Wednesday, November 2, 2016

The death of “Child 1”: Philadelphia’s child welfare agency makes such tragedies inevitable

A child dies in “residential treatment.” But the heart of the problem is “residential treatment” itself.

This post has been updated to reflect the fact that the Philadelphia Department of Human Services says it had no role in the placement of this particular child in this particular residential treatment facility.

Suppose, hypothetically, we were building our public child welfare and mental health systems from scratch. We could design them any way we wanted.

Now, suppose somebody said: Hey, I have a great idea!  Let’s take the young people we believe have the most serious emotional and behavioral problems, at the very age when they are most susceptible to peer pressure and put them all together in the same place! Won’t that work well?

Odds are most people would think it’s the guy who thought up the idea who really needs a mental health intervention.

Yet that’s exactly what we do.  We slap a nice, reassuring label on it – residential treatment – dress it all up with psychobabble and try to make the grounds look as pretty as possible to impress visitors, but at bottom it’s an approach doomed to failure.

This is one of the relatively few areas in child welfare where the research is close to unanimous. Even when the institutions do not devolve into hellholes, residential treatment is a failure that does terrible harm to children – and costs a fortune. (The link to the research also goes to an
all-purpose foster care-industrial complex excuse check-list, which lists all the standard rationalizations for residential treatment, and why they don’t stand up to scrutiny.)

There is nothing – nothing – that residential treatment supposedly does that can’t be done better and safer with intensive in-home services. In this video, a pioneer in providing such services explains how it’s done:

The death in Philadelphia

All these problems are inherent in the RTC model. In other words, these problems exist before we even reach the issue of horrible conditions and abuse at RTCs – issues that are now getting attention in Philadelphia because a 17-year-old, known only as “Child 1” died in one of them, a place known as Wordsworth Academy. 

It took that death, and a litany of other failures, before the state stepped in and shut down the residential treatment program.  The state did it, not the Philadelphia Department of Human Services,  actually placed “Child 1” at Wordsworth,  which actually oversees child welfare in the city and which has contracted with Wordsworth to provide an array of services to the city’s vulnerable children. DHS says it was not involved in placing "Child 1 at Wordsworth. DHS can't pull a facility's license, but it certainly could have pressed the state on the matter before a child died.

Indeed, when you lock away a large group of people who are overwhelmingly poor, disproportionately people of color, people we don’t want to think about or fear, then keep them out of sight and out of mind, what do you expect?  That’s why these kinds of scandals happen over and over again.  

So why does DHS keep relying on these places?

Because DHS is begging for beds and beggars can’t be choosers.

Though DHS has reduced its reliance on all forms of “congregate care” – group homes and institutions – it still uses these facilities at a rate above the national average. It has to.  Because DHS tears apart families at the second highest rate among America’s big cities, even when you factor in rates of child poverty. When you don’t factor in poverty, Philadelphia is number one.


Philadelphia's high rate of removal

The rate of removal in Philadelphia is triple the rate of New York City and quadruple the rate of Chicago.  Does anyone really think Philadelphia children are three times safer than New York children and four times safer than Chicago children.

And no, that’s not some inevitable result of a bunch of terrible new state laws passed in the wake of the Jerry Sandusky scandal that encouraged child abuse hysteria and foster-care panic. Philadelphia’s dismal record predates those laws. The figures cited above are from 2014.  And those same laws apply in Pittsburgh, where, unlike Philadelphia, the foster care population did not increase after those new laws passed.

This latest tragedy is one more consequence of years of willful blindness at DHS, an agency that has refused to learn from other cities and states that do a far better job keeping children safe while taking proportionately far fewer children.

Yes, those other places also use group homes and institutions – but they use them less.  So tragedies like the latest death in Philadelphia are less likely.

There’s a lot we still don’t know yet about this latest tragedy.  We don’t even know the boy’s name.  Surely he deserves at least to be known in death by his own name.  And we deserve to know if he ever really needed to be in “the system” at all, much less how he wound up institutionalized.

Perhaps it will turn out his removal to substitute “care,” however it happened, was entirely justified. Perhaps it will turn out that the child was placed "voluntarily" by parents or other caretakers who felt they had no other choice - because no one offered them better alternatives.  Or perhaps there was some other set of circumstances.  But that would mean only that some other child, who did not need to be taken, was in the safe placement that should have been reserved for the youth we now know only as “Child 1.”