeless Adolescents 2002 reports that:
- 46% of homeless girls surveyed in Midwest States were pregnant at least once
- Nearly ½ of those girls reported they had had multiple pregnancies
- 31% of young men reported having impregnated someone
In Montgomery County, Ohio 842 teens age 15 to 19 gave birth in 2006 making our county's teen birth rate 45.5 per 1000 compared to the State of Ohio at 39.2 per 1000. (2009-2010 OCSAO Fact book).
Daybreak Statistics: In 2009, Daybreak provided 4,406 nights of emergency shelter for 210 homeless youth including pregnant females. We also provided transitional housing for 92 youth which included 60 single youth (about 10 were pregnant or expecting) and 32 teen parents (representing 35% of the population) as well as their 37 children. These youth are vulnerable to many risks related to health, pregnancy and poor pregnancy outcomes including birth defects. Irregular sleep schedules, cigarette smoking, alcohol and drugs use, poor nutrition, lack of access to medical care, exposure to communicable disease, untreated chronic conditions, victimization, sexual exploitation and chronic stress are all factors that increase the likelihood that they will experience complications during their pregnancy. Linking to prenatal care, parenting classes and healthy pregnancy education focused on the role of their choices and behavior as a pregnant parent is vital for them if they are to deliver healthy babies and form appropriate attachments to those children.
Since homeless teens and teen parents already constitute two high risk populations, it is logical that the combination of these characteristics make Daybreak's population extremely high risk for abusive parenting. Even more critical, is the fact that poverty is the most frequently and persistently noted underlying risk factor for child abuse. And, the youth that Daybreak serves have much higher than average incidents of their own childhood victimization from violent parents and family members. They have few emotional and resources for controlling their impulsive behaviors have low levels of frustration, are developmentally behind in their interpersonal skills and generally uneducated regarding the roles of a healthy and responsible parent. Since homeless teens that are pregnant are also impoverished, they are especially vulnerable for becoming abusive parents.
Population Served
Daybreak’s programs serve runaway and pushed out minors and homeless 18-year-old young adults, who are at or below 35% AMI – most are poverty level. These young adults have special needs related to their age and stages of development and represent an under-recognized growing subpopulation of homeless.
- Geographic Target Area:
Montgomery County Youth (birth-17)
Montgomery County Young Adults (18 years old)
- Race: 28% Caucasian 70% African American 2% Hispanic
- Households served: 210 unduplicated households in shelter
235 unduplicated youth in Outreach (non-housing) services
92 youth in Supervised Transitional Housing and Scattered Site Housing
Eligibility and Characteristics of Target Population: Any runaway, homeless, abused or neglected youth between the ages of 10 and their 19th birthday in Montgomery County is eligible to receive shelter services with the following exceptions: 1) youth with a known history of repeated or extreme violence or sexual offenses, 2) known predators of younger children, 3) youth offenders requiring a secured, locked facility, and 4) youth who have a history with Daybreak and whose files indicate that they are inappropriate for readmission. Youth reach Daybreak via the 24 hour crisis hotline, Street Outreach program, and
Locally, Daybreak conducted a retrospective survey of 107 shelter youth between July 1, 2008 and December 31, 2009, and found that 65% of youth reported that one or both of their parents was chemically dependent or alcoholic and, in many cases, the entire nuclear and extended family had extensive issues of mental illness and/or substance abuse. This fact speaks for itself in terms of the instability of the family, the reasons for the youth's bout of homelessness and the complexities of returning a child or teen to that environment and is largely the reason that Daybreak's recidivism rate of 14% has remained stable over the years.
