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.

Don’t let Philadelphia DHS off the hook for what happened at Glen Mills

The Commissioner of Philadelphia’s Department of Human Services, Cynthia Figueroa, didn’t know what was going on at an institution where her agency warehoused scores of children. But she should have known. 

It took me two days to get through the Philadelphia Inquirer’s 6,000+ word expose of the nation’s oldest “reform school,” the Glen Mills Schools in Delaware County, Pa.  That’s not because it isn’t gripping reading. On the contrary, it’s a compelling, rigorously documented narrative.  But it was unbearable to read the litany of horrors allegedly inflicted on youth at the institution in one sitting.  (Glen Mills denies the findings in the Inquirer story. The institution reportedly has sent out a six-page memo to juvenile justice officials in response.)

Don’t let anyone kid you into thinking Glen Mills is an aberration.  At the end of last year, the Education Law Center and the group that calls itself Children’s Rights found serious, widespread problems at Pennsylvania youth institutions – and their report was based only on officially reported incidents. 

And, of course, there has been one expose after another after another about such places all over the country. That includes places such as Maryville, near Chicago. Like Glen Mills, Maryville had long been touted as a model institution.  And it includes places such as Clarinda Academy in Iowa – which says its approach is modeled on Glen Mills.

But perhaps the best indication that Glen Mills is no aberration comes from how Glen Mills reportedly stopped youth and their parents from complaining about abuse: They reportedly warned that, if they complained about abuse, the youth would be sent someplace worse.

How Philadelphia DHS helped keep the place open

But there is one aspect to the story that is almost more disturbing.  Though Glen Mills took in youth from all over the country, in recent years 40 percent of them have come from Philadelphia – courtesy of the Philadelphia Department of Human Services.  Philadelphia DHS pays Glen Mills $52,000 per-year per-child for the privilege of warehousing youth there. It’s possible that without Philadelphia DHS Glen Mills could not have stayed in business.  That means a succession of agency leaders, including the current commissioner, Cynthia Figueroa, share responsibility for what happened there.

The revelations about Glen Mills were the result of dogged reporting by Inquirer reporter Lisa Gartner.  She combed through court records.  Philadelphia DHS could have done that. She pored over incident reports.  Philadelphia DHS could have done that.  She interviewed scores of former residents and staff.  Philadelphia DHS could have done that, too.

In fact, Philadelphia DHS could have done something more: Made unannounced visits (though as Gartner documents, it wouldn’t have been easy).

I can hear the DHS Excuse Machine already: Hey, it’s not our fault, they'll say. In Pennsylvania, the state Department of Human Services actually licenses places like Glen Mills, and if the state says the place is o.k., how are we supposed to know?

But while the state hands out the licenses, it’s Philadelphia DHS that decides if Philadelphia youth have to be warehoused at Glen Mills and similar institutions. The young people themselves have no say, and neither do their parents. So it’s damn well Philadelphia DHS’ responsibility to know. 

The problems Gartner documents go back decades. So it’s not as if Figueroa had no reason to look deeper.  News accounts have hinted at what was just below the surface.  In fact I wrote about one such account while doing a report about child welfare in Rhode Island (where a local judge was so in love with Glen Mills that he sent the head of the state Court-Appointed Special Advocates (CASA) program to see how wonderful it was. Glen Mills paid the airfare).  It’s all laid out in this NCCPR report, starting on page 14.

In an Inquirer op-ed column drawing apt comparisons to Pennsylvania’s notorious “kids for cash” scandal, Marsha Levick, chief legal officer at the Juvenile Law Center writes:

The abysmal failure of local and state children and youth agencies to scrutinize the Glen Mills program despite the filing of many incident reports of abuse over the years, as well as the persistent rumors of a “fight club” culture there, is simply inexcusable. [Emphasis added.]

What Glen Mills says about its own program

The nature of the program itself should have been cause for alarm. As we noted in our Rhode Island report, Glen Mills boasts of using “peer pressure” and “group confrontation” to manage behavior.

