Boys Town (OJJDP Model Program Guide)

Office of Justice Programs, Innovation - Partnerships – Safer Neighborhoods

Office of Juvenile Justice and Delinquency Prevention (OJJDP) Serving Children, Families and Communities

PREVENTION

IMMEDIATE SANCTIONS

INTERMEDIATE SANCTIONS

RESIDENTIAL

REENTRY

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Boys Town

Intervention:

Boys Town (BT) Treatment Family Home program is a family-style residential group home program for delinquent youths ages 10–17. Founded in 1917 by Father Edward Flanagan to help about a half dozen troubled boys, the residential program still operates at the original site located on 900 acres near Omaha, Neb., and has expanded to several other sites across the country. Today there are more than a hundred long-term, residential-care homes for troubled youths, featuring family-style living in the least restrictive environment.

BT applies a behavioral treatment model that emphasizes positive relationships, skill teaching, and self-control. The program is delivered through the Treatment Family Home program, in which a married couple—trained to teach youths how to build positive relationships with others—lives with six to eight youths in a large domestic home. These couples are trained to use every opportunity to reinforce appropriate behavior and apply consequences to inappropriate behavior. The curriculum teaches specific social skills to develop the thinking, feeling, and choice-making needed to replace the inappropriate ways the youths have learned to deal with difficult and stressful situations. Children stay in a residential home on average 18 months.

The Treatment Family Home program, an adaptation of the Teaching Family Model, has five major elements:

Teaching skills.

Building healthy relationships.

Supporting moral and spiritual development.

Creating a family-style environment.

Promoting self-government and self-determination.

In addition to making the treatment environment like a family home, BT organizes the entire ecology of the child through positive peer, school, and neighborhood support systems. This approach to behavioral treatment helps support and reinforces the youths’ positive behaviors, lessens factors that put children at risk, and increases the factors in their lives that will protect them.

Finally, more traditional treatments such as psychotropic medications, individual and family therapy, and outpatient chemical use treatment are available to supplement everyday treatment. These adjunct treatments are used on a case-specific basis because many youths progress with the Family Home Program treatment alone.

Evaluation Methodology:

The effectiveness of BT has been evaluated in more than 200 studies. The preeminent study (study 1) used a single-group pretest–posttest design to assess the functioning of 440 youths 3 months after discharge. The sample included youths who were discharged from BT from October 1998 through September 2000. The youths included in the sample were 38 percent female and 60 percent white, 20 percent African-American, 10 percent Hispanic, 3 percent Native American, and 6 percent multiethnic. Their preliminary referral sources included juvenile justice (34 percent), social services (21 percent), mental health (17 percent), family or self (17 percent), and other (11 percent). The most common presenting problems were noncompliance (in 89 percent of all youths), academic problems (59 percent), school behavior problems (56 percent), drug or alcohol usage (53 percent), verbal aggression (48 percent), truancy (45 percent), peer-relationship problems (45 percent), theft (45 percent), and depression/withdrawal (44 percent). Youths are generally admitted only if less restrictive placements are unsuitable because of family dysfunction such as child maltreatment, previously failed placements, or the severity of a youth’s problems. Youths’ lengths of stay ranged from 31 days to 9.7 years (M=1.8 years; median=1.5 years).

Treatment fidelity was maintained through an ongoing process of training, close supervision, consultation, and evaluation. Before working with youth, family teachers complete an intensive, 2-week competency-based training. Training topics include principles of behavior, building healthy relationships, teaching social skills (e.g., effective praise, proactive teaching, corrective teaching), foundations of family life, motivation systems, nonviolent crisis intervention, treatment planning, youth rights, medication, safety, nutrition, and professionalism. Family teachers also participated in more than 60 additional hours of advanced training workshops during their 1st year and 48 hours annually thereafter.

Standardized measures included the 1) Child Behavior Check List (CBCL), 2) the Restrictiveness of Living Environments Scale (ROLES), and the 3) Diagnostic Interview Schedule for Children (DISC). CBCL is a widely used measure of problem behaviors, providing three broadband scales (internalizing, externalizing, and total behavior problems) and eight narrowband scales (e.g., withdrawn, social problems, delinquent problems). ROLES indicates the relative restrictiveness of 25 settings in which a youth may be living. It was used to rate the restrictiveness of each youth’s treatment setting before intake, immediately following the Family Home Program treatment, and at a 3-month follow-up. Finally, the DISC is a structured interview that yields an objective measure of most DSM–III–R or DSM–IV diagnoses.

