Colorado task force’s solution to stop children from running from residential treatment: Fence ‘em in & lock ‘em up!

 

When NCCPR released a comprehensive report on Colorado “child welfare” in September 2023, we included a section called “Tapeworm in the System.”  It’s about Colorado’s love affair with the worst form of “care” for children – group homes and institutions.  At the time, we noted that, as of 2021, Colorado was using them at a rate 33% above the national average.  By 2022, use of group homes had fallen, but Colorado was using the worst of the worst, institutions at a rate 40% above the national average.

We wrote this about a “task force” the legislature created, overseen by the state's child welfare "ombudsman," to spend two years

determining “the root causes of why children run away from out-of-home placements” and figure out how to stop them from running.

Allow us to save the state a little money and a lot of time: Children run away from out-of-home placements because they are in out-of-home placements. You stop children from running away from awful places by not putting them in awful places.

Alas, the “task force” did not take us up on this offer.

Ignoring lived experience

They did, however, meet with adults who, as children, had run away from placements.  According to the task force report:

All the panelists … recalled their desire to return to their home of origin and/or parents, regardless of circumstances

They also commissioned a study which found that

Youth stated that they feel disconnected from family, friends and experiences while they are in residential care. They stated a strong desire to remain connected to family and friends and to remain connected to familiar environments or places. This desire to feel connected is often a reason for running away from care.

But these young people were ignored. The task force report says nothing – nothing – about reducing the “need” for residential treatment, shortening time in care or even increasing “connectedness” for the inmates residents.

Instead, recommendations include this:

[M]embers agreed that residential facilities should not resemble jails or prisons and should remain inviting for children or youth. … However, the task force also noted that perimeter security is essential for keeping dangers out. There was unanimous agreement that fencing could be an effective method for preventing children and youth from running away from care.

Presumably, they mean inviting fences – painted in pretty colors perhaps?

If you’re wondering why fencing also might be “needed” to “keep dangers out” – it illustrates another reason why residential treatment is so harmful.  When you bring a lot of troubled, vulnerable children into one institution it becomes a magnet for predators – because predators go where the prey is.

The task force also called for a study of

the use of delayed locks, fencing and alarms. Funding should also be provided for the implementation of these mechanisms, if the study finds their use to be appropriate.

The alarms they have in mind include “motion sensing alarms” for when children leave their rooms at night.  According to the report: “This was also presented as a way to support facilities working with minimal staff.”

The report notes that these recommendations are not meant to apply to family foster homes – not because the idea of fencing a foster home necessarily appalled them, but because of

the diverse needs of children and youth in foster home placements and the large volume of foster homes located throughout the state.

The false premise at the heart of it all

Part of the problem is that the task force started with a fundamentally false premise. The report claims that

Colorado’s state-licensed residential treatment facilities provide critically important services to some of the state’s most high needs children and youth, including those with severe behavioral health needs.

That is not true. 

On the contrary, as a U.S. Senate Committee report points out:

[Residential treatment facilities] are costly, not as effective as community-based behavioral health treatment options, and often harmful to youth in their care.

The report added:

The risk of harm to children in RTFs is endemic to the operating model.

There is much more documentation concerning why residential treatment is worthless, how there are alternatives that are far better and far less costly, and why the usual excuses for using group homes and institutions don’t hold up to scrutiny in the Colorado report excerpt below.

Stacking the deck from the start

The reason the task force ignored all this evidence – and the young people whose time they wasted – is clear when you look at the makeup of the task force; who was on it, and who wasn’t. That, too, is discussed below. Suffice it to say that Colorado’s residential treatment task force was like a task force to study climate change that included no environmentalists but lots of representatives of the fossil fuel industry.

Worst of all, the task force exploited two of the members, parents of two children who died after
running away from such places. Of course, a parent whose child ran from an institution and died would want a fence. But surely even more they would want the kind of help that would have made it unnecessary for their children ever to be institutionalized in the first place.*

And on that score, if anything, NCCPR’s 2023 prediction about the task force was too optimistic. We wrote:

The residential treatment industry will make sure that when the task force issues its report it will include claims that the industry is all for Wraparound and they love foster families and they really, truly want to keep children in their own homes “whenever possible.” They’ll say they just want a “full continuum of care.”

But what stands in the way of a full continuum of care is – the residential treatment industry. 

We were wrong. Apparently, the residential treatment industry is so confident that Colorado lawmakers and media will buy anything they sell that they don’t even have to pretend to support alternatives. The word “wraparound” does not appear in the task force report even once.

Two bills

So far, the Colorado Legislature has not gone as far as the Task Force. But there is a bill “sailing through the legislature” to build a fence around a new residential treatment facility scheduled to open in Denver next year. In other words, a plan to make a facility the state doesn’t need in the first place even worse. It requires legislation because under current law you can’t force youth to be institutionalized behind a fence if they haven’t committed a crime.

Another bill, (also "sailing through the legislature) based on another task force recommendation, calls for creation of a standard pre-admission “risk assessment tool” to predict how likely it is that a given child will run. 