As the Inquirer story explains,

To this day, reporting on their fellow classmates earns students “status," allowing them to move through campus without adult supervision and enjoy privileges like home passes and the chance to compete on sports teams.

But even the Child Welfare League of America, a trade association for public and private agencies, condemns this approach.  According to CWLA’s so-called “standards of excellence” for “residential services”:

The following practices shall be prohibited under any circumstances: corporal punishment such as slapping, spanking, paddling, or belting; marching, standing or kneeling rigidly in one spot, or any other kind of physical discomfort; denial or deprivation of sleep or nutrition: denial of access to bathroom facilities; verbal abuse, ridicule, humiliation, shaming or sarcasm; punishing a group of children for the actions of one or a select few; withholding family visits; other impingements on the basic rights of children to care, protection, safety, and chemical, mechanical or peer restraint. [Emphasis added]

Was Figueroa aware of Glen Mills’ own stated practices of “peer pressure” and “group confrontation”? Was she aware of the CWLA standards concerning this approach? 

A poor response to an earlier incident

Or consider what happened as recently as August, 2018.  As Gartner explains in her story:

 The Inquirer reported that a Glen Mills counselor had lifted a boy in the air, slammed him down on his back, then choked the asthmatic teen for several minutes while he cried, “I can’t breathe.”

Figueroa suspended admissions to Glen Mills. But she did not pull the other youth out. In fact, Gartner writes, Figueroa praised Glen Mills leadership for their “100 percent ownership and accountability" for the incident.

Yet now, Figueroa's tweets almost leave the impression she exposed the problems at Glen Mills.  When Philadelphia DHS announced – after the latest Inquirer revelations – that it is finally pulling the youth it sent to Glen Mills in the first place out of there, Figueroa tweeted:

@PhiladelphiaDHS commitment is and continues to be safety for our youth! We have demanded and and [sic] will continue to do so

But Figueroa has been running DHS for two-and-a-half years, and all that time the agency was sending youth to Glen Mills.  Why didn’t she demand “safety for our youth” during all that time? 

Then, when Gartner tweeted that, in the wake of her reporting, the executive director and chairman of the board of Glen Mills are “stepping aside,” Figueroa retweeted it with the comment “Demand quality for youth!”

So, what exactly was Figueroa demanding of Glen Mills in 2016 and 2017?

I’m not suggesting that Figueroa actually knew what was going on.  But she should have known.  And it’s not just Figueroa.  The problems have festered for decades. Her many predecessors share responsibility.  And it’s not just Philadelphia DHS.  Glen Mills gained a nationwide reputation for being, as the Inquirer put it, “the Harvard of reform schools.”  So all of child welfare and juvenile justice needs to do some soul searching.

Perhaps they just didn’t want to know

Why didn’t they know? Perhaps they didn’t want to know.

Institutions such as Glen Mills feed off places like Rhode Island, which takes away children at one of the highest rates among the states, and Philadelphia, which, notwithstanding Figueroa’s desperate attempt to fudge the figures, takes away children at the highest rate among America’s big cities.  Those high rates of removal leave states and localities begging for beds – and beggars can’t be choosers.

And yes, high rates of removal affect institutions for children labeled “delinquent” too.  That’s because children consigned to foster care are more likely to commit acts that will get them labeled delinquent.  Indeed, whether a child is labeled dependent or delinquent may depend on which “system” notices them first.

DHS would say that they are continuing to reduce the number of children it institutionalizes, something I noted during my recent written testimony to the Philadelphia City Council.  But if DHS were not taking away children at such an obscene rate, it wouldn’t have needed to use Glen Mills at all.

Get the children who don’t need to be in foster care back home and there will be plenty of room in good, safe foster homes for the children who really need them.  Would foster parents take such “difficult” children?  They would if DHS took the $52,000 it spends per child per year to warehouse them at places like Glen Mills and spent it on intensive support for the child’s own family or a foster family.

