Tuesday, October 25, 2022

Three key failures undermine a New York Times exposé of the “troubled teen industry”

It’s part editorial, part documentary exposé: A brilliantly presented New York Times Opinion section column on the enormous harm done to children institutionalized in “residential treatment.” 

The commentary begins this way: 

It’s known as the troubled teen industry. Spread across the country, this array of boot camps, wilderness therapy programs, therapeutic boarding schools and residential treatment centers is supposed to help children with mental health and behavioral issues, through a mix of therapy and tough love. 

In reality, it is harming many of the children it purports to be treating, because of … 

I’m stopping the excerpt in mid-sentence because it’s after the words “because of” that the column goes wrong – so wrong, in fact, that it may inadvertently bolster the prospects of the industry it exposés. 

OK, here’s the rest of the sentence: 

…archaic tactics, a lack of oversight and a focus on maximizing profit. 

All of that is true, of course.  But because this exposé, like almost every other, never looked any deeper, the result will be, at best, no significant change or at worst a strengthening of the system. 

There are two reasons for this.  First, for reasons I’ll get to, none of these problems is fixable without looking at the issue at the root of all of them – and exposés like this almost never do that.  And second: Even if you could fix all of those issues, even if there were intensive oversight, even if all the for-profit institutions were closed and even if the “archaic” practices ended, residential treatment still would do enormous harm. 

At one point the column declares: “not every program in this industry is bad.”  But that’s not true.  Yes, not every program is physically abusive, not every program uses “archaic practices,”  and some programs are run by people with good intentions. But every residential treatment program is bad – because residential treatment is inherently bad. 

And no wonder.  The whole concept is based on the idea that if you take children who supposedly have the most serious problems and put them in the same place just at the age when they are most vulnerable to peer pressure, somehow they’ll get better.  

Study after study confirms what should be obvious.  It doesn’t work.  Often it does enormous damage.  And there are far better options. 

But as long as journalists blind themselves to those better options, then the spiral of abuse-exposé-lawmaker declarations of shock and outrage-promises of reform-blue-ribbon commission/committee/task force–public hearings-new regulations-failure to enforce new regulations-abuse will never end.


The "residential treatment" spiral of failure

Now, let’s look at the failings in the Times editorial in detail

Failure 1: How children end up in these hellholes.  There are two ways, but the Times focuses almost exclusively on one: desperate parents who hand their children over to these places voluntarily. Or, as the column puts it: “The industry depends on desperate, often compassionate parents, some of whom fall for slick marketing.”  These are more likely to be the kinds of parents newspaper reporters and editors can identify with: white and middle-class.  

But there is a second category: Children torn from their parents by family police agencies – often when family poverty is confused with “neglect” - and institutionalized over those parents’ objections.  Those children are far less likely to be white and middle-class.  But solving this problem, which the Times largely ignores, is key to solving everything else. 

Failure 2: Focusing almost exclusively on for-profit institutions.  Like so many other exposés,  this one focuses heavily on for-profit companies, who have an obvious incentive to maximize profits by cutting corners -- or worse.  That winds up leaving the false impression that if we just got the for-profit players out of the business everything would be fine. 

But the for-profit players are relatively new, while institutions that warehouse children have been revealed to be hellholes pretty much forever.  If eliminating the profit motive would solve the problem, then… 

● How does one explain what happened at the Glen Mills School, exposéd by the Philadelphia Inquirer?  

● How does one explain all the abuse exposéd, again by the Inquirer, at institutions run by the Devereux nonprofit McTreatment chain.  Devereux is where their own Senior Vice President and Chief Strategy Officer Leah Yaw said:  

“This is not an aberration that happens at Devereux because of some kind of lack of control or structure.  This is an industry-wide problem." 

How does one explain Maryville, a place supposedly so steeped in nonprofit goodness it was the subject of a gushy profile on 60 Minutes – and then, just seven years later, exposed as rife with abuse?  

● How does one explain MacLaren Hall, a house of horrors that had been run directly by Los Angeles County until it finally closed in 2003? 

● Or go back further to the seminal 1975 New York Daily News series “Big Money, Little Victims,” exposing how New York City’s network of private nonprofit agencies were deliberately prolonging foster care to keep the per-diem payments rolling in.  

Does adding an overt profit motive make things even worse? Probably.  But the notion that nonprofits are noble and selfless and behave accordingly reflects a surprising naïvete on the part of journalists. 