Other common histories among the target population regardless of age include:
- history of familial abuse, neglect and sexual abuse and/or witnessing violence
- poverty, homelessness, unemployment, underemployment, and poor living conditions
- lack of health care
- mental illness or alcoholism/substance addiction in the family of origin
- criminal history including parental incarceration in the family of origin;
- poor school attendance, performance and school drop out;
- school IEP (individualized educational plan) indicating developmental disabilities or delays
- higher likelihood of having a history of premature sexual activity, pregnancy, and childbearing
- death of one or both biological parents
- chronic instability and frequent moves from family member to family member for the youth
- behavioral problems, suicide attempts, hospitalization, involvement with juvenile court
Homeless youth face many challenges on the streets. Because of their age, homeless youth have few legal means by which they can earn enough money to meet basic needs. Many homeless adolescents find that exchanging sex for food, clothing, and shelter is their only chance of survival on the streets. In turn, homeless youth are at a 2 to 10 time’s greater risk of contracting AIDS or HIV-related illnesses.
The number of older youth, ages 17 and 18, being forced to leave their homes has virtually exploded in
Not surprisingly, returning home at age 17 or 18 is typically not a viable option, yet sadly, the community has very few services and supports available to help them mature and transition into healthy adulthood. Fortunately, Daybreak saw this emerging trend a few years ago and embarked on an ambitious campaign to educate the community to the growing problem of older homeless youth and the need to help them before they join the adult homeless or criminal populations.
Substance Abuse and Mental Health: It is often a vicious cycle. On one hand, substance abuse or mental illness is often cited as a contributing factor to youth homelessness while on the other, youth who are rendered homeless and living on the streets, are at extremely high risk for substance abuse and mental illness. Regardless of the cause, the local Alcohol Drug and Mental Health Services Board estimates that 500 youth, ages 10-17, require residential treatment for substance abuse; 4,500 youth require outpatient treatment, and the prevalence rate for mental illness in children and youth is 8.2% in
Daybreak's Mental Health Services
Target Population Mental Health Issues: Mental health issues are related both to the immediate crisis facing the youth when they enter Daybreak’s care and to longstanding problems from their history. In some cases, homeless teens and young adults are experiencing the early precursors of major mental health disorders. Homeless adolescents often suffer from severe anxiety and depression, poor health and nutrition, and low self-esteem. In one study, the rates of major depression, conduct disorder, and post-traumatic stress syndrome were found to be 3 times as high among runaway youth as among youth who have not run. Daybreak provides an array of mental health services including Mental Health Assessment, Cognitive Behavioral Therapy (CBT), Trauma Focused CBT (TF-CBT) individual and group behavioral health counseling, individual and group community psychiatric supportive treatment and referrals to Crisis Care for emergency and stat psychiatric evaluation and medication evaluation. Daybreak's youth consistently meet the criteria as an SED population and most of the young adults also have SMD diagnosis. About 60% of the adults served will meet the criteria for SPMI.
Many youth seeking long term housing were also victims of long term chronic interpersonal trauma including physical abuse, neglect, emotional isolation, frequent disruptive moves, poverty, sexual abuse, witnessing violence, death or incarceration of primary caregivers and repeatedly being passed from one caregiver, foster parent or family member to another without regard for the stability, health or mental health of the child. As a result, many Daybreak youth are experiencing Complex PTSD and therefore require longer than typical CBT as well as other EBP therapies and intervention.