Once again, I would urge those who still think institutionalization is the only answer to watch this video in which Karl Dennis, the father of Wraparound explains how it was used to keep a youth safely in his own home – after the local jail found him too hard to handle:

As noted above, Figueroa actually had been on the verge of resuming sending Philadelphia youth to Glen Mills – based on the institution’s promises to do better.  Then, according to an Inquirer follow-up story,  in the wake of the most recent revelations, Figueroa now says

She has been “crystal clear” that the school’s leadership team needs to go, she said, and even then she would have to see a “significant shift in culture.”

But institutions are inherently unfixable.  The culture of institutionalization, even without physical abuse, is poisonous for children and youth.

The place that really needs a “significant shift in culture” is Philadelphia DHS. 

Drug using moms: Threat or menace? The Philadelphia Inquirer veers toward “crack baby journalism”

The Inquirer could learn a lot from some journalism students in Montana

 

As far back as 1989, when the "drug plague" was crack, Pulitzer prize-winning
columnist Ellen Goodman understood what many reporters still don't get.

In a previous post to this blog, I discussed how actual experts on substance abuse keep pleading with reporters not to make the same mistakes in covering the opioid epidemic that they made covering the crack epidemic – in which coverage was infused with hype and hysteria that did enormous harm to children.  I discussed how the Washington Post ignored all of those warnings.

The Philadelphia Inquirer did a better job in a story about a case going before the Pennsylvania Supreme Court.  So it was disappointing to see what happened when the same reporter wrote a more detailed story on February 23, about infants born with opioids in their systems and how hospitals should respond.  Though it still was an improvement over the Post, the story veered toward “crack baby journalism.”

Perhaps because the stories were written by a longtime health reporter, they show more care than most when discussing the health effects of opioid use on infants.  But to know how child welfare should respond to opioids, knowing about opioids isn’t enough. You need to understand the realities of child welfare.  That’s where the story fails.

In contrast, a much smaller newspaper, the Missoulian, and some outstanding journalism students covered the issue with far more insight and nuance.

In discussing the “debate” over when to turn in mothers to child protective services, the only “sides” discussed by the Inquirer are whether to turn in those who use all drugs or only illegal drugs.  The idea that the best interests of children would be best served by allowing medical professionals to decide on a case-by-case basis if a child truly is endangered is not even offered to readers for consideration.

That’s not surprising given that the entire story is built on a false premise, aptly summed up by this subhead: “Infant safety vs. respect for moms.” 

The Big Lie of child welfare

The idea that taking away children is inherently safe and standing up for “children’s rights” while leaving them in their own homes is inherently risky and a sop to “parents’ rights” is the Big Lie of American child welfare. Framing the debate as “infant safety vs. respect for moms” is a way of tailoring that Big Lie to cases involving substance use.

The real debate is: What is in the best interests of children – automatically turning in their mothers, or respecting professional expertise?  But Inquirer readers will find that nowhere in the story.

When hospitals report substance using mothers to child protective services, the article falsely

suggests, they are just siding with child safety, rather than jeopardizing safety just to show “respect for moms.”  So a state legislator demanding tougher reporting requirements declares: “I am biased in this debate. I am biased toward the child.”

The reporter herself declares at the top of the story that the infants “are known to be at higher risk of neglect or abuse when they go home with mothers battling addiction.”  Later she suggests that even mothers who are in treatment and taking legally prescribed opioids, such as methadone, as part of their treatment, should be turned in to authorities – because, she suggests, you never know when those awful moms will relapse.

Lessons from the crack epidemic

But if the legislator were really “biased toward the child” she would have done her homework and learned from the crack cocaine experience.  She would know about the study that made what amounts to a head-to-head comparison of sending those infants home versus forcing them into foster care:

University of Florida researchers studied two groups of children born with cocaine in their systems; one group was placed in foster care, another left with birth mothers able to care for them.  After six months, the babies were tested using all the usual measures of infant development: rolling over, sitting up, reaching out.  Typically, the children left with their birth mothers did better.  For the foster children, the separation from their mothers was more toxic than the cocaine.

