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Esta página no está disponible en español. The Allentown Morning Call Hogar Crea Attempts Makeover In Wake Of Money, Licensing Woes By Tim Darragh and Matt Assad Of The Morning Call November 2, 2003
The international nonprofit's local leaders say they're still committed to helping its basic clientele -- Latino men and women addicted to drugs. But the blows to Hogar Crea -- the Spanish word hogar means "home" and Crea is an acronym for "Community for the Re-Education of Addicts" -- are rippling beyond Pennsylvania and threaten to split the stateside organization in two. Crea has flourished into 152 facilities worldwide since its founding 35 years ago in Puerto Rico. It expanded to Bethlehem in 1981 and eventually to seven Latin American countries, and has plans to open sites in Mexico and Brazil. But recently, the organization in Pennsylvania has faced troubles, largely stemming from officials' strict adherence to the amateur-based methods originally envisioned by its late founder, Juan Jose Garcia Rios. The setbacks include: The loss of its license to provide drug treatment in Pennsylvania. Deficits for the Pennsylvania branch for two consecutive years, capping a period when government contracts and referrals evaporated. The deaths of the charismatic Rios last year and a key local administrator in September. Internal disputes following Rios' death that may lead to a split among the nine states in which Crea operates. Locally, Crea suffered another setback last week when the deadline passed for complying with the terms of a $1 million federal grant it was awarded last year. A weakened Hogar Crea would be bad news all over eastern Pennsylvania, where the program has about 150 beds in men's and women's centers in Allentown, Bethlehem, Freemansburg, Reading and Lancaster. Less drug treatment, officials and residents say, leads to increased crime, tied-up courts and more-crowded jails. Despite the troubles, drug-addicted men and women continue to enter the organization's centers, ready to submit to Crea's 30-month "re-education" program. With the loss of its license, Crea officials have had to make adjustments to the program, but say the changes largely are matters of wording and that they simply cannot refer to Crea as a "drug treatment" program. "The grass-roots stuff is going on as it always has," said Don Miles, Crea's attorney. People such as Jose, a resident at the men's center in Freemansburg, say they depend on Hogar Crea. "This is my ninth or 10th program," Jose said. "I've been in Christian programs, but they weren't teaching me about what led me to my addiction. This program will help you, but you have to be ready." Dave Clark, president of Crea's volunteer state Steering Committee, said his desire to help people such as Jose keep him fighting to preserve the organization, despite its admitted flaws. "I'm not a quitter," Clark said. Addicts helping addicts Hogar Crea's treatment plan was built on a program that breaks down addicted people boot-camp-style over several months and rebuilds them, partly by turning those in the program into group leaders. "Like a building, we have to knock it down from top to bottom and then we build it back up," said Juan Roque, supervisor at the Freemansburg center. But this addicts-helping-addicts idea also is the root of many of its current troubles. In 1996, Pennsylvania's Department of Health passed regulations that required the state's 700 licensed drug treatment operations to have certified counselors. When the three-year period to begin complying expired in 1999, the state threatened to yank Crea's license -- while still working with the organization. "They did bend over backwards to help us get certified," Clark said. But since the idea of formally educated counselors did not fit with Hogar Crea's method, and Crea officials deemed the cost of paying them too high, the two sides reached an impasse. Finally, in March 2002, the state revoked Hogar Crea's license to perform drug treatment. Miles called the new requirements irrelevant regulations required by insurance companies. "They didn't even apply to what Hogar Crea was doing," Miles said. "We weren't the only program angry that the state allowed insurance companies to dictate regulations." But Crea was the only one to lose its license, said Cheryl Williams, director of the Pennsylvania's division of drug and alcohol program licensure. "Everyone else complied, but they couldn't comply with any of the regulations," Williams said. "Their clients were not meant or trained to become drug counselors. They never really even came close to keeping their license." Hogar Crea began reinventing itself. The way to do it, officials reasoned, was to stop promoting Crea as a drug treatment facility and call it a homeless shelter program instead. The loss of the license did not turn off potential residents. As of last month, Clark estimated that Crea's centers were 80 percent occupied. "I don't think