Nonstandardized outcome measures included 1) departure success, 2) percentage of problems improved, and 3) follow-up functioning. Departure success was a composite of six items indicating successful treatment and a favorable prognosis, as rated by a clinical supervisor at a youth’s discharge. Four items rated concerned the favorableness of the youth’s overall behavior, departure conditions, goal achievement, and predicted future success, using seven-point scales ranging from “very unsuccessful” to “very successful.” Another two items were the restrictiveness of the youth’s postdischarge placement and whether treatment was completed as planned. The departure success scale showed excellent reliability in a previous study. The percentage of problems improved was also based on ratings by a clinical supervisor at discharge. Presenting problems were selected from a list of 38 problems at intake and were updated early in treatment. At discharge, a clinical supervisor rated each of these presenting problems as improved, unchanged, or worsened. From this, the percentage of presenting problems rated as improved at discharge was calculated. A follow-up interview of an adult responsible for the youth was implemented 3 months after discharge. Follow-up functioning was based on six questions: about being in school, being arrested, having a job, the perceived effect of the treatment program, the restrictiveness of living environment (ROLES), and peer relations.

To determine whether less successful cases were overrepresented in the incomplete-data sample, attrition analyses compared incomplete data samples with complete-data samples of all intake and discharge measures. The results suggest that there were no overall differences between the complete CBCL sample and the incomplete CBCL sample on 11 intake scores, on 6 twelve-month scores, and on 3 discharge scores. There also was no overall difference between the complete-DISC sample and the incomplete-DISC sample on 11 intake scores. However, there was an overall difference between the complete-DISC sample and the incomplete-DISC sample on three discharge scores. The incomplete-DISC sample had lower discharge success scores, fewer improved problems, and higher restrictiveness of their discharge placement than the complete-DISC sample showed. Notably, this was expected, because discharges before 12 months are less likely to be successful cases.

Subsequent studies have assessed gender differences (study 2) and youth functioning 5 years (studies 3 and 4) and 16 years (studies 5 and 6) postdischarge.

Evaluation Outcome:

Evaluation results of study 1 indicate that BT produces positive benefits for both boys and girls. Overall, the outcome measures indicate that most youths improved from intake to discharge and were functioning at levels similar to national norms at a 3-month follow-up. These improvements were shown on standardized instruments as well as on more subjective measures. The average broadband CBCL scores improved from the clinical or borderline range at intake to normal levels at discharge, including an improvement of a full standard deviation on total problems. The proportion of youths with diagnosable psychiatric disorders decreased from over 60 percent at intake to less than 25 percent 12 months later. The Family Home Program discharged 80 percent of the youths to either their families’ home or to independent living.

Study 2 indicates that girls improved as much as boys both on DISC diagnoses and on CBCL scores. However, girls improved more than boys in perceived success at discharge and in the restrictiveness of their subsequent living situation, which were the only areas of differential improvement by gender.

Study 3 found that as BT youths enter young adulthood (5 years postdischarge) they function similarly to their peers in the general population in terms of high school graduation, employment, mental health, and having a social support system. Moreover, study 4 indicates that positive departure status was associated with less recidivism.

Study 5 found that as BT youths reach their late 20s to mid-30s (16 years postdischarge) they continue to be functional members of society. Further, they continue to be similar to the national population in regard to their high school graduation, employment, marriage, and family situations. In fact, study 6 found that those who were in this program 18 months or longer were significantly less likely than those in the general population to be in a physically abusive relationship, demonstrating healthy relationship development.

Other Information:

References:

Davis, Jerry L., and Daniel L. Daly. 2003. Girls and Boys Town Long-Term Residential Program Training Manual (Fourth Edition). Boys Town, Neb.: Father Flanagan’s Boys Home.

Friman, Patrick C., D. Wayne Osgood, Gail L. Smith, Dave Shanahan, Ronald W. Thompson, and Robert E. Larzelere. 1996. “A Longitudinal Evaluation of Prevalent Negative Beliefs About Residential Placement for Troubled Adolescents.” Journal of Abnormal Child Psychology 24:299–324.

Handwerk, Michael L., Kerri Clopton, Jonathan C. Huefner, Gail L. Smith, Kathy E. Hoff, and Christopher P Lucas. 2006. “Gender Differences in Adolescents in Residential Treatment.” American Journal of Orthopsychiatry 76:312–24.

Handwerk, Michael L., Gail L. Smith, Ronald W. Thompson, Douglas F. Spellman, and Daniel L. Daly. 2008. “Psychotropic Medication Utilization at a Group-Home Residential Facility for Children and Adolescent.” Journal of Child and Adolescent Psychopharmacology 18:517–25.

Huefner, Jonathan C., Jay L. Ringle, Stephanie D. Ingram, and M. Beth Chmelka. 2007. “Breaking the Abuse Cycle: The Long-Term Impact of a Residential Care Program. Child Abuse and Neglect 31:187–99.

