even for the adult offender who has already been convicted and sentenced to jail (4). One such alternative program is offered by Ellsworth. House, a community.
Ellsworth
House:
El. RICHABI)
13Y
Ellsworth f or adult carceration Residents
A Community
LAMB,
M.D.,
AND
Alternative
VICTOR
GOERTZEL,
House is a community rehabilitation program offenders. It offers an alternative to inwithin the regularjail and prison system. ofihe house are able to engage in competitive
employment
in the
community
while
participating
in a
therapeutic program at the house. In a controlled study ofthe effectiveness ofthe program, offenders already sentenced to the countyjailfor a term offour months or more were randomly assigned either to Ellsworth House or to a comparison group ofoffenders who remained in thejail system. Earh’ results have been used to identify and correct problems in the program. Recidivism is now companablefor the two groups. but the Ellswonth House group has a higher rate of employment.
ADVERSE EFFECTS of our jail and prison system are well known. Although penal reform within the existing institutions is being urged, it is becoming increasingly clear that a more promising approach would be to eliminate much of the prison system and instead treat the offender in the community (1-3). Such an approach has been shown to be feasible even for the adult offender who has already been convicted and sentenced to jail (4). One such alternative program is offered by Ellsworth House, a community rehabilitation center in downtown San Matco, a city of 80,000 situated on the peninsula south ofSan Francisco. Ellsworth House was established as a joint project of the probation department and the rehabilitation service of San Matco County. Ellsworth House provides an alternative to incarceration of the adult offender within the jail and prison system by placing him instead in a small, unlocked, noninstitutional setting within the community. Its goal is to provide a milieu that is conducive to rehabilitation of the offender but that still maintains control over him.
THE
DESCRIPTION
OF
Selection
THE
PROGRAM
of Participants
Participants
in this
three-year
experimental
program
Revised version of a paper read American Psychiatric Association,
at the 126th annual meeting of the Honolulu, Hawaii, May 7- I I, 1973.
Dr. Lamb
Services,
ment
is Chief,
of Public
Rehabilitation
Health
and
Calif. 94070. Dr. Goertzel San Mateo, Calif.
This work
was supported
Welfare, is Research
San
Mateo
1050 Brittan Psychologist,
in pant by the California
AmJPsychiatry
Depart-
Canlos, House,
Council
Justice.
64
County
Ave., San Ellsworth
/31.’I.January /974
on Criminal
to Jail PH.D.
are randomly selected (using a table of random numbers) from the population of offenders already sentenced to the San Mateo County jail for a term of four months or more. This method of selection ensures that the program will serve people who would otherwise be in the jail system (in this progressive county the jail system includes a rural honor camp and a work-furlough facility). Our intention at Ellsworth House is to reduce the jail population and not simply to enrich an offender’s probation. The method of selection we use also enables us to compare the results of our program with the outcomes for a group of offenders who remain in the jail system. No one is compelled to enter the program, and several men have refused and have opted instead to enter the honor camp or the work-furlough facility. The courts give the staff of Ellsworth House a daily list of all the men sentenced to jail, so that selection can be done on the day of sentencing. A request is then immediately sent to thejudge, asking him to modify the sentence of those men selected. The only offenders excluded from consideration for selection are those who arejudged from experience to be severe escape risks, those who have a history of heavy involvement in the sale or use of narcotics, and those who pose a threat of uncontrollable physical violence. This permits us to take men with a wide range of offenses (see table I for a description of the offenses
of
the
men
enrolled
in
our
program).
