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.
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 …
EXCERPT
FROM NCCPR’S REPORT ON COLORADO “CHILD WELFARE"
TAPEWORM
IN THE SYSTEM
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. It’s the same kind of chutzpah that demonizes young
children with fearmongering tripe about homicidal 6-year-olds (or sometimes it’s 5-year-olds) who supposedly
will be rampaging through Colorado unless they’re institutionalized.
Yet
that’s the snake oil the residential treatment industry has been selling in
Colorado. Unfortunately, a lot of politicians and media have been
buying it.
News
accounts have documented a litany of failure, from abuse of
institutionalized children to runaways dying. Such failures have been
exposed all over the country. It’s been one scandal after another, after another after another. Most of the time,
the industry trots out cliches about “rotten apples” and insists that most
institutions are free of rampant abuse. Occasionally someone lets the
truth slip, as when a top executive of Devereux, a nationwide chain of what should
be called McTreatment centers, told The Philadelphia Inquirer:
“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."
This
is striking both for the acknowledgement of widespread abuse, and for calling
residential treatment what it is: an industry.
It
takes a special kind of chutzpah to make the case for more taxpayer money based
on your own failure.
But in
Colorado, the industry goes even further. They don’t bother to deny
that the problems are rampant. Instead, they say 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. (That’s an average of $155,000 per child per year.) The industry
says we also should make residential treatment
more like jail, allowing locked doors and physical force against youth.
They’re also complaining 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 (usually minus the candid admission of widespread
abuses). And, as in Colorado, the claims have been ramped up as
children are forced into terrible makeshift placements such as offices, hotels
and emergency rooms. The argument is that there are not enough family
placements and, in any case, only institutionalization will work on some
children.
Now the industry has reached a new low – conjuring up nightmare visions
of demon homicidal six-year-olds in order to justify institutionalizing even
the youngest children.
So the head of the industry’s trade association, Becky Miller
Updike, told a Colorado legislative committee: “We’re seeing suicidal, homicidal 6-year-olds … and they do not
belong in foster care.” (Later she changed the age to 5.)
If young children are depressed enough to contemplate suicide, those
children desperately need a loving family; the worst thing you can do is
institutionalize them.
Apparently, no one asked Updike for evidence of a plethora of
6-year-old likely murderers in Colorado. But it turns out, there’s been a
little bit of research on this. While, of course, no one knows for sure
and the database we found is
short on citations, that database found ten children age 6 and under have
committed murder – over the past 131 years. Ten children in the entire
world. None was from Colorado.
And if young children are depressed enough to contemplate suicide, those
children desperately need a loving family; the worst thing you can do is
institutionalize them. They absolutely do belong in
foster care – or, far better, in their own homes.
What the research tells us
Institutionalization is among the worst things you can do to any young
person. The research is overwhelming: Even
when residential treatment centers are not rife with abuse, they are terrible
for children. Institutionalization is inherently harmful, inherently
traumatic and almost never necessary. (Wherever a link is not
included in the following list of studies, a citation is available here.)
● A review of the scholarly literature by the
office of the U.S. Surgeon General found only “weak evidence” for the
success of residential treatment.
● A second review found “when community-based
services are available, they provide outcomes that are equivalent, at least [to
residential treatment centers (RTCs)].”
● Still another review, published in 2020, found that “the dearth of
research supporting the effectiveness of interventions delivered in
[residential treatment] should be alarming to families, advocates,
practitioners, and policymakers.”
● Yet another study, of children institutionalized
for mental health problems, found that seven years after discharge from
residential treatment, 75 percent of the children were back in the only
settings they could understand: institutions. They were in psychiatric
centers or jails.
● Even Shay Bilchik, former President of the Child
Welfare League of America, a trade association for residential treatment
centers and other agencies holding children in substitute care, has made a
startling admission: Bilchik admitted that they lack “good research”
showing residential treatment’s effectiveness and “we find it hard to
demonstrate success…” (In fairness, he said they would be successful, if
only they rushed to institutionalize children sooner. In other
words, if the kids don’t have any problems – we can cure them!)
So it’s no wonder even the thoroughly mainstream child
welfare litigation group Children’s Rights says institutionalization is so
awful it needs to be drastically curbed.
● And when Think of Us, a group run by former
foster youth canvassed young people who had been institutionalized, what they
said was so harrowing that the report they issued had to
begin with this astounding list of warnings:
“This report contains descriptions of:
Physical violence
Sexual violence
Emotional and verbal abuse
Drug and alcohol abuse
Eating disorders
Mental health and mental illness
Suicide and self-harm
Racism
Ableism
Homophobia and transphobia
Islamophobia.”
Because that is the real world of “residential treatment.”
None of this should come as any surprise. The residential
treatment model is based on the idea that if you put young people who
supposedly have the worst behavior problems all in one place and cut them off
from their families and communities, right at the age when they are most
vulnerable to peer pressure, they will get better. Who seriously
thinks that’s a good idea?
Per diems make everything worse
As bad as how much residential treatment centers are paid is how they are paid. RTCs have the ultimate perverse financial incentive to claim that the children are too difficult for any other placement and to claim that the difficulties require prolonged institutionalization: They are paid for each day they hold a child. The longer they can hold on to the child – by persuading everyone that, really, the child’s problems are just so intractable they have to stay for a long, long time or “Who knows who that six-year-old is going to murder if he ever goes home!” – the more money they get. That is, as long as the young people aren’t really too difficult.
The residential treatment model is based on the idea that if you put young people who supposedly have the worst behavior problems all in one place and cut them off from their families and communities, right at the age when they are most vulnerable to peer pressure, they will get better.