Perhaps I was spared these illusions by having worked in the original nonprofit sector of journalism – public broadcasting.  On at least two occasions, I watched while, during early morning pledge breaks at a station where I worked, the pitch person told children that if their parents didn’t send enough money, they might have to take away Sesame Street!  So let’s not kid ourselves: The will to survive can induce in nonprofits a form of greed that is as corrosive to common decency as the worst corporate behavior. 

Predators go where the prey is 

But there also is another reason why non-profit status makes little difference – a flaw built into the residential treatment model: Predators go where the prey is. 

So consider a “residential treatment center" (RTC): All those adolescents trapped behind closed doors in facilities that, if not locked, often are located in isolated, rural communities.  All those adolescents who’ve had all sorts of labels attached to them – labels that compromise their credibility if they come forward about abuse by staff.  For a predator, a residential treatment center is the ultimate target-rich environment. 

Here are a few cases in point

All that leads to the biggest failures of all: 

Failure 3: The idea that residential treatment is necessary – and fixable.  That idea is why much of the Times exposé is devoted to the problem of lax regulation and the need for more regulation.  So, the story includes this: 

“This nation’s residential child care system is broken — and without oversight, congregate care often becomes congregate abuse,” Senator Jeff Merkley of Oregon told Times Opinion in a statement. He added that he’s working on “a bipartisan basis to write legislation that will protect children by reforming our congregate care system with adequate oversight and accountability.” The legislation is expected to be introduced this year. 

The first problem is the one noted at the outset. Even if you got rid of the overt abuse, residential treatment is inherently abusive. No matter how well-intended, institutionalizing children is abuse, period.  But also, no matter what regulations you pass, they’re almost never enforced.  Because everyone has an incentive to look the other way. 

Children wind up institutionalized because of a supposed shortage of foster homes. There is no shortage of foster homes, it is an artifact of tearing apart so many families needlessly.  Unfortunately, the Times seems also to have fallen for the residential treatment industry party line – the one that says these children are simply to difficult for a home setting.  The story notes that “Many kids have already been through foster care …” 

That, too, is bull.  When it comes to supposedly “high needs” cases, there is nothing an institution can do that can’t be done better, and at less cost, with Wraparound programs. 

But as long as the system operates on the false premise that there is a shortage of foster homes, residential treatment is a sellers’ market.  No matter what the regs say, the incentive to ignore them, and to ignore abuse, is enormous because, supposedly, there is no place else to put the kids.  And as long as residential treatment is scarfing up all the money, there will never be enough for better alternatives.  So those children who really need to be in foster homes will “fail” in those homes because Wraparound is not available, and the residential treatment industry will point to that failure to perpetuate its own existence. 

One can see this play out simply by looking at statistics concerning abuse in foster care.  Most states report that, in any even year, only about one percent of foster children are abused in any form of foster care.  Think about that for a moment.  What these agencies are saying is that if you gathered 100 former foster youth in a room and asked them: “During your final year in foster care how many of you were abused?” only one would raise her or his hand. 

If common sense isn’t reason enough to doubt that, consider that one study after another has found abuse in one-quarter to one-third of family foster homes – and the record of abuse by institutions is even worse. 

Why do official figures differ so much from the findings of independent scholars? Because when agencies investigate abuse in any form of substitute care they are, in effect, investigating themselves.  And, of course, if they find that yes, the child was abused, they have to move the child to another placement.  So there is an enormous incentive to see no evil, hear no evil, speak no evil and write no evil in the case file.  And an enormous incentive not to enforce “tougher regulations” on residential treatment centers. 

Yes, these kinds of exposés might make some small changes around the edges. At least while the heat is
on, they may curb the worst excesses and maybe even force a couple of places to close. 

But for the industry as a whole, exposés that presuppose residential treatment is needed and  propose regulation as the answer actually can redound to their benefit.  Because their leaders know full well that as long as it’s a sellers’ market, most of them don’t really have anything to worry about 

Indeed, right now, Michigan is proposing to pump even more money into institutions and Colorado – which institutionalizes children at a rate 60% above the national average – is going to spend two years and nearly $100,000 on a “task force” to find out why children run away from these places! (Yes, really.)  Oh, and a voting member of the task force heads the trade association for the state’s residential treatment centers. In other words, a voting member of the task force is someone whose whole job is to fight to give RTCs more money and more power.  How is that different from, say, putting Donald Trump’s lawyer on the Jan. 6 Committee? 

None of this is necessary.  After you watch the searing videos about abuse in institutions in the New York Times column, watch this video about what really works: Wraparound.  Watch as Karl Dennis describes using Wraparound to safely keep at home a youth supposedly so difficult a county jail couldn’t handle him.


And then ask yourself: Why didn’t The New York Times tell me about this?