on the surface that [losing the license] was a bad thing," said Gary Millspaugh, executive director of the Allentown Rescue Mission, an agency that also serves homeless and drug-addicted populations. He said Crea's streetwise group leaders could still fulfill a mentoring role for addicted people. Jose, the Crea resident, called licensed counselors "book-smart" only. Drugs addicts, he said, identify with their peers in the program. "As they say, you can't con a con artist," he said. The transition to homeless shelter, Clark said, is not the major change in direction that it may seem. "Close to 90 percent of the people who come to us for drug treatment are homeless anyway," Clark said. "We'll be helping the same clients get back on their feet, but because of the state's decision to revoke our license, we can't give them drug treatment." The state Department of Public Welfare now oversees Crea's license to provide homeless services. Meanwhile, Crea residents still endure disciplines that go beyond staying clean. Men are expected to cut their hair short. Income from sales and other jobs go to the organization. Attendance at group counseling and Christian religious services is mandatory. Residents are taught that such measures are not punishment, but part of the process of challenging and undoing their "inversion of values." But Crea cannot operate essentially the same program by simply using different terminology, Williams said. "According to the regulations, they cannot provide drug and alcohol treatment," Williams said. "They cannot provide the service. What we understood they were going to do was restructure, to provide some form of housing with support and assistance." If regulators believe Hogar still is performing drug counseling, she said, the department could take "some form of legal action." Williams said her office has received a complaint that Hogar Crea was still providing drug treatment. However, the office did not investigate, she said. Clark said Hogar Crea is trying to operate within the rules and that residents know what they're getting when they enter one of its facilities. If they're unclear, it's there on the walls of the Freemansburg center -- a flow chart explaining the phases of the Hogar Crea program. The first phase includes "detox." $1 million grant is dead While the move to a homeless shelter program may have been at least a nominal change, in one sense, things didn't change for Hogar Crea. By the end of last week, the organization apparently ran out of time on a federal homeless services grant that would have doubled its annual income. The $994,586 grant from the U.S. Department of Housing and Urban Development was to help Hogar Crea open a center for homeless women and children in a donated building at W. Gordon Street and Ridge Avenue in Allentown. "We were too premature in thinking that we could handle that," Clark said, saying that the grant required local zoning approval and 50 percent matching funds. "We didn't have 50 percent. We didn't have 2 percent." Crea was hampered further when program coordinator Anna Cessna, who ran the local Allentown office and handled the application, died in September. "Anna basically did everything," Clark said. Hogar Crea now wants to sell the property and will explore shedding other tracts and vehicles. "What we have to do and what we've started doing is looking at what we own -- property, vehicles," Clark said. "Let's consolidate down to the bare necessities and get by." Hogar Crea's financial condition demands a retrenching. The state organization ran a deficit of $131,000 in the fiscal year ending June 30, 2002, and officials anticipate that the most recent year will be no better. More significantly, financial reports show that Hogar Crea lacks the means to improve the bottom line soon. Since the dispute with the state over licensing began in the late 1990s, area counties' drug and alcohol offices stopped contracting with Hogar Crea. The impact of the licensing dispute becomes apparent when comparing Crea's Connecticut affiliate to the Pennsylvania branch. In the fiscal year ended June 30, 2002, both reported similar annual incomes of more than $900,000. But while 85 percent of the Connecticut affiliate's income came through government contracts, Pennsylvania's Crea reported no government funds and $21,449 in donations. The lack of public funding put increased pressure on the local Crea to step up its primary means of raising money -- door-to-door trash bag and pastry sales, working food stands at festivals and staffing concession stands at Dorney Park. In contrast, the Connecticut branch charged its clients less and raised relatively small sums fund-raising. "They have kids who should be getting real treatment out on the streets selling trash bags all day," said LaRue Carrigan, a former Crea supervisor. "I don't want Hogar to end, but I'd like it to be about helping the residents, not bringing in money." Local officials defended their practices, saying that fund-raising