Group home industry admits what we’ve always known: It’s $ first, kids second

● Their public face is all about how they don’t even think about money (except that they wish they had more of it to help those poor, helpless children, of course.) But when they think we’re not listening the talk is all about “capital” “revenue” and “equity portfolios.”

● And when they think we’re not listening they admit that tens of thousands of children warehoused in institutions don’t need to be institutionalized.

No, the people who run residential treatment
centers are not like Montgomery Burns
on The Simpsons. But financial incentives for
needlessly institutionalizing children are very real.

 Discussions about financial incentives in child welfare usually revolve around incentives for governments.  Sometimes that discussion is oversimplified with claims that governments “make money on foster care.”

Actually they don’t.  But the reality is almost as bad. A series of perverse incentives lead to a situation in which governments sometimes lose more money by helping a family than they lose by just consigning the children to foster care – even though the help for the family costs less in total dollars.  So even though governments don’t literally make money on foster care, there are financial incentives to misuse it and overuse it.

Another set of perverse incentives encourages quick-and-dirty slipshod adoptive placements, by paying bounties for every finalized adoption over a baseline number.  Even when the adoptions fail, the states still get to keep their bounties.  There is no similar incentive for reunifying a family.

Incentives for private agencies

But there is another set of even worse incentives that gets far less attention: incentives for private agencies. Such agencies typically provide most of the worst, and most expensive forms of “care” – group homes and institutions. In some states and localities they also oversee foster homes. 

These agencies typically are paid for each day they hold a child in their care.  So of course, they have a profound incentive to encourage needless removal of children and then hold them in foster care for a long, long time. 

This does not mean that your typical private agency leader is like Montgomery Burns on The Simpsons, gleefully rubbing his hands each time another child is placed in his group home or institution.  Rationalization is powerful. So the group home industry, (a term that encompasses all forms of “congregate care” from your basic group home to your “residential treatment center,”) convinces itself that, contrary to a massive amount of evidence, the children really, truly benefit from being institutionalized and really, truly have to be in their care for a long, long time.

(The term group home industry itself was coined by the director of a residential treatment center who had a crisis of conscience and had to fight the industry when he sought to vastly reduce institutionalization and emphasize services to children in their homes or foster homes.)

Nonprofits can be greedy, too

The various components of the group home industry are typically, though not always, nonprofit organizations.  That’s a big blind spot for journalists.  Reporters are trained to be skeptical of government and of big corporations. But there is surprising naiveté about the so-called “independent sector.”  But the will to survive can induce in nonprofits a form of greed that is as corrosive of common decency as the worst corporate behavior.

And that brings me to a column written by Jennifer Jones and Theresa Covington, two leaders of the so-called Alliance for Strong Families and Communities.  That’s one of those Orwellian names so-beloved in child welfare. It’s actually a trade association for human services agencies, including many that run group homes and residential treatment centers.

Writing in what they apparently consider their safe space, the Chronicle of Social Change, they effectively admitted that what really concerns many of their members is: Money, money, money.

The column deals with the so called Family First Prevention Services Act. They claim that “One of the areas that will be most impacted [sic] by the bill is residential care.” (In fact, that part of the law is so strewn with loopholes that, unfortunately, the “residential care” industry is unlikely to be impacted – or even affected – much at all.) They go on to write about how they’re conducting “a series of cohort initiatives to help inform and advance a transformational shift …”

True confessions, part 1:

But two elements of the column are striking. First, this trade association that includes so many residential treatment providers admits, in writing, that a huge proportion of the children their members have institutionalized don’t need to be in institutions.

They write:

“Therapeutic Residential Care,” as it is known, focuses specifically on providing treatment for youth who have a mental health diagnosis or have experienced trauma and need help regulating their emotions. … However, according to recent data, more than 4 in 10 children who are currently in residential care have no mental health diagnosis, medical disability or behavioral problem that would warrant such a setting. [Emphasis added.]

… Recent research suggests that young children living in residential programs are at a higher risk for developing physical, emotional and behavioral problems. These young children are also less likely to be placed in a permanent home than those who live in foster care.

