How much is an institutionalized child’s life worth? According to the State of Minnesota: $200

 

Photo by Doug Wallick

The child is identified only as C. We don’t know the child’s age or gender. We do know that C was institutionalized at a center in East Bethel, Minnesota, run by Nexus Family Healing. We also know that C was prone to self-harm. And, according to the child welfare trade journal The Imprint, the incidents occurred so often when C was in a bathroom that staff were supposed to have “near constant verbal checks” on the child whenever C was in a bathroom.

 

But on May 19, 2025, no one checked when C was in a bathroom for 45 minutes – enough time for C to wrap strips of cloth around her or his neck until C’s face turned blue.

 

The institution paid a price for this failure. The price was $200. That’s how much Nexus was fined.

 

In fairness, the fines weren’t always that low. For failing to maintain the required staff-to-resident ratio, Nexus was fined $1,200 – which, presumably, is less than it would cost to actually maintain the required staff-to-resident ratio.

 

Finally, the state suspended the facility’s license – after piling up violations and incurring piddling penalties almost from the day Nexus took the place over from a prior operator, which also “ran into regulatory troubles.” But then, the state restored the license.

 

At least three other similar Minnesota facilities have similarly ugly records, but none of them has been ordered to close either.

 

In news accounts, there seems to be far more handwringing about the prospect of not having enough places to institutionalize children than about the abuse that children suffer when institutionalized. And no one has confronted the most basic fact of all: Institutionalization doesn’t work, and the institutions aren’t needed.

 

Sometimes parents place their children in these places voluntarily; other times, the children are taken by county child welfare agencies. Either way, we’ve all heard the residential treatment industry’s sales pitch: These children have such severe behavioral problems that no family can possibly handle them. The only option supposedly is to institutionalize them.

 

So the Minnesota Star Tribune tells us that if institutions close 

That could mean more kids remain with family members who are unable to meet their serious needs, go to day treatment instead of the more-intensive residential services, or are stuck in emergency departments or juvenile detention. Others will be sent to out-of-state facilities. 

But none of that has to happen. Because, as a comprehensive report from the Senate Finance Committee and a mountain of research makes clear, the whole residential treatment model is a failure. There is nothing residential treatment supposedly does that can’t be done better and at lower cost with community-based alternatives, such as Wraparound programs. Such programs bring everything a family needs right into the family home or, when the children truly can’t live with their parents, into a foster home – so family members can “meet their serious needs.”

 

Think it can’t be done? If you haven’t already seen it the many other times it’s appeared on this blog, watch the late Karl Dennis, the father of Wraparound, describe how he did it for a youth so difficult the local jail couldn’t handle him.

 

The industry has a ready answer for that, too: They say there’s a shortage of foster homes, so there’s no place else to put the children except our institutions.

 

But the shortage is artificial.

 

Although the state has been making progress, Minnesota still tears apart families at a rate nearly double the national average, even when rates of child poverty are factored in. That’s not because Minnesota is a cesspool of depravity with double the child abuse of the nation as a whole. In 2025, of all the Minnesota children forced into foster care, 79% did not involve even an allegation of physical or sexual abuse. And 58% did not involve even an allegation of any form of drug abuse.  Far more common are cases in which family poverty is confused with “neglect.”

 

Get the children who don’t need to be in foster care back home, provide parents and foster parents with all the Wraparound services they need, and there will be plenty of room in good, safe foster homes for the children who really need to be there. And it all costs less than institutionalization, which, in addition to being the worst form of care, also is the most expensive.

 

Instead, this artificial “shortage” becomes a reason to keep shoveling children into institutions and allowing the abuses to pile up (with the occasional $200 fine and brief license suspension).

 

Break the cycle, confront Minnesota’s ugly history of needless family separation, and the system can be rebuilt to the point where the state won’t hesitate to shut down institutions and we can treat such closings for what they really are: cause for celebration.

Child welfare loses two heroes

There are not many true heroes in child welfare. Recently, we lost two of them.

Paul Vincent

Paul Vincent died on July 25. Paul led the child welfare division of the Alabama Department of Human Resources when it was the subject of a pioneering class-action lawsuit that demanded the system rebuild to emphasize keeping families together. (A member of NCCPR’s Board of Directors, Ira Burnim of the Bazelon Center for Mental Health Law, was co-counsel for the plaintiffs.) Paul welcomed the suit and worked hard to make it succeed.  And it did. For a while, Alabama was the unlikely leader in doing child welfare right – to the point that it made the front page of The New York Times. 

