LACONIA — Next Steps Community Services, an Orford-based operator of residential facilities for people with mental disabilities, will take over from the Laconia Designated Receiving Facility, offering treatment for mentally disabled people accused of crimes such as arson and sexual assault at its secure settings in Bethlehem and Wakefield.
Like the DRF in Laconia, these centers will house and treat people with mental disabilities who have been found incompetent to stand trial for crimes including fire-setting and sexual assault involving children.
Keri Thompson, director of Next Steps, declined to comment on what the programs offer or when they will begin. The new contract for services was approved June 2 by the governor and executive council and the New Hampshire Department of Health and Human Services.
The change is “about being able to provide care more widely,” said Jake Leon, communications director for DHHS. In choosing Next Steps, the department considered the organization's history of providing intensive treatment, supporting residential programming for former residents of the Laconia DRF, and its positive track record of caring for individuals with similar diagnostic backgrounds, Leon said.
“The Department determined that Next Steps was the ideal candidate” to furnish more comprehensive services' than what was offered in Laconia, but with comparable security, said Leon.
The Laconia Designated Receiving Facility or DRF, located on the grounds of the former Laconia state school, is set to close at the end of June after the last resident is transferred.
Since 1994, 43 people have been housed and treated there, staying 3.7 years on average, according to DHHS. The average length of stay at similar facilities has been 2.6 to 5.7 years, Leon said. One reason some residents have remained at the Laconia DRF for over a decade has been a shortage of options to move to, said Leon.
DRF residents will continue to step down to secure, community-based residential settings, depending on their mental health diagnoses and behaviors, learning styles, adaptability and personal goals, which can include returning to work or semi-independent living when safety and readiness is demonstrated.
Since the 1990s, treatment philosophies for people with disabilities who have criminal or aggressive backgrounds have shifted away from coercive and punitive measures. These included requiring residents to wear different-colored uniforms when they acted out or endangered themselves or others, and losing privileges and adding chores as consequences for bad behavior which sometimes included minimal breaches, such as taking too many desserts at meals in violation of facility rules, Leon said.
Data showed that this had negative consequences for developing the skills “necessary to deal with situations in a better way,” Leon said.
Several years ago the DFR’s prior approach – the behavioral treatment contract – was discontinued in favor a model that concentrates on positive reinforcement for good behavior and meeting personal goals — a method that psychiatric and educational research has found to be more effective at increasing skills for independence and positive interactions. The new approach focuses on positive feedback when people make good choices, rather than on punishment for wrongdoing. But “it’s not a consequence-free environment. There are still consequences for bad behavior," Leon said.
Since April 2019, when the Laconia DRF’s paradigm shifted, there have been fewer incidents of maladaptive behavior or physical aggression, according to DHHS. “The rate of aggressive incidents directed at staff has decreased over the past two years. There have been no incidents in the community since 2019. There have not been any high-risk incidents among people who have stepped down,” Leon said.
In the past, staff at the DRF have reported injuries from residents who lack an ability to control impulses and emotions. Some workman’s compensation claims have yet to be resolved, according to staff who no longer work there. Some violent residents shifted between the Laconia DRF and the secure psychiatric unit at the New Hampshire state prison, they said.
“Before two years ago we did see people who had to go to prison,” said Leon. “Since 2019, we haven’t had to transfer anyone to a more secure setting, or bring them back from less secure settings because they couldn’t handle it.”
Leon said misunderstandings abound when it comes to plans for the DRF population, and where they will be heading.
“The new setting will not be less restrictive than the DRF at Laconia. It's supposed to be a temporary placement,” said Leon. “Our job is to try to rehabilitate them and support them in their recovery, whatever that might mean. Even though the Laconia DRF is closing, the same types of programming will be available.”
Some will still stay longer “because of the nature and severity of their disabilities and behavior,” he said. The long term goal is for them to acquire skills to reintegrate in society at a level that is realistic for them.
“That process is safer when they receive treatment,” said Leon. “They will have close supervision and treatment for the rest of their lives.”
Under the contract, which can extend to 2026, the state will pay roughly $675,000 annually to operate the two centers in Wakefield and Bethlehem. The money will come from the state's general fund.