And if the reporter were truly concerned about what puts children at “higher risk of neglect or abuse” she would have noted the many studies showing abuse in one-quarter to one-third of foster homes.  She also would have shared with readers the data on the long term awful outcomes for children consigned to the foster care system - and how, in typical cases those outcomes are worse than the outcomes even for comparably-maltreated children placed in foster care.  Links to all of these studies and data are available here.

Scaring mothers away from care

There also is no mention of another, obvious consequence, if doctors and nurses at hospitals turn in every mother who uses drugs: The mothers won’t go to the hospitals, significantly increasing the risk to their children. 

The story says that “when women use drugs during pregnancy, they are more likely to neglect prenatal care …” Note the contemptuous term “neglect.” In some cases that’s accurate; in some cases far worse terminology would be accurate.  But in other cases, the mothers can’t get prenatal care due to poverty, don’t know how to find it or are afraid to seek it out, precisely because they fear being turned in to child protective services.

We’ve known about that for decades. Here’s what happened in Utah, according to a 1999 Salt Lake Tribune story* after a highly-publicized crackdown on drug using mothers:

Fewer pregnant women with substance-abuse addictions are seeking treatment and prenatal care -- out of fear they will be arrested or lose custody of their children, according to Utah officials who counsel and treat them.

While Utah prosecutors have not charged a substance-abusing pregnant woman with felony child abuse since January 1998, the fear of legal reprisal apparently still exists, said Lynn Martinez, program manager for the Pregnancy Risk Line at the Utah Department of Health.

"We've been in business for 15 years. Last year and so far this year have been the worst as far as the number of substance-abuse referral calls," she said. "We're probably getting about half the number of calls we are used to."

Donald Dudley, an obstetrician specializing in high-risk cases at University Hospital, said he has noticed a drop.  "And it's not like they're all of a sudden getting better and not using drugs," he said. "I have patients who are methadone users, so they're out there. But I think there is a lot of fear out in the community about this issue. A lot of them have been driven underground."

The Inquirer story even minimizes the findings from the latest research on treating newborns born with opioids in their system. The story mentions in passing that some babies “get sufficient relief with cuddling and swaddling” but it neglects to mention the importance of who does the cuddling:

In contrast here’s what The New York Times found

[A] growing body of evidence suggests that what these babies need is what has been taken away: a mother.  Separating newborns in withdrawal can slow the infants’ recovery, studies show, and undermine an already fragile parenting relationship. When mothers are close at hand, infants in withdrawal require less medication and fewer costly days in intensive care.

“Mom is a powerful treatment,” said Dr. Matthew Grossman, a pediatric hospitalist at Yale-New Haven Children’s Hospital who has studied the care of opioid-dependent babies.

In my column about the Washington Post story, I quoted one of the few journalists to get it right during the crack epidemic: Pulitzer Prize winning Boston Globe columnist Ellen Goodman.  “There simply is no way to save the babies,” she wrote, “if you throw away the mothers.”

That doesn’t mean we can simply leave children with hopelessly addicted parents.  But it does mean that in most cases, drug treatment for the mother is a better option than foster care for the child. 

 But we just want to help

To which those supporting turning in all parents probably would say: But that’s all we want!  We just want the moms turned in so child protective services can decide what kind of help to give them.

The story cites the former Pennsylvania congressman James Greenwood, who sponsored amendments to the federal Child Abuse Prevention and Treatment Act requiring reporting all mothers of infants “affected” by prenatal drug exposure to child protective services so they can develop a “plan of safe care” for each child. (If states choose to take a wiser approach and not blindly follow the CAPTA mandate, they only risk losing a relatively small amount of federal money.) 

The story notes how Greenwood stressed that

the goal is to help families, not target struggling women.  “In crafting the federal law, I never envisioned that the ‘referral’ from a health care provider was the same as a child abuse report,” said Greenwood, a former child protection caseworker.