Paul also served on the “Marisol Panel,” an advisory group that grew out of a class-action lawsuit settlement in New York City. The group was strictly advisory. But because of who was on it, and because the head of New York City’s Administration for Children’s Services, Nicholas Scoppetta, surprised almost everyone by taking a lot of the panel’s advice, it did a lot to set in motion some of the changes for the better in  New York City. 

Then Paul founded the Child Welfare Policy and Practice Group, which issues outstanding reports on systems across the country, including Iowa, Indiana and Philadelphia. You can read more about Paul here. 

Karl Dennis 

Karl Dennis, the "father of Wraparound” -- or, as he preferred to call it, Unconditional Care -- died in June.  In a tribute to Dennis in Youth Today, David Osher writes: 

Karl also understood that each person and each context was unique and that settings, programs and even systems had to adapt to the youth and family rather than the opposite. Just as Karl never wrote off a young person, he never wrote off families even though most or perhaps all Kaleidoscope youth had experienced trauma, and agencies claimed the parents were hard to find and would not comply. He believed in family ties and understood that family included aunts, uncles, grandparents, even close friends, neighbors, and the whole tribe. Because Karl viewed families as valuable resources — and Kaleidoscope worked hard to find them — when they found them they treated them with respect and worked to earn trust, believing that wraparound should be family-driven. 

Karl understood the toxic impacts of language on people, worker-youth/family alliance, and organizational behavior. Karl insisted that his staff never applied the pejorative clinical language of “dysfunction” to families; rather, he saw systems that did not provide appropriate support to families and youth as dysfunctional. 

But it’s best to let Karl Dennis speak for himself, as he did in this presentation in 2009: 

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?

Child welfare and sex trafficking: The problem with residential treatment centers for sexually trafficked youth is residential treatment itself

The New York Times published a story Wednesday about how some residential treatment centers are having problems “treating” victims of sex trafficking. The problem: the young people keep running away.

The story focuses on two institutions, Pleasantville Cottage School and Hawthorne-Cedar Knolls in Westchester County. According to the story:

People who have worked in child welfare in and around New York City say there is a pipeline from centers like the ones here back to the streets, where children fall prey to the abuse that they were supposed to escape. Over the last 18 months, the state, which oversees residential treatment centers like Hawthorne, stopped sending children to Hawthorne and to the nearby Pleasantville Cottage School. Among the 51 centers statewide, Hawthorne and Pleasantville are the only ones to have faced such severe sanctions over missing children in recent years.

Although not mentioned in the story, both institutions also have had severe problems in the past. For example, a 1990 New York Newsday story found that Hawthorne-Cedar Knolls was

 plagued by violence, unchecked sex, and poor supervision. ...  Said one counselor: "They have lost sight that the program is no longer safe to kids.  It's outrageous."

 
The “dilemma” that overlooks the obvious

Wednesday’s Times story goes on to discuss the supposed dilemma: They can’t “treat” people who keep running away, but if you make it harder for young people to run then the places become more like jails – and people who have been victims of sex trafficking shouldn’t be treated like criminals.

Hawthorne-Cedar Knolls opted to go the jail route. They’ve added security cameras, new lighting and “installed a six foot high fence that stretches 200 feet through trees and bush.” The institution may have been prodded by the fact that the Westchester County town where it is located started imposing a $250 fee for every call about a missing child.

And, of course, the institutions say the solution is to give them more money for programs that “engage” the residents – because the more than $400 per day per child they already get clearly isn’t enough.

But once again, the institutions and their supporters overlook the obvious: The solution to the problems of institutionalizing children is to stop institutionalizing children.

There is overwhelming evidence that residential treatment is a failure.  Even the former head of one of their own trade associations was forced to admit that  they lack “good research” showing

residential treatment’s effectiveness and “we find it hard to demonstrate success...”

There is nothing a residential treatment center can do that can’t be done better with Wraparound services – in which an intensive array of services are provided to young people in their own homes or in foster homes.