The “recent research” comes on top of the vast store of research that has told us as much for a long, long time. Back in 2005, Shay Bilchik, who then was running another trade association for agencies that has an Orwellian name, the Child Welfare League of America, admitted that they lack “good research” showing residential treatment’s effectiveness and “we find it hard to demonstrate success...”

What’s new is that now the so-called “Alliance” is admitting it as well, and suggesting that tens of thousands of institutionalized children should not, in fact, be institutionalized. (The 4 in 10 number is an underestimate. There is no evidence that residential treatment is successful for any population – but, hey, it’s a start.)

True confessions, Part 2:

So, what is it that is stopping the Alliance’s member agencies from abandoning this largely worthless endeavor?  After all, these agencies tell us over and over that their only concern is the best interests of the children, and they don’t even think about what the agencies themselves need. 

But now Jones and Covington tell a different story:

This shift requires residential providers to make significant changes in policy, practice, budget, historical programming and organizational culture. The growing evidence base continues to point to this change movement as being in children’s best interests and necessary, yet providers continue to seek out clearer and more efficient pathways to understand this new reality and make this transformation a reality.

Translation: We might be willing to do this, but only if we don’t lose any money, or, God forbid, go out of business.  Money first, kids second. 

Jones and Covington cite figures from one of their member agencies indicating that residential treatment brings in a disproportionate share of its revenue. And, they write,

Many child welfare providers and operators of residential treatment facilities have a tremendous amount of equity and capital in their physical structures and campuses and a large portion of their organizational identity is encompassed in their role as residential providers.

Translation: If we do what’s best for the kids, where will we get our money?  We’ve got all that equity and capital to think about! 

Jones and Covington continue:

It can be challenging for leaders and board members of these organizations to still deliver on their stated mission when such a large part of that mission is being transformed.

But if the stated mission is institutionalizing children, then the mission is crap and it should be scrapped. 

Jones and Covington again:

Child welfare providers are among the oldest community-based nonprofits in the country, with a significant number of them owning and operating facilities that began as orphanages more than a century ago.

Actually, they’re still orphanages.  “Residential treatment” is largely an exercise in rebranding. 

And finally, Jones and Covington tell us:

These physical campuses make up a large part of their equity portfolio and many organizations are hesitant to make the leap to repurpose or divest these resources.

But why?

If all they care about is what’s best for the children, as they keep telling us, they should be thrilled to follow pioneers such as Children’s Village, EMQ Child and Family Services and Youth Villages which all have dramatically altered their mission to put far more emphasis on services in children’s own homes, in foster homes.

Unless of course, what they really care about is self-preservation.

Meanwhile, back at the whine cellar …

And, of course, no column by a trade association of providers would be complete without whining about how they don’t get enough money for whatever it is they provide. So, Jones and Covington write:

The theory of change represented within the [Family First] bill requires a robust array of home- and community-based services, yet there was no federal funding put in the bill to help states build up that part of the system. So, state legislatures and local governments are going to need to make further investments into developing this part of the system in order to keep children in the least restrictive, most family-like settings. 

Actually, that’s not quite true. As the authors note in the same column, Family First does include some funding for reforms. It allows money once limited to substitute care to be spent on better options – though the options are severely limited, so very little money actually is likely to be available.

But more important, you get the money for alternatives to institutionalizing children by not institutionalizing children. 

Institutions are not just the worst form of care, they’re also the most expensive.  So pretty much anything else you do for a particular child will cost less than institutionalizing the child. So all you need to do to “make further investments” in better alternatives is to take the state and local money you would have spent to institutionalize children and spend it on those better alternatives. 

That is, if all those concerns from agencies about “capital” “revenue” and “equity portfolios” don’t get in the way.

The Keystone Kops of commissions holds another conference call: We listen, so you don’t have to!

The "Commission to Eliminate Child Abuse and Neglect Fatalities"
held a conference call Saturday.

● Commission chair suggests raiding scarce prevention funds to pay for more child abuse investigations.