This is, at best, hopelessly naïve. When a doctor picks up a phone and calls the agency that

investigates child abuse reports to report that a mother’s newborn is “affected” by her drug use, you may be sure the agency that investigates child abuse reports will treat it as a child abuse report, and act accordingly.

That doesn’t mean the child automatically will be removed to foster care. But why should we assume that the judgement of a typically inexperienced, underprepared minimally-qualified caseworker for a child protective services agency is superior to the judgment of medical professionals?

And the Utah experience suggests that, once the word gets out that hospitals have to turn in all drug using mothers, a lot of those mothers will steer clear of hospitals.

Mischaracterizing the debate

Given all the unquestioned assumptions the Inquirer reporter brought to the story, it’s disappointing but unsurprising that she mischaracterizes the debate solely in these terms:

One side of the debate argues that hospitals should report all drug-exposed babies to local child protection agencies, while the other side says only babies whose mothers used illegal drugs should be reported.

Behind the distinction are good intentions. Many women work to control their misuse of legal or illegal drugs with counseling and prescribed opioids — namely, methadone or buprenorphine — that prevent wrenching withdrawal symptoms. Some are taking prescribed opioids for chronic pain under a doctor’s care. What’s more, women who are motivated to quit drugs altogether when they discover they’re pregnant are typically prescribed methadone, because going cold turkey increases the risk of miscarriage.

But newborns exposed to legally prescribed opioids still can suffer withdrawal — and still can be at long-term risk of neglect or abuse, given the chronic relapsing nature of addiction.

In other words: Drug using moms: Threat or menace?

Consider what this leaves out:

● Why does the Inquirer consider it relevant that newborns exposed to legal drugs still can suffer withdrawal?   What the writer really is saying is: Look what bad mothers they are to put their infants through this – they don’t deserve to have them. (And they probably “neglected” to get prenatal care, too.)

● How does a referral to child protective services now diminish the possibility of relapse months or years from now?

● And most important: How does the risk of relapse compare to the risk of abuse, and other known harms, if the child is consigned to the chaos of foster care?

Were all these questions to be considered it would require adding a third option to the debate:

1. Do not allow child protective services to accept reports based solely on a mother’s use of legally prescribed medication to control drug abuse. It should be presumed that the risk to a child posed by such a mother – who is already under medical supervision and getting treatment – is less than the risk caused by involving child protective services and placing the child at risk of foster care.

2. Change state laws to give medical professionals discretion to determine when a mother’s substance abuse presents such a danger to her child that a report to child protective services is necessary.

3. Where drug treatment is needed, make it as easy for a doctor or nurse to get a new mother into a high quality drug treatment program as it is to call a child abuse hotline.

In some cases those medical professionals will get it wrong. They will fail to report some children in real danger, and also report some children who are not, in fact, in danger.  But they are likely to make fewer errors than a system that requires a knee-jerk report to child protective circumstances in all circumstances.

I don’t expect the reporters and editors at the Philadelphia Inquirer to rush out and endorse this approach.  I would hope they could bring themselves to at least share the existence of this side of the debate with their readers.

Of course, it’s easy to write off any request from an advocate as biased.  And in this case, those who would make such a claim have a point.

Because I am biased in this debate. I’m biased toward the child.

*-The story does not appear to be available online. NCCPR has a copy.

A lot of good journalism about child welfare

Here’s a good problem to have: So much good journalism about child welfare lately that it’s hard to keep up.

●The Arizona Republic has begun a new project on child welfare – and it’s off to an excellent start. Check out the first story.  And a strong editorial.

● But you don’t have to be a relatively large news organization to do outstanding work.  Check out this story from The Day in New London, Ct., about the biggest problem in American child welfare: the confusion of poverty with “neglect.” The same reporter wrote this excellent story as well.

● The nonprofit journalism site ProPublica has a detailed look at the misuse of “psych evals” – and how advocates in New York City brought about some improvement.

● And, as you read this story from the Philadelphia Inquirer, imagine what the response would be if the status of the alleged killer and the people who lost custody of the child were reversed.