That’s what the Westchester Journal News found in 2009 when the failures of institutions in Westchester prompted the newspaper to take a long, hard look at institutionalization, and at better alternatives.  Unfortunately those excellent stories no longer are available online, but I’ve highlighted some of their findings here.

And if anyone still doesn’t believe Wraparound is a better option, even in the toughest cases, have a look at this video from Karl Dennis, who pioneered that approach.

The fundamental failure of institutionalization

If anything, sexually trafficked youth appear to be a particularly poor choice for institutionalization.  It is a classic example of the fundamental failure of institutionalization - the idea that taking children who have endured severe trauma and putting them all together in one place at precisely the age when they are most vulnerable to peer pressure somehow is a good idea.

It should be obvious that this approach would lead to precisely the pipeline referred to in the Times story. Indeed, what the Times found in the Westchester institutions, and worse, has been the pattern all over the country.

The Times story also says this, citing the head of the agency that oversees the Westchester RTCs:

The majority of the children return to their homes or are sent to a foster home or other setting closer to their families in less than a year 

That is another indication that, had they used Wraparound, the chances are excellent that the children need never have been institutionalized in the first place.

The headline on the Times story is: “How Do You Care for Sex-Trafficking Victims if You Can’t Hold On to Them?”

And the answer is obvious: You place them with people they want to hold on to – in other words, a family.

Home from foster care: At last, a day to celebrate reunification

A GOOD IDEA FROM PITTSBURGH SPREADS ACROSS THE COUNTRY

Many years ago, I sent an e-mail to Marc Cherna, the reform-minded Director of the Allegheny County, Pa. Department of Human Services. I noted that, like so many other child welfare systems, the one in Pittsburgh had a day to celebrate adoptions. So how about one to celebrate birth families that have been reunified?

Cherna was way ahead of me. He'd already created such an event in Pittsburgh, an annual picnic for reunified families.

After that, whenever a reformer was named to run a child welfare system, I would tell them about Pittsburgh's celebration and suggest they do something similar. That led to three big systems across the country following Pittsburgh's lead.

And on Saturday, for the first time, there will be celebrations of reunified families across the country. The National Project to Improve Representation for Parents Involved in the Child Welfare System, a part of the American Bar Association Center on Children and the Law, is coordinating the effort. Not everyone is celebrating on June 19. Florida held a week of celebrations around Mother's Day, and Los Angeles County held its celebrations earlier - though you'd never know it if you relied for information on the Los Angeles Times.

I suspect one of the best celebrations will be the one in Chicago, sponsored not by a child welfare agency, but by the Family Defense Center. The keynote speaker is Karl Dennis, pioneer of Wraparound services.

If the child welfare agency in your community isn't sponsoring one of these events, and didn't do one earlier this year, this might be a good time to ask them a question:

You say your first priority is reunification. So why is it that all you ever celebrate is adoption and foster care?

A few minutes with Karl Dennis

HAVE A LOOK AT A VIDEO THE RESIDENTIAL TREATMENT INDUSTRY DOESN'T WANT YOU TO SEE

I've often mentioned the great paradox of child welfare: the more expensive the option the worse it is for children. The most expensive, and worst, option of all, is locking children away in "residential treatment centers" (RTCs) – really just orphanages with fancy new name. The evidence is overwhelming that they simply don't work.

There are far better, and less expensive, options. One of them is Wraparound. To steal a line first used to describe the child welfare reform in Alabama, Wraparound moves the system instead of the child. Wraparound brings whatever help a family needs right into the home or, when some kind of placement really is needed, right into the foster home. One of the most extensive such programs, Wraparound Milwaukee, just won an Innovations in American Government award from Harvard's Kennedy School of Government.

But precisely because Wraparound will be different for every family, it can be hard to explain exactly what it is. Some examples help. And who better to offer them than the father of Wraparound, Karl Dennis? Mr. Dennis founded the first Wraparound agency, Kaleidoscope, in Chicago. Though he now is retired, Mr. Dennis still speaks all over the country, and I've never met anyone who's heard one of his presentations who wasn't glad she or he took the time to listen. (Of course, I don't speak to many RTC directors, so…)

So I hope everyone who reads this Blog will take advantage of the opportunity offered by the Family Advocacy Movement, the excellent grassroots group in Nebraska. They invited Mr. Dennis to be their keynote speaker at a conference on Oct 2. Here's an except from his presentation: