Structure

February 19, 2008 permalink

Child protectors have a warm-sounding word for every atrocity. Richard Wexler comments today on the way group homes (euphemism for orphanage) subject their wards to regimentation. They call it "structure". Below is an abridged version of his comments.

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February 19, 2008

THE NEVER-ENDING GAME OF “MAY I?”

Last month, The New York Times published a column about a teenager torn between a “mentor family” that wasn’t prepared to adopt him and someone he barely knew in a state far away who was.

It was one small part of the column, mentioned only in passing, that was truly striking.

Here’s what one of the parents in the “mentor family” remembers of the first time they invited the young man to spend a weekend with them:

His first visit we're all waiting for him to come down to breakfast. I go up, he'd been in the group home so long, he was making hospital corners on his bed. He thought he couldn't eat breakfast until the bed was perfect.

And here’s a former resident of a group home in California, writing in L.A. Youth, in an essay reprinted in the trade journal Youth Today:

You have to ask permission for everything: to get food from the fridge, cook, watch TV, use the phone, go in the backyard or take a shower.

If the mountain of research such as the Surgeon General’s review of the literature, and the University of North Carolina review of the literature showing the failure of “congregate care” be it in group homes, orphanages or “residential treatment centers” (which are essentially orphanages rebranded) isn’t enough reason to get rid of a lot of them and scale back the rest, listening to the young people describe life there ought to be. Even when the residents are not abused by staff or abusing each other, which happens all too often, life in congregate care is an almost sadistic, never-ending game of “May I?”

No wonder one study found that seven years after getting out of institutions, 75 percent of the residents were back in the only setting where they knew how to live: Institutions. They were in jails or psychiatric centers.

Of course the residential treatment providers, who scarf up huge sums of government money, have a euphemism for this regimentation of day-to-day living. They call it “structure.” Whenever you hear a residential treatment provider babble about how his program provides young people with “structure” what he means is: Nobody gets breakfast until they get those hospital corners right!

Children don’t need this kind of rigidity – but institutions do. They need it in order to keep large numbers of troubled children in line and prevent their institutions from descending into chaos. So they turn around and claim that, by amazing coincidence, all the things that ensure that their institutions run smoothly happen to be “therapeutic” for children.

If that were true, we wouldn’t have that mountain of evidence showing institutionalization doesn’t work. If that were true, even Shay Bilchik, the former head of the trade association for residential treatment providers and other child welfare agencies, the Child Welfare League of America, would not have been compelled to admit that they lack "good research" showing residential treatment's effectiveness and "we find it hard to demonstrate success.”

But then, common sense should be enough to figure that out. Imagine if we were starting from scratch to figure out how best to help severely-troubled young people. And suppose somebody said, “I’ve got a great idea! Let’s take teenagers with the most difficult problems and throw them all together in one place – just at the time in their lives when they are most influenced by their peers.” If anyone suggested that, people might well wonder about his mental health. And yet, thanks to an accident of history – and the enormous political clout of the group home industry - that is exactly what we do.

To top it off, residential treatment is a prime example of an iron law of child welfare: The worse the option, the more it costs. Residential treatment bleeds child welfare systems of huge amounts of money, leaving very little for better alternatives.

Occasionally, institutions themselves have crises of conscience, shut down most of their institutional beds and embrace better alternatives. But then they come up against what the director of one such conscience-stricken institution called “the group home industry” which opposes any attempt to change government funding formulas to redirect money from their largely worthless, incredibly expensive institutions into better alternatives.

Source: Richard Wexler's blog