The claim that RTCs are needed for “the most difficult kids” rings
especially hollow when it turns out that Colorado’s RTCs actually refuse to
take the most difficult kids. It would appear that Colorado does not
believe in no-eject no-reject contracts. Instead, the legislature has been
forced to make even more money available in the form of “incentive payments” to
get RTCs to actually take what the news story revealing the payments calls
“hard-to-place kids.”
It appears some RTCs are engaging in a common industry practice known as
“creaming” – as in skimming the cream. Use scare stories about “the
most difficult kids” to get more money – and then turn them away.
And, contrary to the industry myth-making machine, there are
alternatives. At the root of all Colorado’s child welfare problems
is the take-the-child-and-run mentality discussed earlier. And
Colorado loves institutionalization. News organizations repeatedly
write about residential beds closing. But Colorado still
institutionalizes children at a rate 33% above the national average.
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 good safe foster homes for children
who really need them – without having to institutionalize them.
As for the claim that all those children (including the homicidal five- and six-year-olds) are simply too difficult for families – that’s only true if you don’t help those families. There’s nothing an institution can do that can’t be done far more humanely and at far less cost with Wraparound programs that bring anything a family for foster family needs right into the home. They’ve done it for young people far more challenging than any 6-year-old. In this video, wraparound pioneer Karl Dennis explains how wraparound kept safely at home a youth so difficult that even the local jail couldn’t handle him.
There are more details about the success of Wraparound here.
The stacked-deck “task force”
The Colorado residential treatment industry hasn’t completely gotten its way yet But last year they got the legislature to create a “task force” with a budget of nearly $100,000 run – once again -- by Stephanie Villafuerte. It’s supposed 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.
Colorado’s residential treatment task force is like a task force to study climate change that includes no environmentalists but lots of representatives of the fossil fuel industry.
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.
There are two main ways children wind up institutionalized. One is when family policing agencies take them from their parents. The other is when desperate parents feel they have no alternative — a false impression the residential treatment industry is eager to exploit. As The New York Times put it: “The industry depends on desperate, often compassionate parents, some of whom fall for slick marketing.”
So the industry tells us for some youth nothing else works. After all, these young people have, to use the industry’s own offensive term, “blown out” of foster homes. But that’s because “child welfare” systems fail to provide the intensive help children’s own families or foster families need.
How successful has this exploitation of desperate parents been? Consider what happened when Colorado closed a residential treatment center with an appalling history:
In 2019, state regulators identified 83 potential licensing violations, including that illicit drugs, such as LSD, spice and Xanax, were smuggled into the facility. Many of the complaints involved runaways, lax supervision, fights between youth and inappropriate use of restraints, or physical altercations between staff and kids.
But a father whose 17-year-old son ran away when the center was closed said he actually was sorry to see the place shut down, because he couldn’t imagine any other way to handle his son and when he was restrained he only “occasionally had bruises.”
This father couldn’t imagine anything else because the residential treatment industry has so monopolized the debate that Colorado media almost never mention that alternatives exist.
The younger the child the worse the effects of institutionalization. The Colorado task force is named after Timothy Montoya, a boy institutionalized at the age of 12. He was killed when he ran away and was hit by a car. His mother has bravely shared his story and, in an act of incredible courage, is willing to relive the trauma to help others, by serving on the task force. We applaud her for her effort. The father of that 17-year-old who only “occasionally had bruises” is showing the same courage and doing the same.
But the deck is stacked. The task force is filled with foster parents and residential treatment providers, and an assortment of state and local government agency representatives. But there is no parent on it who had a child needlessly taken away against that parent’s will, and ultimately institutionalized. Nor is there a lawyer who regularly represents such parents.
In a state where Black children enter foster care at nearly triple their rate in the general population and Native American children enter foster care at a rate 50% above their rate in the general population, the task force began its work with not one Black or Native American member. Villafuerte’s office told us it was trying to find at least one of each to join the task force. We don’t know if they succeeded. But the fact that they were comfortable moving full-speed ahead without them is like a neon sign flashing “tokenism.”
In contrast, the task force does include, as a voting member, the aforementioned Becky Miller Updike. In short, Colorado’s residential treatment task force is like a task force to study climate change that includes no environmentalists but lots of representatives of the fossil fuel industry.
All that will make it all
but impossible for the task force to face up to the hardest truth: Timothy
Montoya might be alive today if his mother could have gotten Wraparound
services in her own home — but none were available where the family lived.
That’s not an argument for spending more on places like the ones that failed
Timothy; that’s an argument for more alternatives — or for just giving parents
the $250-to-$600-a-day to buy their children whatever help they need.
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.
The Rule of Residential Treatment is simple: If you build it, they will
come. If you leave it open, they will stay. If you leave
it open long enough, it will become a hellhole. The only way to
create a genuine continuum of care is to expel the tapeworm from the
system.
Residential treatment is not care. And it is as expensive as it is
ineffective. It’s the tapeworm in the child welfare
system. As long as the tapeworm is consuming all the body’s
nutrients – in this case, money – the body will starve. Instead,
Colorado should phase out residential treatment and pour the vast amounts of
money it consumes into Wraparound and other safe, proven
alternatives. Or just give it to the parents, who undoubtedly could
find better ways to help their children with $155,000 per year.
The Rule of Residential Treatment is simple: If you build it, they will
come. If you leave it open, they will stay. If you leave
it open long enough, it will become a hellhole. The only way to
create a genuine continuum of care is to expel the tapeworm from the
system.
We know exactly how the residential treatment industry will respond when asked about this. So we’ve provided as an appendix to this report: The All-purpose Residential Treatment Industry excuse checklist.