● The Commission vs. the evidence base.

● Meet Michael Petit, born again fiscal conservative.

● One commissioner raises questions about keeping drafts hidden from the public.

 After NCCPR issued its comprehensive “pre-buttal” to draft recommendations by the “Commission to Eliminate Child Abuse and Neglect Fatalities” the Commission responded immediately – they stopped making their drafts public.  (See the discussion below concerning whether this is legal.)  So now they conduct long, drawn-out conference calls discussing later drafts and other documents that no one outside the commission can see.  It’s sometimes been necessary, therefore, to draw inferences concerning what, exactly the commission is talking about.

If any commissioner feels these inferences are inaccurate, the Commission is welcome to set the record straight – by releasing the documents and the tape recordings it makes of its conference calls.

When we last left the “Commission to Eliminate Child Abuse and Neglect Fatalities” they were debating a recommendation for a “surge” in which states would be forced to reopen thousands of cases of alleged child maltreatment in which children were allowed to stay in their own homes, in order to see which ones should be torn from everyone they know and love and consigned to the chaos of foster care after all.  There would be no comparable look at children already trapped in foster care to see if they could go home.

Another draft recommendation calls for prohibiting state child abuse hotlines from “screening out” any call alleging child abuse or neglect involving a child under age 5, no matter how patently absurd that call might be.  Even among calls that are screened in, 87 percent turn out to be false.  We estimate this recommendation would increase investigator caseloads by 44 percent, and almost all of that time will be spent spinning their wheels as they look where abuse and neglect are least likely to be found – stealing time and effort from finding children in real danger.

The Commission has been going around in circles debating which would scare Congress more: saying out loud that they want $1 billion in new funds just for the “surge,” or whether they should just say, in effect: “If you don’t throw gobs of money at our unscientific recommendation that has no evidence behind it, children will die!”

But on a conference call that lasted nearly three hours Saturday (about one-third of which was devoted just to figuring out whether there would be an up-or-down vote on all recommendations) Commission Chair David Sanders floated a new idea:

Either instead of, or in addition to, asking for more money, it’s not clear which, Sanders suggested that the Commission might want to recommend letting states use money from something called Title IV-B.  This is the meager pot of money the federal government now makes available, in part, for prevention and family preservation. 

Even though the evidence is clear that it is prevention programs, as well as broader anti-poverty efforts, that actually curb child abuse fatalities, Sanders is proposing allowing states to divert money from such efforts and pour it into investigating more families and taking away more children.

This is a bit like telling states: Hey, you know that federal money that now goes to food stamps for poor families – how would you like to spend it on hiring more cops instead?  It’s not hard to imagine the result. 

Actually, we know the result because it’s already happening: Many states already raid funds from the Temporary Assistance for Needy Families program (TANF) – the program that replaced “welfare as we knew it” to fund child abuse investigations and foster care, now Sanders is proposing to rob poor families again.

At another point there was some discussion of making the far bigger program that funds foster care and adoption, Title IV-E available for these investigations as well.  And one time I would have thought that wasn’t so bad.

But, as it happens, right now, for the first time in decades there is serious discussion in Congress about actually allowing those foster care funds to be used for prevention and family preservation – soon there may even be legislation to that effect.  But some on the Commission already appear ready to swoop down and urge that some of that money be carried off to fund giant schemes for traumatizing thousands – maybe more than a million – children every year with needless child abuse investigations.

Ignoring the evidence base

Sanders made his suggestion at a particularly revealing moment in the deliberations.  He’d just finished admitting, in effect, that the Commission had failed.

He noted that after two years of searching the Commission had found exactly one approach to reducing child abuse deaths that met the standard for being “evidence based.”  (A few others were “promising.”  The terms are not just rhetoric, there actually are formal definitions.) 

But that one evidence-based practice had nothing to do with screening in more hotline calls or “substantiating” more cases or taking away more children.  No, the one and only evidence-based practice they found was a well-known, highly regarded home visiting program known as the Nurse Family Partnership.  In other words, a prevention program.  That’s exactly the kind of program that might be funded by, say, Title IV-B – if David Sanders doesn’t succeed in getting that money diverted into all those things that don’t work!

