At last! One news organization gets the makeshift placement story right!

Once touted as a model institution, the Glen Mills School was closed after
the Philadelphia Inquirer exposed widespread abuse.

The Philadelphia Inquirer zeros in on real solutions 

Here’s something I never thought I’d see in a story about children trapped in night-to-night placements because family policing agencies (a more accurate term than “child welfare” agencies) had no place else to put them: 

Advocates say what’s needed now is to address the short-term glitches while pursuing the long-term vision of supporting more families at home — not backsliding into the era when congregate beds were ample and eagerly filled by a system that saw removing and institutionalizing kids as an easy fix.

But there it was, in one of two outstanding stories in The Philadelphia Inquirer Thursday.  It’s taken a long time. 

For as long as I’ve been following family policing – and that’s more than 45 years now - I’ve been reading stories exposing the horrors inflicted on children forced to endure days, sometimes months in makeshift placements such as family policing agency offices, hotels, hospital wards, jails – even parked cars. 

As I recall, every one of those stories got the solutions wrong.  Oh, there might be a token paragraph somewhere about how “prevention” is a really good thing.  But that part about “not backsliding into the era when congregate beds were ample and eagerly filled by a system that saw removing and institutionalizing kids as an easy fix”?  Never! 

Instead, the reporters would accept as gospel the party line from the “residential treatment” industry. It’s always some version of: “See, we need to build more places to institutionalize kids!” Or, “See? We told you you shouldn’t have shut down our hellholes sorry, therapeutic communities!”  

It would have been easy for The Philadelphia Inquirer to fall into the same trap.  After all, Philadelphia has made significant progress in reducing the number of children torn from their families.  But Philadelphia now has a serious problem with children staying night-to-night in family police agency conference rooms, among other awful places.  Workers sum up the conditions there as “chaos.”  And Philadelphia either shut down or pulled kids out of several institutions in recent years – because the institutions themselves were so abusive. 

But perhaps because colleagues of reporter Samantha Melamed exposed horrific abuse in some of those institutions, such as Glen Mills (which is now closed) and Devereux, she wasn’t ready to accept the idea that the answer is to reopen them, or build new ones. 

Yes, the story includes the usual claim from a residential treatment trade association representative, whining that, now that the city has “reduced capacity” (by refusing to warehouse all those children in hellholes) it’s “destabilized the industry” making it hard to find placements for children with “really complex or sophisticated behavioral health needs.”  

But instead of simply accepting this claim at face value, Melamed broadened her source base.  For starters, she explained Philadelphia’s longstanding dismal status as a child removal outlier: 

For years, Philadelphia DHS removed children from their homes at one of the highest rates in the nation. It was an agency shaped, in many ways, by its response to abuse scandals including the 2006 starvation death of 14-year-old Danieal Kelly while under DHS supervision. 

Now, the city is part of a national and statewide push to stop institutionalizing kids, spurred on by the federal Family First Prevention Services Act. That shift comes amid a widespread recognition that abuses happen in those institutional settings, too — and with startling frequency. It’s also an acknowledgment of racial disparities: Black children account for 13% of Pennsylvania youth, but 35% of those in foster care and two-thirds of those in state juvenile-justice placements … 

But the story goes on to explain that, even with the improvements, Philadelphia still is an outlier when it comes to tearing apart families.  That means there still is plenty of opportunity to free up “capacity” by not filling family foster homes with children who don’t need to be there. 

From the story: 

In the child-welfare system, Community Legal Services of Philadelphia’s Kathleen Creamer said the city needs to double down on preventing family separations. 

Already, she noted, Philadelphia DHS has reformed its process for screening and investigating abuse allegations, and increased funding for legal aid for families. It also begun holding rapid-response meetings to enlist extended families to help kids in danger of being removed. She said that work now needs to go even further, reallocating some of the millions that would be spent on group homes or foster care to properly fund the supportive services that can help families working to stay together. 

“The question is, what’s the policy solution for this?” she said. “The policy solution is to stop separating so many families. We don’t have good placements for them, so let’s actually try to work with the family.” 

Indeed, in a sidebar serving as what Malamed herself tweeted is “the tl;dr version” of the story she includes that paragraph I quoted at the top: 

Advocates say what’s needed now is to address the short-term glitches while pursuing the long-term vision of supporting more families at home — not backsliding into the era when congregate beds were ample and eagerly filled by a system that saw removing and institutionalizing kids as an easy fix. 

The residential treatment typically responds by saying something like: Even if you have enough families, what about all those children with “really complex or sophisticated behavioral health needs”?  

But even when residential treatment centers are not hellholes, there is no evidence that they can meet “really complex or sophisticated behavioral needs.”  On the contrary, the evidence is overwhelming that residential treatment is a failure. 

In contrast, Wraparound services, in which anything a child needs is brought right into the child’s own home, or, when placement is genuinely necessary, a family foster home, do work.  There is nothing residential treatment does that Wraparound doesn’t do better and at less cost. 