After
deduct-
ing time off for good behavior, work time, and credit for time served, the minimum sentence of four months generally lasts about three months-which is, in our opinion, the minimum amount of time required for the program to have an impact upon a man. Program
Staff
Ellsworth House has the capacity to house 20 men (age 18 and over). The facility is close to shopping areas and one block from a bus station. The program director of Ellsworth House is a supervising probation officer who is on leave from the county probation department. The house counselors who work under him have at least two years ofcollege education and relevant experience. One is an ex-offender; another worked as a probation officer on a temporary basis for nine months. The house maintains staffcoverage 24 hours a day and seven days a week. In our opinion probation personnel offer a largely untapped resource in the movement for penal reform. A progressive probation department can combine a rehabilitation orientation with a thorough knowledge of the criminal justice system and good working relationships with the court, the district attorney, the jail system, and the police. All offenders entering the program are assigned to a
H. RICHARD
regular county probation officer, whose office is located in Ellswonth House. This officer’s role is an integral part of the program and he participates in regular staff meetings. An important goal of the project is to help the offender, at an early point in his involvement with the cniminal justice system, to see his probation officer as a helping professional rather than simply as a person who keeps him under surveillance. A vocational rehabilitation counselor from the county rehabilitation service is assigned to Ellsworth House on a part-time basis to provide vocational evaluation and counseling. Residents with a poor work history and poor working habits are referred to a vocational workshop on placed in one of the work situations especially developed by the rehabilitation service. Creating
a Therapeutic
Milieu
TABLE
I
Offrnses
ofthe
Men
Who
Hate
LAMB
Etitered
AND
VICTOR
E/Isworth
GOERTZEL
House
( V = 92
*
Offense
N
Offenses Burglary Grand Offenses
associated
with
drugs
theft associated
with
alcohol
stolen
property
Receiving Robbery Forgery
and
Auto
credit
29 16 9 6
6
card
5 5
forgery
theft
4 3
Armed
robbery
Assault
with a deadly
3
weapon
Manslaughter voluntary Driving with a suspended Failure to support Manslaughter involuntary
2 I I I
license
-
I
Sex offense
We avoid labeling residents as criminals on mental patients but, rather, help them to see themselves as peopIe whose problems have led them to antisocial behavior and thus have brought them into conflict with the legal system. We expect the offender to use our program to work on his problems and to change his life-style. Ifhe is unwilling to do this, he is first confronted with his attitude and behavior by his peers and the staff, and if there is still no change he may be returned to thejail system. When the program began only a few offenders were brought into the house so that they could be thoroughly exposed to this philosophy and could adopt what for them was a new value system. As the culture became established more offenders were brought into the house in small numbers until its capacity was reached. The staff is aware of the importance of continual reinforcement of this milieu, with its emphasis on discussing and clarifying problems in order to change life-styles. Established residents influence newcomers in the same direction through peer pressure. The residents choose their own resident chairman, whose duties are to preside over the weekly resident-staff meeting, to prepare its agenda, and to be a member of the resident council. This elected body has four other members, who are chosen as representatives by the men. The resident council makes decisions on many problems that arise in the house, and it also makes recommendations to the staff concerning the overall program. The idea for this council originated with the residents. Being on the resident council can be an eye-opening cxpenience for an offender. When they themselves have to deal with the antisocial behavior of their fellow residents, the men get some insight into what society, the criminal justice system, and their families and fellow citizens expenience in trying to cope with people like themselves. The experience of being in a position of authority to discipline other residents helps them to develop a sense of responsibility for themselves and for others. At Ellsworth House a man has the opportunity to begin his rehabilitation while he is still under sentence. The program is designed around the therapeutic community concept and gives a significant share of the responsibility for decisions to the residents themselves. Group meetings
*
This list includes
only the offense
the 92 offenses
committed,
that
79 are
resulted
in the index
considered
felonies
incarceration.
and
I 3 are
Of
considered
misdemeanors.
and
individual
of view cleaning,
help
a man to Residents ofthc house. friends help
counseling
and his behavior. and maintenance with family and
activities from becoming
isolated
from
his
All residents must participate time activity-employment, gram. the
As
they
house,
their with
begin
they
families. increased
and
increased
permitted
to
The program responsibility.
The Three Phases
family
community.
in some constructive college, or a training
to accept
are
change his point do the cooking, Visits and group prevent the man
leave
matches
fullpro-
responsibility for
in
weekends
increased
with
privileges
of the Program
The program at Ellsworth House has three phases. On entering the house a man spends at least 30 days in phase I. During this period he may leave the house on weekdays for work, school, training, or a vocational workshop. At all other times he is restricted to the house, although he may receive visitors and make phone calls. He may, of course, leave the house to participate in an organized group
activity.
evaluated
residents
he
This
keeping
behavior.
this
into
does
not since
30-day
resident
more
to
mean
assume
would
only
To
beginning resident
do
only
this
much
would
the
entire
man
in return
increased
responsi-
just
for
perpetuate
is
group
privileges,
responsibility
this
men are only too willing game of getting privileges
simply running Responsibility evening groups, willing to look
period
II by the
phase
is expected
chores,
that the jail-the
and The
entry
and staff. II offers the
Phase for which
bility.