Developmental delays, poor interpersonal skills, exposure to repeated and prolonged trauma, social and emotional chaos, teenage parents, early prenatal exposure to smoking, alcohol, drugs and other substances as well as poor parental prenatal nutrition combine to create social, interpersonal and emotional deficits in nearly every aspect of functioning. Some youth are nearly paralyzed by inability to meet the developmental expectations of adulthood although they are chronologically of age. Therefore, Daybreak routinely offers a longer length of care for these youth as is appropriate for the formation of adequate mental health. (Presidents New Freedom Commission on Mental Health, 2002; Trauma Recovery Initiative for Youth, 2007, Child and Family Studies, Florida Mental Health Institute SAMSHA study)
Evidenced-Based Practices: Since there is no single best practice SAMSHA model identified for homeless youth and young adults, Daybreak uses other best practices from the models outlined below:
- Cognitive Behavioral Therapy and Trauma Focused Cognitive Behavioral Therapy
http://tfcbt.musc.edu/login.php
- SAMHSA Model Program - Trauma Focused Cognitive Behavioral Therapy
http://www.samhsa.gov/ebpwebguide/index.asp
- Trauma Informed Care
http://mentalhealth.samhsa.gov/nctic/trauma.asp
- Contingency Management system (Daybreak Dollars)
http://ajp.psychiatryonline.org/cgi/content/full/158/5/694
- Ansell Casey Life Skills Assessment
http://www.caseylifeskills.org/
- EBP - Nurturing Parent Curriculum
http://www.nurturingparenting.com/evidence_based.php
3 & 4. Description of Services Provided and Hours of Operation
Other Mental Health Services:
Emergency Shelter: Daybreak operates a 24-hour crisis hotline and emergency shelter for youth. The shelter program serves youth, aged 10 to 18, who are homeless, runaway, or pushed out of their homes, aging out of foster care or are in need of emergency placement due to age, neglect or other social problems. Daybreak cannot accept youth who:
- are in an active psychotic state
- are intoxicated
- have violent felony offenses
- require assistance with ADL’s or personal health care
- might jeopardize the safety of other youth in the shelter owing to severe behavior difficulties
The shelter offers bed, meals, personal items, 24-hour supervision, structured programs including activities and educational experiences. Referrals are accepted from community resources, walk-in, parents, law enforcement professionals, children services or self-referral. The majority of youth receive a Mental Health Diagnostic Assessment within 72 hours.
Hours of operation: 24 hours a day/365 per year
Mental Health Services attached to emergency shelter:
Hours of operation are 24 hours a day at
Mental Health Assessment Service – offered on site. All youth receive a mental health assessment within 72 hours of admission to the shelter.
Behavioral Health Counseling and Therapy Services – offered on site. Youth and their parents are offered individual and group counseling services while the youth is in the shelter and on an aftercare basis by appointment.
Community Psychiatric Supportive Treatment Service – offered on site at shelter by appointment and via crisis hotline. These services are available at least 12 hours a day and on a rotating schedule on the weekends by Intervention Specialists.
24-hour in-house Clinical Consultation – a Daybreak LISW and/or LSW is available 24 hours a day for Clinical Consultation to after-hours staff.
Community Residence: The Self-Sufficiency program provides homeless young people and those at risk of homelessness, who are aged 17 to 21, with the tools to succeed at living independently as they transition into adulthood. The program emphasizes education and career planning, service coordination, group and individual counseling and stabilization.
Transitional Living Program (TLP)
- services for homeless youth ages 18-21
- housing options include scattered site apartments
- 33 clients at any one time
- Individual counseling and CPST
- Housing for up to 24 months with
Supervised Transitional Living (24 units on site 605 S. Patterson)
Housing for youth aged 18 to 21 single or with one child under age of three years
- 24 supervised apartments
- Rental subsidy in exchange for program participation via the Daybreak Dollars contingency management system
- 24 hour supervised by trained Residential Specialists
- Comprehensive developmentally appropriate supportive services
Mental Health Services attached to Community Residence:
Hours of operation are 9 a.m. to 8 p.m., Monday through Friday, by appointment.
Mental Health Assessment Service – offered on site at 605 South Patterson. Youth are scheduled for a mental health assessment when they have maintained contact with the Outreach department that has verified their eligibility for services.
Behavioral Health Counseling and Therapy Services – offered on site at or in community based locations and by home visit.
Community Psychiatric Supportive Treatment Service – comprehensive CPST services are provided on site, through home visit and in community-based locations. Services include life skills education, pre-employment preparation, facilitation of activities of daily living, parenting skills, anger management and other areas that impact the youth’s ability to manage basic needs.