How does it work? differently for every child – that’s the point.  So the best way to understand Wraparound is to let one of its pioneers, Karl Dennis, give you an example: 

But perhaps the best indication of why building more institutions won’t work comes in this part of the Inquirer story, the ultimate example of the adage that the definition of insanity is doing the same thing over and over and expecting a different result: 

Wordsworth, Philadelphia’s lone juvenile psychiatric residential treatment facility, was shut down by the state in 2016 after 17-year-old David Hess died in a fight with staff. A replacement opened in 2020 — then quickly lost its license, too, due to what the state said were “multiple child right violations.” (The city last year invited two new providers to negotiate contracts for yet another replacement, but it’s not clear when such a facility may open.) 

So what if, instead of trying to build an institution to replace the abusive institution that replaced another abusive institution, Philadelphia invested those funds in Wraparound programs and other supports for families? 

What if, at the same time, Philadelphia built on its progress to date and reduced its rate of removal to, say, that of New York City?  That would be well under half the Philadelphia rate.  What if Philadelphia then said to the foster parents in those now-empty homes: Take in the relatively few children who really need placement – and we will bring into your home whatever help the children – and you – need to cope with those “really complex or sophisticated behavioral health needs” and make the placement work? 

Would that mean that no Philadelphia child ever again would have to spend even one night in an office or some other awful makeshift placement?  Probably not.  But it would happen to a hell of a lot fewer children than endure it now.

The Philadelphia Inquirer exposes Devereux – and Devereux exposes the entire residential treatment industry

Here’s the most tragic thing about the Philadelphia Inquirer’s searing expose of Devereux, the nation’s largest non-profit chain of “residential treatment” centers: You’ve already read it.

Maybe not literally, of course. But abuse in these places is so common, so pervasive that it’s become a sad staple of investigative reporting.  Take this paragraph for example:

 Devereux’s programs had been hunting grounds for predators. Interviews and documents show that, despite bringing in $467 million in annual revenues, Devereux understaffed its campuses and failed to adequately supervise its patients and staff members, who all too often disappeared for hours and slept through shifts.

 Or this one:

The streets had prepared Kenny for the [Devereux] treatment center. In many ways, it was a culture he recognized. Tough kids were respected. Weak ones became prey. Kenny was one of the tough ones. …”

Except that second paragraph is not from the Philadelphia Inquirer expose in 2020.  It’s from a Washington Post expose – in 2003.

None of this is meant to be critical of the Inquirer – on the contrary, the reporting by Lisa Gartner and Barbara Laker is superb; reporters need to keep doing these stories.

And in one crucial respect, the Inquirer story breaks new ground – in the form of a stunning admission from Devereux’s Senior Vice President and Chief Strategy Officer Leah Yaw:  

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

 She’s absolutely right.

This is crucial because first, at long last, the residential treatment industry admits it’s an industry. More important, it illustrates that residential treatment is unfixable.  A bunch of new laws, a flurry of “program improvement plans” even a blue-ribbon commission, will change nothing.  The cycle of abuse-reform-repeat continues forever.

But it doesn’t have to. That’s because residential treatment also is unnecessary.  That’s something I discuss and document in this column for the trade journal The Imprint, published coincidentally just as the Inquirer published its expose. (There’s more detail about the research showing even “good” residential treatment fails, and more detail about better alternatives, here.)

My column in The Imprint is in response to one by a trade association for nonprofit residential treatment centers, the Association of Children's Residential Centers. The Association’s column did two things: First, it tried to co-opt the rhetoric of the #BlackLivesMatter movement (possibly the worst such example yet, though there are plenty of others). Then, it tried to sell us on the idea that it’s all a matter of a few rotten apples, and it’s only the for-profit McTreatment chains that are abusive.

In my response, I discuss examples of abuses at nonprofit institutions that are members of this very same trade association.  Originally, I’d had a paragraph about Devereux – their Massachusetts division also is a member of the ACRC. But I cut it because I didn’t have recent documented examples of abuses at Devereux facilities.

Now, thanks to some great reporting by the Inquirer, we do.

And now we know: It’s an industry and the problems are industry-wide.

At least close the Presents for Pimps Loophole

The only way to fix residential treatment is to abolish it.  But Congress could at least take one small step by repealing what should properly be called the Presents for Pimps loophole.

Much of the abuse documented by the Inquirer occurred at institutions specifically designed for victims of sex trafficking.  But predators go where the prey is. So few things are more ludicrous than setting up programs in which victims of sex trafficking are all institutionalized together.  But the residential treatment industry (remember, it’s their own phrase now) actually managed to get a loophole added to the vastly overhyped Family First Act.

That law puts some small curbs on where a state can institutionalize children and for how long and still get federal reimbursement for part of the cost. But the industry managed to add a loophole, exempting from these limits institutions specifically designed for victims of sex trafficking – presumably like some of the ones run by Devereux.

So yes, everyone should read the Inquirer’s latest expose – whether or not you’ve, figuratively, read it before. And then Congress should start down the road to abolition of “residential treatment” by repealing the Presents for Pimps Loophole in the Family First Act.