Probation, With House Calls

By RICHARD LEZIN JONES
July 16, 2004

PATERSON, N.J. - David Benjamin said that he expected the probing, no-nonsense
questions from his probation officer: Where were you when I stopped by earlier?
You remember your curfew, right? You're not down with that gang anymore?

What the 17-year-old didn't expect were the concerned questions that would
follow, not from his tough-minded probation officer but by the avuncular
physician who accompanied the officer on the visit to David's home: How' s your
blood pressure? Are you feeling dizzy? How are those headaches?

"You're going to have headaches for a long time," said the physician, Dr. James
N. Pruden, who explained that David was suffering from post-concussion syndrome,
but tried to lighten the mood when he noticed the youngster turn downcast at the
news. "But I still think you're going to live." He paused. "Just not forever."
Both doctor and patient smiled.

David is one of several hundred juvenile offenders in Paterson who, as part of
their probation, receive free home health care visits from Dr. Pruden and a team
of nurses from St. Joseph's Regional Medical Centerhere. Dr. Pruden and the
nurses, who all volunteer their time for the monthly consultations, accompany
probation officers on home visits, answering questions, dispensing medical
advice and offering cursory checkups to youngsters and, sometimes, their family
members.

But it is not just altruism at work here. Paterson juvenile justice officials
hope that something as simple as reaching out to those on probation in a gentler
way might help reduce the number of repeat offenders.

According to the county's statistics, the visits - which are part of a program
called the Village Initiative (as in, "It takes a village") - might be showing
some promise in cutting recidivism. In the five years since the program began,
recidivism rates that once hovered around 37 percent have fallen to just over 5
percent for those who receive visits.

Although those involved with juvenile probation concede that a more in-depth
analysis must be done before a direct cause-and-effect relationship can be drawn
between the visits and the decrease, they are encouraged by what they have seen.

"This stuff is hard to quantify," said Chief John V. Krieger of the Passaic
County Probation Division. "But I ask myself, 'Why is the rate as low as we've
ever seen it?' "

Whatever the debate over the effectiveness of the visits, there can be no
question that the doctor's presence shows a different face of a system that
often seems to care about these children only when they misbehave.

"These children are in a position where the system is coming down pretty hard on
them," Dr. Pruden said. "Now, they see the other side. It becomes less of a
cold, uncaring, police-state situation and more of a 'Look, we care.' "

This marriage of handcuffs and stethoscopes was the brainchild of Chief Krieger
as an effort to reach some of the county's most troubled youngsters and alter
their path of self-destruction, whether it is involvement in gangs, as in
David's case, or drug use.

The idea, Chief Krieger said, was to identify what was going wrong in the lives
of youngsters on probation before they decide to commit another offense. For
many of the teenagers, who often live in communities where the push and pull of
poverty and drugs is ever present, the visits give officials another entryway
into the lives of youngsters whom they serve.

Last year, the medical team made about 250 home visits. The $150,000 cost of
running the program is financed through grants from the office of the New Jersey
attorney general, Peter C. Harvey.

"It's a holistic approach," Chief Krieger said.

And one of the reasons why officials say that approach seems to be working is
the work of Dr. Pruden and the nurses. On a recent Friday, the medical team and
the probation officers set out in a caravan from the Probation Division offices
and began wending their way through the night.

The first stop was the narrow second-floor apartment on 18th Street where David
Benjamin lives. In April, during a stay at a juvenile detention center, he was
attacked by a few members of a gang that is the rival of one in his
neighborhood. With a single punch from David's blind side, a boy drove his head
into the floor.

He does not remember much between then and waking up in the hospital,
vomiting. Now, just over two months later, he still has intense headaches.

After exchanging introductions, David sits in a rocking chair and Dr. Pruden
starts with a series of tests - follow my finger with your eye; lift your left
leg - and questions about the weeks since David's injury.

"How long were you out?" the doctor asks, referring to the time David was
unconscious after he was struck.

"They told me a couple of minutes," David replied.

"How many times did you vomit?" Dr. Pruden asks.

"The whole day I was in the hospital," the youngster replied. "I was spitting up
blood."

Dr. Pruden stretches a stethoscope to David's chest. Both of them are in jeans
and T-shirts - the uniform of a generation for David, camouflage for the
doctor. David confides that although he had a CAT scan several weeks ago at a
local hospital, he's still worried about his recovery.

He received the results of the scan - several typed pages - but found them
confusing and never saw a doctor to discuss them. He asks Dr. Pruden to take a
look.

For a few minutes the conversation turns to zygomatic fractures and the rates at
which bones heal, but after a few minutes of reviewing the scan results the
doctor offers a prognosis that is easy enough to understand: David will be
fine. The lanky teenager, who had seemed worried and nervous for much of the
visit, visibly relaxes.

And although the medical team is there to assuage many of the probationers'
health concerns, that does not mean they are necessarily treated with kid
gloves. At one point during the visit - shortly after Dr. Pruden and a nurse,
Barbara Koegel, packed up an electronic blood pressure gauge - a member of the
probation team, Sonia Valentin, pressed David on his gang membership.

"No more," Ms. Valentin said, "right?"

David, silent, nodded.

"You can be real with me," she said, insistent.

"I am being real with you," he replied, defensively, a hint of an edge in his
voice.

"Good," she said, "because that brought you nothing but problems."

He nodded again, sheepishly.

Later, framed by a half-dozen posters of Tupac Shakur in his room, David said
that he appreciated the visits, but Dr. Pruden did not hear him. He was already
headed down the stairs to his next appointment.

There will be many probationers to see this night. At one visit, the team
encountered a 16-year-old who is eight months pregnant with her second child. At
another, they checked on a probationer's grandmother who complained of a serious
shoulder strain. At each stop, Dr. Pruden was sent off with handshakes,
embraces, and words of thanks.

In the end, though, perhaps it was Ashley Orr who paid Dr. Pruden the highest
compliment in the lexicon of 17-year-olds when he nodded in the direction of the
departing physician and said simply, "He's cool."

Copyright 2004 The New York Times Company