Other Non-Clinical Services:
Daybreak conducts a variety of outreach and prevention programs throughout the community to reach all youth, but especially street youth and youth who are at high risk of becoming homeless. These programs are not necessarily Clinical in nature unless noted. Those programs are:
“Violence Free Youth”- VFY presentations are programming that address the skills and resources youth need to stay safe and violence free. Youth, aged 11-18, are presented with the signs of family, relationship, and peer violence and ways to avoid and/or deescalate the threat of violence. Power Clubs provide high-risk youth with intensive anger management/violence prevention skills training. These plus other skills that focus on effective communication and interpersonal relationships, strengthen positive personal development and relationships within the family. The programming addresses the youth’s ability to build and then practice skills that will lead to the promotion of individual, family, and community strength. Programming also works to provide the youth with an awareness of their role, responsibility, and responses in promoting positive, healthy relationships. Hours of Service: Variable - These programs are conducted at various times during the business week on site in the schools and community sites.
Street Outreach –all youth contacting the crisis hotline for Self Sufficiency services are offered Street Outreach services. The Street Outreach team works with youth identified as homeless or imminently homeless. They are also responsible for screening youth for referral to the Self Sufficiency program. Street Outreach reaches out to the youth that are living on the streets or couch hopping, and those at high risk of becoming homeless an in need of some assistance. It utilizes a team consisting of one adult and one young adult to seek out homeless youth in their own environment (i.e. the streets, cars etc.) and to provide information on accessing Daybreak services as well as other community resources. Hours of Service: Various activities include some evening hours on an as needed basis.
Community Education Program – conducted on a request from various service organizations, churches, schools, groups and other professional organizations throughout the year. Community education includes information about Daybreak and its services as well as trends, research, and developments that relate to and/or effect the target population of homeless teens and teens at high risk of becoming homeless.
Safe Place –Over 300 organizations, fire stations, the Regional Transit Authority, libraries and other agencies, stores and businesses provide a safe outreach for youth throughout the
5. Community Agency Affiliations
If a client requires an emergency screening for mental health or substance abuse concerns, a referral is made to CrisisCare for screening and treatment recommendations. Daybreak has an agreement with CrisisCare wherein they will provide this service 24 hours a day, seven days a week, 365 days a year on an as needed basis. Daybreak also routinely transports or arranges for transport of youth in crisis to
CrisisCare agrees to provide crisis intervention to Daybreak clients in the event of a mental health crisis during the day, evening or weekends, when the Daybreak clinical staff may not be readily available. Daybreak shall assume responsibility for providing the Crisis Hotline telephone number to its staff and clients.
CrisisCare also agrees to dispatch licensed staff to Daybreak, or provide the service on site at
Daybreak is collaborating with Montgomery County Children Services to provide transitional housing for youth aging out of foster care and is providing safe housing for homeless youth in prior MCCSB custody to ensure they have safe housing.
Daybreak is collaborating with
Daybreak is collaborating with Goodwill/Easter Seals and other partners in the Pathways II project. In addition, a Vocational Specialist is on site 20 hours a week through a private partnership with Goodwill Easter Seals to work specifically with Daybreak youth that do not qualify for Pathways II.
Daybreak is collaborating with the Samaritan Homeless Clinic in weekly on site availability of a nurse practitioner and LPN for shelter and supervised transitional living youth.
The
6. Amendments to the plan since 2009-2010
- ODADAS Safe and
- In the fall of 2010, Daybreak intends to reopen its old facility which is being refurbished to become a IVE certified group home for youth in the custody of Children Services Board or the Montgomery County Juvenile Court. The facility will house ten beds for youth age 16 to 18 who require a paid placement. Mental Health Services will be provided on site including pre admission mental health assessment, individualized services planning, individual and group counseling and individual and group CPST as needed. (see attached flow chart)
7. The Agency Service Plan is available for review by person served, their family, significant others and the public. The agency service plan shall be posted on the agency web site at: www.daybreakdayton.org.