Shimon E. Spiro and David Jackson Tel Aviv University and Geha Mental Health Center, Israel

 In Israel, about 6500 children and young persons have been placed in group homes due to the inability of their families to care for them.  Group homes are graded according to the severity of the emotional and behavioral problems of the children placed in them.  The more severely disturbed children are in “Treatment homes”. Some of these are designed for mentally ill children and youths.

 The Ministry of Social Welfare is responsible for the placement of children in group homes.  The ministry pays for the upkeep of the children, sets standards, and supervises the homes.  The homes are owned and operated by NGOs, by private owners, or by local governments.  A home can accept or reject a child referred to it.

 Every year, youngsters, mostly in the age group, cannot be placed.  These children are rejected by the homes to which they are referred, or expelled after a short stay. Some may have been shifted between as many as a dozen group homes and foster families.

 They pose a danger to themselves and/or to other children and staff.  They have a record of attempted suicides, or of sexual and physical assaults on fellow residents and staff.  Some have been diagnosed as mentally ill. Others have records of juvenile delinquency.  Attempts to engage them in educational or therapeutic processes have been unsuccessful.

 The ministry of welfare responded to the problem by issuing a tender offering to pay an enhanced fee to group homes that accept all youths referred to them, and promise not to expel anybody.  Two private operators accepted the challenge and opened two small homes, one for 20 boys and one for 25 girls.  The two homes did accept all those referred to them, and for two years were able to contain and retain almost all of them.  The manner in which they operated can be characterized as “trial and error”.

 The ministry was not satisfies with the bureaucratic solution, and wanted to develop a model for a group home designed specifically to cope with the most challenging population.  A task group was established, composed mostly of professionals with many years of experience in treatment group homes.  The group was asked to prepare a report within one year.

 The experience gained by the staffs of the two homes in their first two years of operation.  A systematic review of the literature from various parts of the world.  The combined knowledge and experience of the 14 members of the task group.

 The proposed home shall not only contain and maintain the youngsters referred to them, but offer them hope for a full and meaningful life and successful integration into society.

 Homogeneity by age, sex, and main problem (mental illness vs. delinquency).  Emphasis on “milieu therapy”, with very limited exposure to the outside world.  Well structured daily schedules and routines.  Individually tailored treatment programs.  Long term stay (till age 18).  Small (12 residents) and staff intensive.  Attachment to existing larger homes, to provide professional and logistic support, or networks of small specialized homes, with some joint operations.

 The proposed network of homes will necessarily be very expensive. It is as yet unclear whether the government will accept and implement the recommendations of the task force.