Following
for
of
housea game
to play at the county and time off for good mean
that
we were
a nice jail. at the house means taking part in the opening oneself up to the group, being at oneself and one’s problems objectively, to take steps is also expected
Am J Psychiatry
to resolve these to take responsibility
13/.’!, January
/974
problems. for his
65
COMMUNITY
AlTERNATIVE
TO JAIL
fellow residents-to help them with problems inside the house and in the outside world. In this program we emphasize the whole man. What is the resident doing in the community to find and hold a job, to get along with his boss and his co-workers’? What is he like when he returns to the house after work’? What progress is he making toward resolving his family problems, toward learning how to use his leisure time’? How is the resident using the overall program of the house in all aspects of his life to change his pattern of behavior so that there will in fact be a change when he returns to the community’? Upon entering phase II the resident is allowed 24-hour weekend passes and is permitted to go on short errands in the neighborhood. There is a constant emphasis by the staff that along with these privileges goes the expectation that the man will assume increased responsibility for himself, other residents, and the house in general. If after one month in phase II the man continues to make good progress, he is allowed 48-hour weekend passes. After a man has been in the house for as long a period of time as he would have spent in jail, he enters phase III, which continues for the duration of his probation. In phase III he is released from having to live in Ellswonth House, but returns to the house to see his probation officer and to participate in social activities. He is expected to exert a positive influence on the men who are currently living in the house. Continuing involvement by the men with the program in phase III is crucial. As is true of psychiatric patients, many of these offenders are marginally functional people who have a limited ability to cope and who need support at times of crisis (5). Many of our men have had a lifelong pattern of responding to crises by impulsively committing antisocial acts; this provides a man with some immediate gratification and ensures that he will shortly thereafter be incarcerated, which removes him from the stressful situation. Although jail is a dehumanizing and unpleasant place, it is also a place where a man is taken care of and is not expected to cope with his outside nesponsibilities. Our goal at Ellsworth House is to persuade the graduate ofour program to turn to his probation officer or the house staff for help before he commits a crime. If necessary a former resident may return to live in the house during a time of crisis.
FOLLOW-UP A COMPARISON
OF ELLSWORTH
HOUSE
GRADUATES
AND
GROUP
Graduates of the Ellsworth House program are rated at six-month intervals after their release on a number of items: recidivism, employment, living situation, criminal or delinquent associates, drug abuse (including alcohol abuse), and difficulties encountered by the probation officer in contacting the probationer. A comparison group of ex-offenders released from the sheriff’s honor camp or the work-furlough facility is similarly rated at six-month intervals. Thus far only 31 percent of the men sentenced to four
66
AmJ
Psychiatry /3/.’l.January 1974
months or more in the county jail have had to be cxcluded from our program because of the nature of their offense or their history of violence or escape. Approximately half of those excluded were serious drug offendens-confirmed heroin addicts or persons involved in substantial sales of illegal drugs. A number of other men were eliminated because of various technical cornplications in the criminal justice system, such as a warrant outstanding in a neighboring county. Since those men with sentences of four months or more represent the more serious offenders held in the county jail, the fact that we are able to accept two-thirds of these men into our
community
program
is in our
opinion
significant.