And then what?  The task force says a consultant should draw up the tool and determine “how the information obtained from the tools may be used to adjust a treatment plan for the child or youth while they are in out-of-home care.” 

And what, exactly, does that mean? Even more restrictions, more onerous “treatment” for any child the assessment tool thinks might run away?

The report makes no mention of the fact that, in other child welfare contexts, such tools have an ugly history of bias.  According to the report “several members cautioned” that objective criteria are necessary and that the assessment of risk can vary “depending on the professional performing the assessment” but there was no mention here of racial bias – something that might have come up had the task force itself been a bit more diverse.

And, what happens if, despite the assessment tool, and the alarms, and the fencing, children still run away? The task force has an answer: Create a whole new type of institution just for them! Or at least a whole new name: “Short-term stabilization units.”

In short, the Task Force did exactly what we thought it would do: pander to the residential treatment industry at the expense of the children. They’re feeding the tapeworm in the system  Because, remember …

 *-The institutions serve two populations, foster children taken from their own parents by force of law, and children placed voluntarily by desperate parents unable to cope, and who have no other option. 

Victims of abuse in foster care shouldn´t have to choose between compensation and justice

Private foster care agencies in New York tell victims of abuse on their watch: If we don´t get a taxpayer bailout, you might not get compensation for what was done to you.  A lawyer for survivors apparently agrees.

 Last month, I wrote a column for the New York Daily News about the attempt by New Yorks´s private foster care, group home and residential treatment agencies to get a taxpayer bailout of up to $200 million.  Why do they say they need it?  To pay settlements in some of the hundreds of lawsuits filed by survivors of abuse in their foster homes, group homes and institutions, going back decades. Otherwise, the agencies say, the could go out of business.

 They say the going-out-of-business part as if it´s a bad thing.  On the contrary. The group homes and institutions are harmful even when they´re not rife with physical and sexual abuse.  The whole model is a proven failure and there are far better alternatives.  But these giant, greedy, well-connected agencies are scarfing up all the money for such alternatives. (And when I say greedy: Have you seen Ron Richter´s salary for running one of them?)

Losing a few of these places would be a net plus, something I discuss in detail (along with Richter´s salary) in the Daily News column.

Fortunately, New York State lawmakers rejected the bailout. They didn´t buy the agencies’ b.s. – though, unfortunately, some media that should know better did.

And, it seems, the agencies have at least one lawyer for the survivors on their side.  According to the child welfare trade journal, The Imprint:

“These victims’ lives have been ruined forever. They deserve justice,” Helene Weiss, a lawyer whose firm is representing dozens of survivors suing under the Child Victims Act, said in an email. “It is incredibly disappointing that New York State decided not to prioritize the needs of survivors of sexual abuse — survivors who were harmed under the State’s watch.”

No, Ms. Weiss.  The state decided not to prioritize the very agencies on whose watch these survivors were abused. It would be perfectly reasonable to create a bailout fund that would apply to survivors of a given agency only after that agency had gone out of business – but not one to keep the agencies alive.

The story also claims that “All sides of the lawsuit [sic] had urged passage” of the bailout.  It´s not clear if this means all survivors bringing all the lawsuits, those represented by Ms. Weiss or something else.

No survivor is quoted. But certainly for those who haved endured the unendurable, if presented by their lawyers with a claim amounting to something like: “look, if the agencies´ claims about going broke are true, this may well be the only way you´ll see any compensation for what was done to you” no one could begrudge them supporting it.

But what if it were presented a different way?  What if it were presented like this:

If the agencies´claims about bankruptcy are true and if bailout fails, your payment will be delayed: it´s possible you´ll never see a dime.  But if the bailout passes, the message to the agencies will be: You can let this keep happening to children on your watch over and over and over, for decade after decade after decade.  The agencies will get the message that they´re too big to fail and they can get away with anything.” 

In that scenario, the survivors get payment – but would they view that as justice?

I hope no survivor ever has to make such a choice.  But if it came to that, I would begrudge no survivor any answer they chose to that question.  I just hope someone asks.

Attn: New Hampshire “Child Advocate” – there are horrendous institutions in your state, too

You shouldn’t be getting “a good night’s sleep” while kids are institutionalized anywhere.  

If your state didn’t tear apart families at a rate nearly double the national average, you wouldn't be institutionalizing children at triple the national average.  In fact, none would “need” to be institutionalized. 

The Bledsoe Youth Academy in Tennessee sure sounds like a hellhole.  That’s what New Hampshire’s “Child Advocate,” Cassandra Sanchez, found when she toured the place. 

As the news site In-Depth New Hampshire reports: 

Sanchez and Assistant Child Advocate Jennifer Jones toured Bledsoe, finding it was run by staff through fear and humiliation … 

At Bledsoe, kids are offered incentives by staff to assault other “problematic” kids, the report said. 

