Tuesday, June 6, 2006

Foster care in America: Primetime gets it wrong, part three

Friday’s blog offered an overview of the failings of ABC News’ Primetime report on foster care.  Today, the start of a look at the program segment-by-segment.

            Much of the program is devoted to a staple of mediocre journalism: The puff piece about a “residential treatment center” in this case Maryhurst in Louisville, Ky.  And Maryhurst knew it would be a puff piece. Days before the program aired, the institution was promoting it, complete with a picture of CEO Judy Lambeth posing with Diane Sawyer.

Like many other Residential Treatment Centers (RTCs), Maryhurst has lovely grounds and a slick p.r. operation.

RTCs know how to sell themselves.  They know how to explain how things like not being able to so much as open the refrigerator to get a snack without permission actually is part of the “therapeutic milieu” and is simply the “structure” that the children need.  Actually, it’s needed to keep the institution running when you take a bunch of troubled children at an age when they are most influenced by peers and put them all in one place.  (As I noted yesterday, I expect Maryhurst to claim that having an 11-year-old’s face on camera as she told about being sexually abused, and abusing others, was “therapeutic” for her). 

They always have a couple of anecdotes about success ready – well, maybe one.  But the anecdotes don’t match the data.  Residential treatment is among the biggest failures in child welfare.

· A U.S. Surgeon General's report found only "weak evidence" of residential treatment’s effectiveness.

· Another study found that within six years, 75 percent of the children released from the centers were back to living in the only places they understood - institutions - either mental health facilities or jails.

· A comprehensive review of the literature by the University of North Carolina School of Social Work found that "when community-based services are available, they provide outcomes that are equivalent, at least [to RTCs]."

· Even the head of the trade association for child welfare agencies nationwide, the Child Welfare League of America, admitted that they lack “good research” showing the effectiveness of residential treatment and “we find it hard to demonstrate success…”

How does Primetime deal with this? By ignoring the facts in favor of pretty pictures and syrupy music.  Maryhurst doesn’t even claim success - -except for one former resident who now works there on the staff.  In other words, even the one success story could be comfortable as an adult only at the institution.  (An almost identical puff piece on another institution, on Now with Bill Moyers a couple of years ago, also could show only one success story, also someone who came back to work at the institution.  As a result, that institution’s innovative new CEO is trying to reduce institutionalization.  Now would find a very different story if they went back).

Primetime avoids confronting all this failure by saying, in effect: What do you expect?  The kids are so troubled.  In a comment that is astounding for its arrogance, CEO Lambeth declares that "If we're not successful, no one can be. These are the children that nobody else can handle.”


There are better alternatives that have shown more success with exactly the same kinds of children.

In 2002, the Journal-News in Westchester County, N.Y. looked at Wraparound, pioneered in Milwaukee, as part of a comprehensive examination of residential treatment.  They found that “[Wraparound] cut the number of Milwaukee children in RTCs by 90 percent, dramatically shortened their stays, reunited hundreds of families, reduced the incidence of crime and saved millions of dollars in treatment costs. It became a national model for treating emotionally disturbed children, offering a more effective and economical means of helping youngsters without the traditional reliance on costly and controversial institutions. …”

Of course, the institutions didn’t shrink without a fight.

“I remember meeting with groups of people and folks saying, 'Let's get some reports out that show they [Wraparound] are going to start hurting kids now,' " the head of a large institution told The Journal News.  "Well, nobody could ever bring the reports to the meetings, 'cause there were none that existed that said we were doing anything all that great. We didn't really have any solid anything that demonstrated we were able to fix kids. … I think, looking back on it now, what we’re doing for kids today [with Wraparound] is far more helpful.”  The full story is available here.

            And sometimes, institutions have crises of conscience. After studying their own program and finding it didn’t work, EMQ Child and Family Services of California closed 100 of its 130 institutional beds.  Now they serve more children at less cost in their own homes or foster homes.  According to this story in the authoritative trade journal Youth Today, EMQ’s biggest obstacle was “the group home industry” which tried to stop the state from funding EMQ’s alternative approach.

Youth Villages in Tennessee also embraced community-based care after finding that residential treatment failed – and their biggest problem also was getting the state to fund it, even though it costs less. Says Youth Villages’ visionary director, Patrick Lawler: “In the 28 years I have been entrusted with caring for other people's children, some of whom come from dire circumstances, I have learned firsthand there is no substitute for a child's birth family. I used to think we could do a better job of raising these children. We know better now. The best way to help a child is to help his or her family.”

And that includes adoptive families.  Primetime is a mass of internal contradictions and one of them is seen here.  Even as the program pushes adoption-as-panacea, it chronicles an adoption that is failing; the adoptive parents are returning their adopted child, -- the 11-year-old seen on camera -- and shipping her off to Maryhurst.  For this child, the “forever family” – wasn’t.  Perhaps things wouldn’t have come to that were Wraparound services available.  But as long as RTCs like Maryhurst bleed systems of so much of their limited funds, there won’t be alternatives.

Of course ignoring community-based alternatives in favor of residential treatment has another advantage: A residential treatment center is a great source of horror stories about the relatively few birth parents who really are brutally abusive and really should have their children taken away. 

But intriguingly, even one of the cases highlighted by Primetime involves a family that might have been saved, the family of a girl who desperately misses her mother.  This child’s mother did not beat her or torture her or starve her.  She may have neglected her because she used marijuana and cocaine.  We see the child visit her mother in jail, and we hear Diane Sawyer’s contempt as she makes clear the child is naïve to chink that mom won’t let her down once again.

But what if, early on, her mother had been offered family-based drug treatment, at a place where parents can live with their children? Such places have excellent track records. What if Maryhurst had been such a place, instead of an institution that scarfs up $186 per child per day for a program that can’t show success?

As it happens, Louisville is home to two safe, successful alternatives to substitute care: Community Partnerships for Child Protection and Family to Family (a project of the Annie E. Casey Foundation which helps to fund NCCPR).  We predicted that Primetime would ignore these programs.  We were wrong.  Elements of one of them were mentioned for all of one minute and 40 seconds, barely noticeable between the endless parade of horror stories about the brutes and the sadists.  There also was a brief mention of the programs on the ABC News website.  It misconstrued how they work and what they’re about. 

            These programs involve working with families, not demonizing them or patronizing them.  These programs recognize how often “neglect” is really poverty.  But that’s not the Primetime worldview. So instead of demonstrated success, Primetime lavishes attention on a proven failure:  residential treatment.

            Later this week: The “National Model Worker” story.