On the sprawling grounds of Crownsville Hospital Center is a red, brick building known as Cottage 15, now home to a dozen youths from a half-dozen counties.
It is the end of the road for most of them, who have been bounced out of other programs for mentally ill and troubled youngsters both in Maryland and elsewhere, and the beginning for the state's new Focus Point program.
The program, which opened in July with newly allocated money, is designed to help youngsters whom others can't. Or won't.
"A lot of places won't take them anymore. They've got behavioral problems that make it difficult to place them," said Dr. Jerry Kowalewski, the director.
For this group, "behavioral problems" mean breaking someone's arm during an argument or taking a staff member hostage. "Of troubled kids, this is probably the bottom 5 percent," Dr. Kowalewski said.
The program has 21 beds in a secured residential facility to serve youngsters from throughout the state. Another 10 eventually will live in a halfway house designed to ease the transition from the hospital to the community.
Yesterday, administrators invited members of Anne Arundel County's Mental Health Association to tour the facility. Focus Point staff plan to hold an official opening ceremony in January.
Walking the halls of a building serving temporarily as the program's school, Dr. Kowalewski said Focus Point will accept the state's most troubled youngsters, even those who have been sent out of state because no appropriate treatment could be found in Maryland.
Of the first dozen Maryland teen-agers accepted at Focus Point, four have transferred from out-of-state programs. All have been referred from psychiatric hospitals or residential programs elsewhere.
"We don't get our clients right out of the home," said Dr. Kowalewski. "Most have been treated in quite a few places already."
The teens have multiple problems, most of which start with underlying mental illness, such as severe depression or manic-depressive illness. Many have extreme difficulty controlling aggressive behavior, others abuse drugs or have been arrested for assault or drug possession.
Dr. Stuart Silver, director of the state's Mental Hygiene Administration, said the creation of Focus Point stemmed from a 1988 riot in Crownsville's adolescent psychiatric ward.
"The in-patients rioted. They locked up the nurses," he said. "These were young, aggressive, really troubled kids. We realized we really needed a program to deal with this kind of kid."
Dealing with such youths does not come cheap, however. Dr. Kowalewski estimated it costs $120,000 annually per client for the residential and treatment program, as well as the educational program.
But that's about what it costs to send them out of state, he added. And this program might even be more cost-effective, because fewer youths will return to in-patient programs. "The program costs a lot up front, but it will save in the long run," he said. "We often had to start all over again once they came back to Maryland."
Focus Point combines a secured residential program with a half-way house and after-care. After eight to 12 months in the secured program, teen-agers should graduate to the less-structured environment of the "step-down" program. After six to eight months there, they will return home or to another community-based setting with after-care and counseling as long as it's needed.
The goal is to help all the youths back into the community, to return to school or jobs, said Dr. Kowalewski.
"I'd say we're running an uphill game. The success rate in the past has been limited," he said. "But with our continuity of care, focus on community re-entry and the skills we'll help them acquire, I think we will be more successful."