has more than one utility to Crea. "The purpose of that fund-raising is to help them develop life skills and to help them learn to deal with people," Miles said. "It's part of their re-education. It's character building. The purpose is not to raise money." The Pennsylvania chapter has other financial mountains to climb. Clark said it suffered a net loss of about $40,000 after former clients were caught embezzling funds. Additionally, Crea dug into its supervisors' and program directors' pay in September when it began withholding state and federal taxes for the first time. Hogar Crea's claim that its directors and supervisors were contractors providing professional services was illegal, argued former Steering Committee member Larry Stauffer. He said he left the committee because he did not agree with the organization's operations. Those who began seeing taxes deducted from their pay were unhappy about the change, Clark said. But, he said, "as a person in business, I'm glad we did that." According to Clark, the next step is for Crea to find new, dependable revenue sources. "In the past, selling candy bars, trash bags, little things for 50 cent or a dollar profit, we're making it because we had other income. Now those things aren't enough to keep the program going. We need to do something that's going to give us more than 50 cents in less time, less effort and still be an educational process." "You have to change things" But how much Hogar Crea is willing to change is an open question. About a year ago, the agency hired Carrigan. It seemed like a good match. A certified drug treatment counselor with a master's degree, Carrigan was able to beat drug addiction more than 10 years ago as a Crea client at the women's center in Bethlehem. She planned to introduce Narcotics Anonymous and Alcoholics Anonymous meetings to Crea. Carrigan also said she was lining up new funding sources and job training, so residents would have skills when they left the program. But despite Crea's need for licensed counselors, officials decided that Carrigan didn't share their vision for the organization and asked her to leave. Clark said officials didn't want to alter the curriculum -- the one part of Crea that, in their eyes, worked well -- although Clark had no reliable reports on how successful its programs are at keeping clients clean and sober. "I told them you have to change things," Carrigan said. Rios, Crea's founder, "is dead and so is that whole theory," she said. "What worked 30 years ago is not working today. They said Hogar Crea was losing its mystic-ness since I was filling their heads with [ideas of] jobs and opportunities." That type of difference over the vision for Hogar Crea fuels ongoing questions throughout the international organization over its internal management. After Rios' death in December, U.S. Crea officials split over whether to support his son, Javier Garcia, or his widow, Flora Rosario Johnson, to lead the national organization. "In families and in organizations, there are always differences of opinion," said Johnson in an interview at Crea's headquarters in Puerto Rico. "The important thing is that Crea is an organization of norms and rules." Similarly, Gil Arcola, assistant to Javier Garcia at Hogar Crea in Orlando, Fla., downplayed the differences and said the various state organizations were like members of a political party. Belonging to the organization, he said, "doesn't mean you have to agree with all the decisions." After Rios' death, representatives voted on who should lead the domestic organization, said Edwin Rivera, director of Hogar Crea International of Connecticut. Javier Garcia, he said, won the vote. "We don't trust that she has the capacity" to lead the national organization, Rivera said, speaking of Johnson. "Who better than the son?" But Johnson said she was elected vice president. "We have problems like any organization and we are facing them," she said. "When you lose a leader like my husband, it's both difficult and painful. He led with a vision, and we followed it. Now we have to continue by following his vision. That's what we are trying to do." Clark, who along with representatives of New York, Louisiana and North Carolina supported Johnson, said the other states are not adhering to Hogar Crea's philosophy and will have to relinquish its name and curriculum. The split, he said, "is a setback for the organization internationally." He said a meeting to be held this month in Costa Rica should help settle matters, although Rivera said he was unaware of the gathering. Clark said the setbacks shouldn't cause anyone to overlook the organization's benefit to society. Hogar Crea accepts people who seek help regardless of their ability to pay for it. If one center is full, officials find an open bed at another Crea center, even if it is in another state, Clark said. And considering that many, if not most of its residents were committing crimes to finance their drug habits, he said, the time spent in the program