Leaving prison behind for good

As New York City explores ways to eventually close Rikers Island, Federation of Organizations, a 45-year-old nonprofit social wellness agency, has a new program aimed at curbing recidivism and reducing the prison population. Six months ago, Federation of Organizations introduced the city’s first forensic assertive community treatment program to help those leaving prison adjust to their new lives.

About one in five inmates in state prisons suffer from mental illness and return to the community with no plan or safety net for ongoing care. The FACT program steps into the breach by supplying behavioral health and a social support system. Adapted from the 1970s assertive community treatment model designed to support individuals with mental illness, a typical FACT team consists of up to 14 members including a criminal justice liaison, housing specialist, substance abuse counselor and peer support partner.

Programs like this have been tested in Philadelphia, Chicago and California and aim to partner with parole officers and others to help individuals reacclimate to their communities and keep them from returning to prison. Although statistics are scarce on its success rate, the strongest study supporting this type of program emerged from California’s Central Valley in 2010, which showed fewer jail bookings and more use of outpatient mental health services among FACT participants.

“High-need individuals eligible for the program are not connected to a treatment system, which is where we step in,” said Barbara Faron, Federation of Organizations’ CEO since 1986. In the early days, Faron recalled working with families who were passionate about advocating on behalf of their relatives with mental illness. It was an era during the 1970s when long-term hospitalization was the norm. Federation of Organization's programming offered alternatives that kept families together. “We often forget the pain that provided the original energy to mobilize,” she said.

Now, Federation of Organizations serves about 6,000 people and 25,000 meals every year through its 31 programs, offering clinical, residential and outreach services for mentally ill adults plus a mobile nursing home diversion program. Its staff of 550 people operates in Suffolk and Nassau counties plus all of New York City’s five boroughs except Staten Island.

About the new program, Faron said, “Prison provides a structure that obviously is lacking upon release. The FACT team is prepared to offer the necessary support to clients in facing life decisions, escorting them to appointments and breaking free of the old cycle. The team offers the potential for hope.”

Currently, the program is working towards serving 68 clients for the year, drawn from referrals by city agencies or prison authorities. Due to the clear need for the program, Federation has prioritized fully funding it and meeting staffing needs - despite budgetary uncertainties. 

“The financial landscape is changing dramatically as we speak,” Faron said. “All of us in the health care field are experiencing this shift moment to moment. It’s like getting on a plane without knowing the destination.”

Philip Matcovsky, Federation of Organization's chief operating officer since 1997, echoed Faron’s financial concerns. “We’re just covering our costs, without the ability to accumulate capital,” he said. The organization plans to open a new affordable housing facility later this year to add to the 880 beds it provides currently, but that’s contingent upon finding property within its budget.

In the meantime, Faron is dreaming big.

“My dream model is imagining a mixed subsidized residence overlooking Fifth Avenue with a 24/7 concierge and on-site professionals,” she said.

Tracking electronic health records and other information technology demands also strain the budget, Matcovsky said. While quick access to data is welcome, the variety of different delivery systems that must be managed adds burdensome costs.

“Working with Medicaid alone was easy since it was one unified system,” Matcovsky said. “Now we deal with a variety of managed care companies – each with its own standards and report requests – which places the burden of accountability on us. This development has created a major challenge for the entire sector.”

In an effort to simplify the system, Federation of Organizations joined the Advanced Health Network, a nonprofit that works collaboratively to contract with managed care organizations.

Even as new developments put new demands on the organization, the value of its original programming continues to grow. Schools continue to reap benefits from the Foster Grandparent program. It supports at-risk public schoolchildren and benefits older, low-income baby boomers by giving these “foster grandparents” a federally funded tax-free stipend for their work providing tutoring and stability in classrooms. Suffolk County's Foster Grandparent and Senior Companion programs are federal volunteer programs; Federation is the sponsoring agency for both.  

“It’s amazing how many elected officials tell us of a family member who participated in the program and how often a 25 year old (who was in the program) will return to say hello,” said Faron. “What better way to utilize the growing cohort of aging baby boomers?”

Note: This article was adjusted to correct references to the agency's name and update some program information.