What'd we miss?

....catching y'all up after my summer break

Following a nice vacation, a couple of conferences, and final edits to our forthcoming book on child protection policies, the column is back as your “TLDR” source for child welfare news.

Leading today’s column is a recent Senate Committee report on residential treatment centers (RTCs) for children and youth. The culmination of two years of Finance committee staff work, the report inventories alleged abuses at a number of facilities, including psychiatric residential treatment facilities, around the country. “The two-year investigation establishes that [these centers] employ a model that has the potential to expose all children in their custody to harm arising from risk of abuse (physical, sexual, harmful use of restraint and seclusion), inadequate behavioral health treatment, and non-homelike facility conditions,” the report concludes. The Washington Post and PBS Newshour have summaries, but here’s my short version:

• RTCs are designed to be intensive, shorter-term options for children whose behavioral and mental health issues can’t be treated in the community. They should be used only when community-based options have been exhausted, and children should be able to step down from residential treatment to lower-acuity settings. Unfortunately, they’re often relied on only because there are no other options for placement.

• Children and youth stay in residential treatment much longer than they should due to a lack of more appropriate options — sometimes for years.

• There have been serious and severe cases of abuse and neglect at these facilities, both staff-on-youth and youth-on-youth, which the report details at length. Youth often run away from RTCs and get themselves into serious dangers. Youth often don’t get the services they need and are damaged by separation from their home, family, and community.

• “Children leave facilities with insufficient discharge plans in place or without discharge plans whatsoever. Discharge planning failures fundamentally undermine the value of facility treatment as they fail to create the conditions for children to sustain any treatment improvements after leaving the facility.”

• These problems, says the report, are “endemic” to the treatment center “industry,” which “optimizes profit over the wellbeing and safety of children.”

In other words, this Senate committee is telling us: These problems exist in residential treatment centers, so it must be the residential care model that’s to blame. That’s a pretty facile diagnosis, in my opinion, and one akin to suggesting that the problem of homelessness is that people don’t have homes or that alcoholics would be fine if they just didn’t drink.

I don’t doubt that the most restrictive, intensive placements serving children and youth with significant histories of severe and chronic trauma, severe mental illness, and self-endangering behaviors are not the ideal setting for these children. Nor do I doubt that courts and child welfare agencies place these children in RTCs out of desperation and leave them there for too long. But it would have been nice to have seen this two-year investigation delve into the underlying reasons that, all too often, youth end up in the “deep end” of our system, disconnected from the security of family and the stability of home.

The material was there for the Committee staff to do such an investigation. First, why aren’t there less restrictive, more home-like placements? We could identify children with severe behavioral issues and complex trauma and intervene early. We have access to trauma-responsive therapies such as CBT, Trust-Based Relational Intervention, Family-Focused Therapy, High-Fidelity Wraparound, and others designed to address severe behaviors in the home. We could be making better use of therapeutic foster care to give families of behaviorally-challenged children respite and support. We could use these techniques to preserve intact families before the parents or caregivers throw up their hands and abandon the child to a government agency at the emergency room following his or her eighth mental health admission. We could dispose of the outdated Medicaid rules that, in many states, prevent the creation of “step-down” facilities for children and youth who have been in mental health hospitals. We could ensure that Medicaid covered the needs of these children and families regardless of income. We could provide intensive therapeutic support to families who have adopted a child from foster care.

Instead, our governmental leadership at the State and Federal levels have created a system in which government funds “mental wellness” services for schoolchildren regardless of need but ignores those who are most at risk of an out-of-home placement. Government policies of the past 60 years have, unfortunately, disfavored funding the treatment of mental illness even while increasing efforts to reduce the stigma long associated with behavioral health conditions. Ironically, a process that began with concern over the institutionalization of mental health patients has, at least for these children, likely contributed to the very institutional problems that the Senate committee decries.

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In other news:

• I’ve not seen it yet but understand Sound of Hope: The Story of Possum Trot is out in theaters and will make you happy!

• The federal 9th Circuit Court of Appeals heard argument in a case challenging Oregon’s blanket ban prohibiting anyone from fostering or adopting if they have a problem with gender ideology. Meanwhile, Oregon’s DHS has other ongoing problems.

• Tennessee is reportedly placing children in group homes originally designed for developmentally disabled adults.

• Connecticut’s Child Advocate is stepping down.

• Latest report from federal monitors regarding Michigan’s class action child welfare case.

• Texas’s DFPS is trying to remove Judge Janis Jack from her role overseeing the state’s child welfare class action litigation. I’ve written about Judge Jack before.

• We need to educate political candidates on child welfare, says Paul diLorenzo. Agreed.

• West Virginia’s DHHS is trying to get summary judgment on a class action lawsuit filed against the agency.

Hope you’re having a great summer! Please let me know if you see any issues that we need to cover.