at a minimum is time not spent robbing people, stealing property and tying up police, courts and jails. Tony, a 33-year-old Bronx, N.Y., resident, said his heroin use peaked at about $300 a day. When a person is that deep into his drug use, "things lose value," he said. "You can't function if you don't get a fix." Tony, who last year quit his first attempt at Hogar Crea after only five weeks and now is 10 weeks into the program on his second try, said Hogar Crea's spiritual, confrontational group and family sessions help residents learn about themselves. "Here, they show you how to deal with your personal problems," he said. Clark said Crea will continue to try to help people such as Tony, while rebuilding as an organization. "I think now things are looking a little bit better," he said, citing the "unloading of white elephants." Ideally, he said, Crea will regroup and develop a three-year plan that will help it get back on its feet -- and maybe even get licensed to do drug treatment. "We're not going to give up the hope to someday be a full-fledged licensed drug and alcohol facility providing quality care and be certified, licensed and receive funding," Clark said. "It's not like the problem's going away." Reporter Matthew Hay Brown contributed to this story. Program Supporters Say 92% Of Clients Remain Drug Free By Tim Darragh and Matt Assad Of The Morning Call November 2, 2003 RESIDENTS OF HOGAR CREA take part in confrontation therapy, designed to tear residents down and then rebuild them. Some drug addiction experts take issue with the program's procedures and claims. You may have purchased the trash bags they hawk door-to-door. Perhaps you've chowed down on their tasty shish kebab sold at the region's summer festivals. Maybe they've served you at a Dorney Park concession stand. They are drug addicts. And these men and women, dressed in signature navy blue, are trying to break the grip of their addiction through the Hogar Crea method. It's a system for treating addiction that has generated passionate support as well as doubt. Since its founding in 1968 by Juan Jose Garcia Rios "Cheguan" to those who knew him -- Hogar Crea has been a temporary home for thousands of drug-addicted people in the United States and Latin America. But determining how many people have gone through the 30-month-long program, and its effectiveness, is difficult, if not impossible. Hogar Crea makes assertions that some drug treatment experts say are incredible. It advertises that Crea "assures" that drug addicts can be "cured." Juan Roque, supervisor of Hogar Crea's men's center in Freemansburg, repeated a statistic frequently cited by Crea supporters that 92 percent of those who complete the program remain clean. That contrasts with a remission rate of between 50 percent to 70 percent for drug treatment nationally, said Dr. Margaret Jarvis, director of the Marworth Clinic for the Geisinger Health System. Other studies put the remission rate for drug treatment at 40 percent to 60 percent. Crea officials in Pennsylvania and Puerto Rico had no data or reports to support their assertions, however. State Steering Committee President Dave Clark offered assurances that Hogar Crea's regimen works. "The number who stay in through the duration is low," he said. "But the number who successfully complete and fall is very low. I see it working." Leah Young of the Substance Abuse and Mental Health Services Administration, a branch of the U.S. Department of Health and Human Services, says she could find no one at the agency who knew of Hogar Crea. And since Hogar Crea now is unlicensed, no recent government data on it would exist, Young said. Further, the prevailing wisdom among treatment experts is that addiction can be controlled, not cured, she said. "Addiction is not like a broken leg where you can set it and OK, you're now as good as new," Young said. "People can and do recover, and we applaud the hard work it takes to recover, but recovery is not the same as "cured.' " Behind the question of "effectiveness" -- a variable goal in the business of addiction treatment -- is Hogar Crea's exclusion of drug treatment professionals in favor of other addicts. Jarvis said professional counselors can help identify psychiatric problems that frequently are linked to addiction and make appropriate referrals. Since addiction affects people differently, she said, it makes sense to have as many tools as possible to help people suffering from addiction, including licensed counselors. "I think it matters a lot," she said. In contrast, people in Hogar Crea's program can go from junkie to group leader quickly. One Allentown woman who spoke with The Morning Call was just nine months from crack cocaine addiction when she was made director of Hogar Crea's women's center in Bethlehem. "I was still dealing with my own issues when I was put in charge of 19 other women," she said. "I wasn't qualified or prepared to be dealing with that."
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