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

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

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

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

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

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

 
The “dilemma” that overlooks the obvious

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

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

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

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

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

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

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

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

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

The fundamental failure of institutionalization

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

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

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

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

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

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

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

When Children Must Be Saved from Their Saviors

Back when cases involving missing children – many of them runaways from foster care – were making headlines in Washington, D.C., Marie Cohen rushed to try to shift responsibility from a failing foster care system. She told us to be sure to remember that a majority of missing children in the District of Columbia “are fleeing their own homes, not foster care.”

That’s a testament not to the success of foster care but rather to the immutable laws of mathematics. Despite the best efforts of those pushing endlessly for a take-the-child-and-run approach to child welfare, a majority of children still live in their own homes, so those will be the homes from which a majority of runaways run.

To get a sense of the extent to which foster care is a horror show for District children, one needs to look at the proportion of runaways from their own homes and from foster care. Foster children represent less than one percent of all D.C. residents under age 18.  Yet they represent ten percent of the missing children.

This is not exactly a testament to the success of foster care.

In fact, in another column Cohen herself recites a litany of what she deems horror stories about D.C. foster parents she encountered.  Well, not quite a litany – she cites three examples. From there she tells us “many” foster parents “siphon off” money meant for their foster children and that she had to “parent most of the youth in my caseload because their foster parents did not do so …” [emphasis added].

But sweeping generalizations based on horror stories are no more valid when aimed at foster parents than at birth parents. And even if, in fact, systematic research reveals a widespread problem of D.C. foster parents in it for the money, the likely cause would be an anomaly. Unlike most the country, D.C. has a history of paying foster parents way too much.

The Real Horrors are Revealed by Data

The real reasons to worry about needless foster care are the studies showing abuse in one-quarter to one-third of foster homes – a problem illustrated in tragic detail this week by the Arizona Republic – and the studies showing that the inherent trauma of foster care placement is so great that, in typical cases, children do better when left in their own homes. (If anyone conducted a betting pool to predict the paragraph in which I would cite those studies this week, congratulations to those who chose #7.)

Oddly, having spent most of this particular column trashing many foster parents, Cohen suggests that, somehow, if you put foster parents together in one place and call it a “foster care community” everything will be fine. She does not explain how these communities will have only the good foster parents she wants, and not the bad ones she condemns.

Or we could just do what Cohen always recommends: Institutionalize the children! Because if an institution’s own website says it’s wonderful, who cares about the research proving this is the worst possible option – or about all those scandals over the tendency of institutions to turn into hellholes – the most recent examples exposed in Philadelphia in April and in California in May.

Of course, institutions do have one big advantage: All the children are in one place. That is not an advantage for the children; on the contrary, the problems with putting a whole lot of young people who may have serious emotional problems in the same place right at the age when they are most vulnerable to peer pressure should be obvious.

But it’s a great advantage for caseworkers who might be upset about what an imposition it is upon them to have to spend time in a motor vehicle with the children one is supposedly helping, or even, declares Cohen, saving.

As she has before, Cohen complains about driving foster children. In the course of listing some of the things that prompted her to quit her job as a caseworker she writes:

Things that I did that the foster parents were supposed to do included: take my clients to the doctor, the dentist, and the therapist. Talk to their teachers. Pick them up from school when they were sick. Wait with them for hours at the emergency room.

I’m sure that, as she sat beside frightened, vulnerable foster children she’d taken to the E.R., Cohen tried to hide how much she resented having to be there. I hope she succeeded.

Extra time spent with foster children, wherever it may take place, could be viewed as a gift, not a burden. It’s a chance to talk to a foster child without interruptions, truly get to know her or him and, maybe, discover new ways to help. The same is true of chances to talk to foster children’s teachers.

There are times when parents really are horrible and children really need to be saved from those parents. There are times when foster care really is the least detrimental alternative. But everything from the mass of research to the foster children who vote with their feet tells us that, sometimes, what children really need is to be saved from their saviors.