Indeed, Sanders even admitted that there’s “no evidence” that a “case review” – apparently the new euphemism for the surge – “will reduce fatalities.”

The new shade of lipstick

In a previous post about the Commission, I noted that changing the exact language in the surge

Graphic by Murdocke23 

recommendation is just putting lipstick on a pig.  Now, Sanders seems to have come up with a new shade of lipstick.

Michael Petit, the actual guiding force behind the Commission, and the person who, judging by the discussion at Saturday’s conference call, suddenly sprang the surge idea on the group late in its deliberations, has made clear that the purpose of the surge is to investigate more families and remove children who might be at risk.

But Sanders now is trying to reframe the surge – as a research project!  (After all, he admits there’s no evidence it will actually reduce fatalities.)  The theory is that by looking at all fatalities for the past five years (which, in small states, is likely to be an extremely low number) and finding common “risk factors” and then barging into every family that has at least one such “risk factor” we’ll somehow learn more about how to prevent child abuse deaths, even if we don’t actually prevent any.

Sanders offered no evidence that this approach to “research” actually works, nor did he cite any researchers who know how to study the issue who are clamoring for this approach to studying it.

Meet the new fiscal conservative

Michael Petit is the commissioner whose constant cry can be boiled down to “Spend more money!  Spend more money!  Spend more money!”  But on Saturday, he was singing a different tune.

That’s because the issue was a prevention initiative.  A subcommittee dealing with issues that include racial bias proposed a plan involving a special kind of court in which representatives of all the organizations providing services to families were right there at the courthouse, ready to step in immediately to provide the help a family needed to prevent abuse and neglect and stay together safely.  Instead of a collection of referral slips, the family would get immediate help with whatever was needed, perhaps housing, or job training, or drug treatment.

It’s not entirely clear how it would work – because the actual document under discussion is secret – but it sounds similar to this initiative in San Antonio.

Michael Petit was peeved.  He kept denouncing the idea – because it would cost too much money!  (He calmed down when assured the recommendation was only for a pilot project.) And, he argued, it wouldn’t stop fatalities.  “In terms of the immediacy of stopping child fatalities” he said, this was the wrong priority.  Yes, it’s a good idea “long term” Petit said, “But how much does this contribute to stopping children’s deaths now?”

Quite a lot, probably.  As noted above, and in our full report, there is no evidence at all that a surge or anything similar will prevent child abuse deaths.  David Sanders himself admitted as much.  In contrast, both ChildTrends (speaking of abuse in general) and the Center for Public Policy Priorities, speaking specifically about fatalities, found that serious prevention efforts are about the only things that do work.

Hiding behind secrecy

If there’s one thing child protective services agencies love to do it’s hide their errors behind “confidentiality.”  In fact, the Commission appears likely to recommend that Congress demand more transparency from state child welfare agencies when it comes to how they investigate child abuse fatalities.

But for the Commission, transparency does not begin at home.

On Saturday’s call, one of the commissioners, Theresa Covington, said people had complained to her about being unable to follow deliberations because the actual documents being discussed are now withheld from the public.  She asked in particular about written comments commissioners have circulated about the drafts.  It’s not clear if she was aware of the fact that even the drafts themselves are secret.

Sanders blithely assured her that the secrecy is just fine because the Commission regularly checks with the General Services Administration.  That is the federal agency which tells commissions like this one whether what they’re doing is legal under various statutes, including open government laws.

There are two problems with this:

● It’s not hard to get a government agency to tell another government agency what it wants to hear.  Look at the handstands the Bush Justice Department did to justify torture, for example.

● Even if, in fact, hiding the drafts and other documents is legal, that doesn’t make it right.  There is nothing in any law prohibiting the Commission from demonstrating the sort of transparency it appears ready to demand of others.

But apparently David Sanders, Michael Petit and some others on the Commission want to wait until they’ve found enough lipstick for the pig.