“…if a kid is giving staff a difficult time, another kid might be asked by staff to go after him physically and would be rewarded by staff with a snack or some other incentive, and the aggressor would not be written up for the behavior. …” 

So Sanchez was understandably proud of herself for getting two New Hampshire foster youth out of the place.  But Sanchez takes that way too far when, as the story puts it, 

Finally, she and her staffers can breathe and get a good night’s sleep knowing they are no longer at Bledsoe, she said. 

The management of WMUR-TV apparently feels similarly reassured. 

But no one should be getting a good night’s sleep as long as foster children are institutionalized – in Tennessee, New Hampshire, or anywhere else.  In fact, that goes triple for New Hampshire, where, as of 2021, 27% of foster children were institutionalized - a rate triple the national average.

And Sanchez, of all people, should know it. Because just last year her predecessor issued a report exposing widespread abuse at a home-grown institution. In fact, the Child Advocate’s office received a “cascade of complaints” about the place.  And yet, for some reason, that institution got kid glove treatment, not only from the state but in the remarkably tepid recommendations from the Child Advocate’s office itself.  You can read all about that institution, and the state’s lousy response here.

As we pointed out in that post, institutionalization is inherently so traumatic as to be an act of abuse in itself.  It is also unnecessary.  The evidence is overwhelming that there is nothing an institution can do that can’t be done better, and at far less cost, with Wraparound programs.  Watch Wraparound pioneer Karl Dennis explain how it’s done.

 

And that makes Sanchez’s own response even more disheartening.  Again, from the story: 

Two Executive Councilors and a handful of lawmakers have reached out to Sanchez’ office since the report became public to see what can be done to avoid a similar situation in the future. … 

One idea Sanchez mentioned was to form a commission to study the residential treatment placement of children in and out of state and find out what’s working well. 

Just a commission?  You sure you don’t want a blue-ribbon commission?  Or maybe a “task force”? 

That’s what they’ve got in Colorado, a state that also institutionalizes children at a rate above the national average, but actually looks good compared to New Hampshire – and they’ve stacked it with people who run residential treatment centers.  You can guess how that’s going to go. 

So let me make New Hampshire the same offer I made Colorado: I can save the state a little money and a whole lot of time. 

Here’s a list of everything that’s “working well” in residential treatment: 

 

When it comes to institutionalizing children the only thing that works well is not institutionalizing children. It appears the new director of New Hampshire's family police agency knows this.  He says a top priority will be reducing institutionalization.

And yes, New Hampshire could do that.  The so-called “shortage” of foster homes in New Hampshire is artificial.  It comes from the fact that New Hampshire tears children from their families at the ninth highest rate in America – a rate nearly double the national average – even when child poverty is factored in. 

Get the children who don’t need to be in foster homes back into their own homes and there will be plenty of room in foster homes for the relatively few children who need to be taken away. 

But Sanchez undermines any effort to even consider that option when she refers to having concerns that institutionalization is “further traumatizing the kids.”  That reinforces the false impression that every child removed from her or his home had been traumatized there.  In fact, many children are not traumatized until they are taken away.

Sanchez’s false framing makes it that much less likely that the one option that “works well” will be considered by lawmakers. 

All of this means that, at best, those New Hampshire children rescued from the hellhole in Tennessee are out of the fire and into the frying pan. 

That should be keeping Sanchez and her staff awake at night.

NCCPR in Youth Today: You don’t need a task force to tell you why institutionalized children run

Most of the time when industries want more money from government, they cite their success. It takes a special kind of chutzpah to make the case for more taxpayer money based on your own failure.

Yet that’s what the “residential treatment” industry has been doing in Colorado.  News accounts have documented a litany of failure, from abuse of institutionalized children to runaways dying.  Yet we are told the solution is to pump even more money into these places because they can’t scrape by on a mere $250 to $600 per-day per-child.  The industry says we also should make residential treatment more like jail, allowing locked doors and physical force against youth.  They’re also whining about the minimal standards institutions must meet under the federal Family First Act so states can get federal aid for stashing kids in such places. 

Similar themes have been sounded across the country, as news accounts bemoan children forced into makeshift placements – while almost never asking if all those children should have been taken away, or whether there are better options than institutions. (The answers are no and yes, respectively.)  But nowhere is the residential treatment industry as brazen as Colorado. ... 

Read the full column in Youth Today

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?

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.

Two notable works of journalism

…one to read, one to see.


UPDATE: THE "NEED TO KNOW" SEGMENT NOW IS AVAILABLE ONLINE HERE.  (Best bet seems to be to click on "Watch the Full Episode" in the upper right; it's the first story.  When I try clicking on the video of the story alone it tends to cut out about half-way through.)

The cover story in the current issue of the D.C. alternative weekly CityPaper gives hope that the reports of the death of great investigative journalism have been at least slightly exaggerated.  The story is all about the ugly, expensive, soul-destroying world of “residential treatment.”

And tonight, the PBS series Need to Know airs a segment on the misuse and overuse of psychiatric medications on foster children.  Since PBS fiefdoms – I mean stations – consider it a violation of their God-given rights to cooperate and air programs at the same time more than a few days a week, you’ll have to check your local listings for the time.  But it’s on at 8:30pm in New York and 10:30pm in D.C.