Kingsley, David, Jay L. Ringle, Ronald W. Thompson, M. Beth Chmelka, and Stephanie D. Ingram. 2008. “Cox Proportional Hazards Regression Analysis as a Modeling Technique for Informing Program Improvement: Predicting Recidivism in a Boys Town 5-Year Follow-Up Study.” The Journal of Behavior Analysis of Offender and Victim Treatment and Prevention 1:82–97.

Larzelere, Robert E., Daniel L. Daly, Jerry L. Davis, M. Beth Chmelka, and Michael L. Handwerk. 2004. “Outcome Evaluation of Girls and Boys Town’s Family Home Program.” Education and Treatment of Children 27(2):130–49.

Ringle, Jay L., Stephanie D. Ingram, M. Beth Chmelka, Ronald W. Thompson, Jerry L. Davis, and Daniel L. Daly. 2007. “Girls and Boys Town Family Home Program: Outcomes in Young Adulthood.” Teaching Family Association Newsletter 33:11–15.

Thompson, Ronald W., Jonathan C. Huefner, Jay L. Ringle, and Daniel L. Daly, 2005. “Adult Outcomes of Girls and Boys Town Youth: A Follow-Up Report.” In Catherine C. Newman, Cindy J. Liberton, Krista Kutash, and Robert M. Friedman (eds.). The 17th Annual Research Conference Proceedings: A System of Care for Children’s Mental Health: Expanding the Research Base. Tampa, Fla.: University of South Florida Mental Health Institute, Research and Training Center for Children’s Mental Health, 529–32.

Thompson, Ronald W., Gail L. Smith, D. Wayne Osgood, Thomas P. Dowd, Patrick C. Friman, and Daniel L. Daly. 1996. “Residential Care: A Study of Short and Long-Term Educational Effects.” Children and Youth Services Review 18:221–42.

Program Specification:

Current Rating:

Promising

Expected Date of Re-Review:

Winter 2013

Program Type:

Cognitive Behavioral Treatment

Group Home

Ethnicity:

American Indian or Alaska Native

African American

Hispanic or Latino (of any race)

White

Other Ethnicity

Gender:

Both

Age:

11 - 18

Special Populations:

Less Serious Offender

Serious Offenders

Status Offender

Mentally Ill Offenders

Target Settings:

Suburban

Urban

Problem Behaviors:

Family Functioning

Risk & Protective Factors:

Risk

Protective

Additional Information:

Status:

Program is in operation at this time.

Performance Measures:

Suggested OJJDP Performance Measures for the Program Types(s):

Mental Health Services
Cognitive Behavioral Treatment
Logic Model: PDF
Performance Matrix:PDF
Serious Crime
Group Home
Logic Model: PDF
Performance Matrix:PDF

Contact Information:

Program Developer:
Father Steven Boes, National Executive Director
Boys Town
14100 Crawford Street
Boys Town, NE 68010
Phone: 4024981000
Fax: 4024981010
Email: Click Here
Website: Click Here

Training & TA Provider:
Erin Green. Director Internal Training
Boys Town Home Campus
13603 Flanagan Blvd
Boys Town, NE 68010
Phone: 8004483000
Email: Click Here
Website: Click Here

Program Locations:
Keith Rhodes
Executive Director Boys Town of California
2740 N. Grand Avenue, Second Floor
Santa Ana, CA 92705

Thomas Waite
Executive Director Boys Town of Nevada
821 North Mojave
Las Vegas, NV 89101

William Reardon
Executive Director Boys Town of New England
Bazarsky Campus
Portsmouth, RI 02871

Dennis W. Dillon
Executive Director Boys Town of Louisiana
700 Frenchmen Street
New Orleans, LA 70116

Cynthia Armijo
Executive Director Boys Town of New York
444 Park Avenue South, Suite 801
New York, NY 10016

Kenneth Bender
Executive Director Boys Town of North Florida
3555 Commonwealth Boulevard
Tallahassee, FL 32303

Amy Simpson
Executive Director Boys Town of South Florida
3111 S. Dixie Highway, Suite 200
West Palm Beach, FL 33405

Janie Cook
Executive Director Boys Town of Texas
503 Urban Loop
San Antonio, TX 78204

Jeff Peterson
Executive Director Boys Town of Washington, DC
4801 Sargent Road NE
Washington, DC 20017

Bob Pick
VP, Nebraska/Iowa Boys Town Home Campus
13603 Flanagan Blvd.
Boys Town, NE 68010

Greg Zbylut
Executive Director Boys Town Central Florida
37 Alafaya Woods Blvd.
Oviedo, FL 32765