Approximately one-fourth of the men in the companison group entered the county jail’s work-furlough program, which has the capacity to take as many men from thejail as anejudged to be suitable for the program. In this program offenders are employed in the community. Our figures thus far show that while they were in custody, the Ellsworth House group worked an average of more than four times as many days in paid employment in the community as did the comparison group. Our experience shows that many more men are able to continue their community employment and help support their families while in custody than has hitherto been thought possible, even in a prognessivejail system with a model work-furlough program. Ellsworth House accepted its first residents on Novemben 15, 1971. As ofSeptember 30, 1973, 92 men had entered the program. The comparison group was composed of98 men. At the present time only six-month and one-year follow-up statistics are available, although we plan to follow all men in both groups for at least two years after they have left our custody. As ofSeptember 30, 1973, 52 Ellsworth House men and 58 comparison group men had been in the community at least six months; 31 men from each group had been released for at least one year. The results of the two follow-up surveys were comparable for the two groups on the variables of living situation, criminal or delinquent associates, abuse of alcohol or other drugs, and difficulty found by the probation officer in maintaining contact with the probationer. The important differences as of that date were in the areas of recidivism and employment. Recidivism can be measured by many methods, including such sophisticated scales as Moberg’s Recidivism Outcome Index (6). In this study, with its currently small sample, recidivism is defined simply as any offense that results in a jail sentence or revocation of probation. Table 2 shows the recidivism rates for the two groups six months and one year following the men’s release. Recidivism was higher for the Ellsworth House group.than for the comparison group. However, follow-up figures gathered during the most recent six-month period (April 1September 30, 1973) showed the same recidivism rate (15 percent) for the two groups-three recidivists out of 20 men in the Ellsworth House group and four recidivists out of 26 men in the comparison group. Thus, the higher recidivism rate of the Ellsworth House group appears to
H. RICHARD
TABLE
men
2
(oi;ipari.oni
of
Si.v
(1!I(/
%Io,ii/z.s
.
Time of Follo-Up
Reci/irisni
One
Rates
for
Too
Groups
at
Reci divist
Total Number
ElIsorth House group Six months Onevear Comparison group
Six months Oneear
Nonrecidivist
N
Percent
52 31
38 20
14 11
27
58 31
48 22
10 9
17 29
35
result from the policies (described below) that were in effect in the earlier phases of the program. Table 3 shows the data on rates of employment for the two groups at six months and one year following release. In this area Ellsworth House men did considerably better than the comparison group men.
DISCUSSION When we began the Ellsworth House program we were not at all certain that for men with serious offenses an altennative to incarceration could survive in the midst of the community. But after two years we have survived, have gained considerable community support, and have demonstrated that it is possible to maintain, in a community setting, an alternative to incarceration for a group of men who have committed serious crimes. Early results, even those limited to a six-month followup of a small sample, have been essential for program evaluation. These results have pointed up both the positive aspects of our program and the mistakes we have made. Our originally high recidivism rate led us to reexamine our program and to make significant changes. The
TABLE Comparison
program
generally
have
AND
VICTOR
poor
GOERTZEL
impulse
control
a generous amount of support, crisis intervention treatment, and firm, consistent limits. Initially, supervision of phase III, probation for those who left the residential phase of our program, was done primarily on a group basis, whereas the men in the comparison group received close, one-to-one supervision from their probation officers. Furthermore, in our initial concern with setting up the program we involved the probation officer extensively in helping prepare the program, thereby reducing the amount of time he could spend on follow-up of released offenders. These offenders clearly needed more support and structure, and we have now freed the probation officen’s time to allow for intensive individual follow-up supervision. Toward the same end a second probation officer has been added to the program. Still another problem, in retrospect, has been a hesitancy on the part of our rehabilitation-oriented staff to set adequate disciplinary limits on the offenders, both in the residential and postresidential phases ofour program. The men themselves had been telling us, “You’re running the program too loose” -an error all too easily made in a community rehabilitation program. Steps have been taken to remedy this laxness, including giving unannounced uninalyses to all residents of the house at random times and whenever there is any suspicion of drug use. All employment must be verified by the probation officer, who also makes unannounced visits later on to the ex-offender’s place of employment. There is now a stronger emphasis on the necessity for the staff and the residents to identify specific, time-limited goals for each resident to work toward, so that he does not simply drift through the program without being affected by it. Such goals may include vocational planning to increase job satisfaction and work adjustment, the resolution of family problems, learning how to make satisfying use of leisure time, and finding new friends who do not have a delinquent orientation. Since these program changes have been put into effect there has been a marked drop in recidivism in the Ellsand
Year
.
in our
LAMB
often
have
weak
ego
strength;
they
need
to be given
3 of Enp/oii;zent
Rate
for
Tu’o
Group.s
at Six
.i’lo,it/i.s
arid One
Year
Type
of Employment Essentially
Time of Follow-Up
Total Number*
Ellsssonth House group Sixmonths Oneyear Comparison group Sixmonths Oneyear *
Full-time
students
were not included
Regular
Some
None
N
Percent
N
Percent
44 26
27 18
61 69
II 4
25 15
6 4
14 15
47 27
21 15
45 56
15 4
32 15
II 8
23 30
N
Percent
in the comparison.
