Tuesday, July 6, 2010

Foster care in Texas: The solution to the problem of hellholes is NOT more hellholes

If news accounts of a public hearing before Texas lawmakers last week are to be believed, this month's "What was she thinking???" award should go to Anne Heiligenstein, Commissioner of the Texas Department of Family and Protective Services.

The hearing was all part of a ritual that unfolds every few years in Texas. It starts, one imagines, with an editor at some big Texas newspaper saying: "Hey, nobody's done the series exposing abuses at Texas Residential Treatment Centers for awhile – is it our turn?" Or, if the newspapers miss a turn, a politician will do it.

So in 2002 it was the Dallas Morning News, in 2004 it was the former Texas State Comptroller, and this year it was the Houston Chronicle and an online news site.

Of course, the ritual is not complete without legislators declaring themselves shocked and outraged by the same things that shocked and outraged them in previous years, and holding a hearing.

Heiligenstein's testimony started out well enough. She focused on the fact that many Texas children are sent to RTCs far from home. It does indeed compound the trauma of substitute care to send a child to the other end of a very large state – separating the child from siblings – and everyone else loving and familiar – and making it hard for parents to visit. This is doubly true when what they get at the other end of the state is a form of "care" that is a grade-A certified failure: Residential Treatment.

But the solution to this is not to build a whole bunch of brand new failed institutions closer to where children live. And the solution is not giving the people running these failed institutions a rate increase, because paying them $96 to $374-per-day-per-child to leave them no better, and sometimes worse, somehow just isn't enough.

Yet these are among the things Commissioner Heiligenstein says she wants to do.

Is Heiligenstein waiting for a third review of the scholarly literature before she believes residential treatment is a failure – were the first two not enough? Does she need more than one former head of the Child Welfare League of America, the giant trade association that includes many RTCs, to admit that they can't "show success"? (Details and citations are available here).

At least 80 percent of the children now warehoused in Texas RTCs almost certainly could be cared for in their own homes and foster homes – provided even a fraction of the money wasted on the RTCs was spent instead on Wraparound programs, which bring whatever those families need to help the children right into the home.

And yes, it does work on the children RTCs love to describe, falsely, as unable to cope with living in a home. For a great example, listen to the "father of Wraparound," Karl Dennis, describe such a case on a video available in a link from this previous post.

Heiligenstein did have at least one genuinely good idea. She proposed changing a system in Texas that also exists in many other states, in which the sicker the child the more a caregiver gets paid. She points out that this gives caregivers no financial incentive to help children get better. Actually, it's worse than that. It means there is an incentive to pretend children are worse than they are – and that can contribute to the misuse and overuse of psychiatric medications.

But if Heiligenstein mentioned the even bigger financial incentive problem – paying RTCs for every day they hold the child in their "care," it was not mentioned in news accounts.

Almost as bad as what Heiligenstein doesn't seem to know is the hypocrisy of the legislators. This time, it seems, they acted shocked – shocked! - that children sometimes are abused at RTCs. They say they're furious that they had to learn about the latest examples from news organizations.

And why, exactly did this upset them so? Surely not because they'd actually respond this time in some way more useful than their response to the last expose, or the one before that. So I have to assume the outrage has something to do with their feeling they missed out on a chance to issue a press release.