AmJ
Psychiatry
/31:1.January
1974
67
COMMUNITY
ALTERNATIVE
TO
JAIL
worth House group. We feel that we have demonstrated once again the importance of designing new social programs as controlled studies, so that honest and scientifically valid analyses can be made of the program’s effectiveness and so that areas of strength and weakness can be identified. Ellsworth House has done well with regard to employment, both during and after the residential phase. Not only is employment in the community encouraged during the period of incarceration, but efforts toward vocational rehabilitation arc also made at this time. Ellsworth House demonstrates that serious offenders can serve their sentences in a community setting in which they can engage in competitive employment, keep in contact with their families and the community, and participate in a therapeutic program. And this can be done without increasing recidivism, even though we are competing with an excellent county correctional system that includes a rural honor camp and a work-furlough facility, both of which programs are followed by sophisticated probation supervision. Furthermore, programs such as Ellsworth House can obviate the need to build newjail facilitics. Although we cannot demonstrate it conclusively at this point, we think this program may well be laying the foundation for the offenders’ long-range rehabilitation in terms of their overall adjustment to the community. The treatment methods used during the residential phase of Ellsworth House can best be described as a combination of behavior modification, vocational rehabilitation, and confrontation. Confrontation takes the form of frank discussions of the mens’ problems and life-styles during group meetings in which both staff and residents actively participate. In addition, the residents of the house are divided into four small groups; if any man in one of these groups creates a problem, the entire group loses either half or all of its privileges for the next week. The peer pressure thus mobilized has played a major part in creating significant changes in some of the men. The behavior modification aspects of the program include the granting of such privileges as weekend passes to those who earn them by securing steady employment, by making a genuine attempt to change their life-styles and ways of relating to other people, and by performing chores and abiding by rules of the house. Behavior may be penalized as well as rewarded; a resident may be jailed for a weekend or a week when he has not responded to lesser sanctions. Despite our emphasis on Ellsworth House as a place to get help, the men still see the house as a jail. This is mcvi-
68
Am J Psychiatry
/31:1,
January
1974
table inasmuch as they are kept under control and have limited freedom of choice and action in their lives. The community in general and the house staff in particular tend not to see the house as a jail; they feel distressed when faced with the men’s perception of it as such. But the staff must accept and become comfortable with this reality. They must avoid becoming defensive and must try not to paint a dishonest picture of the program to the men or defeat the behavior modification aspects of the program by showing ambivalence about setting limits and imposing appropriate penalties for antisocial behavion. The staff instead should remind themselves and the men that although the constraints found in the house may make it seem like a jail, learning to live with these constraints is good preparation for living in the community-where we must all live with some constraints. Many of the men in our program have come from delinquent families or from delinquent subcultures in which antisocial acting out is not discouraged or punished but instead is admired. At Ellsworth House the man’s peer group and the staff do not band together and rescue the man who has acted out, as his family and friends may have done in the past. Antisocial acting out by house residents is penalized, so that it becomes clear that actions have consequences. The long and drawn-out process of the criminal justice system, with its attorneys, plea bargaining, and dead time in jail, reinforces the offender’s feeling that he is getting a bad deal and obscures the potential behavior modification aspects ofa system of appropriate sanctions on criminal behavior. In Ellsworth House quick handling of incidents and the use of peers and staff to confront the offender can impart to him a new value system, one that he failed to learn in his youth.
REFERENCES I. Tyce
2.
FA: PORT
ofOlmsted
County.
Minnesota:
community
bilitation for legal offenders. Hosp Community Psychiatry 78, 1971 Keller OJ, Alper BS: Halfway Houses: Community-Centered nection and Treatment. Lexington, Mass, DC Heath & Co.
3, Empey dine,
4. Kirby house.
LT, Lubeck
SG: The Silvenlake
Experiment.
neha22:74 Con-
1970 Chicago, Al-
1971
BC: Crofton House: an experiment with a county halfway Federal Probation 33:53 58, 1969 5. Lamb HR: Essential concepts, in Rehabilitation in Community Mental Health. Edited by Lamb HR. San Francisco, Jossey-Bass, 1971, pp 1-27 6. Moberg DO, Enicson RC: A new Recidivism Outcome Index. Federal Probation 36:50-57, 1972
