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Stats on success of treatment centres/group homes

2009

Query 1

Hi I was wondering if somebody could give me some stats on how successful treatment centres and group homes are for troubled youth?

Isabel Jarvis
...

Nobody really knows.  Although there is a world of material on the condition of children before and during such treatment, there is almost no large scale, long term follow up empirical research studying whether children who are in out-of-family settings grow up to be different from other people.  If there is such research, I would like the source. In addition, there almost no studies regarding the comparative success or outcomes of children who have been in adoptive homes, foster homes, orphan homes or other such settings.

David Macarov
...
 
Here's some bad news:
 
Review of Research on Placement Outcomes
 
Pew Charitable Trusts 2007 
A report titled Time for Reform:  Aging Out and On Their Own found that the number of youth emancipating because of age is increasing.  The report states that youth who leave care without permanent families or other ties to caring adults are at a greatly increased risk of poor outcomes:  one in four had been incarcerated within the first two years after foster care; more than one-fifth became homeless at some time after age 18; less than 60 percent acquired a high school diploma by age 19.
_
 
Casey Family Programs 2005 
Two years earlier, a report titled Improving Family Foster Care Findings from the Northwest Foster Care Alumni Study found that one-third of foster care alumni didn't have health insurance; more than half experienced clinical mental health problems, including 25 percent who showed symptoms of post traumatic stress disorder after exiting care.  The study concluded that foster care alumni are so handicapped by their experiences in the child welfare system that four out of five fail to thrive as adults.
_
 
Youth Today May, 2003 
Two years earlier, the following quote was included in an article citing the failures of placements.  "We have evidence of the deeply disappointing results (in child/youth work) that we tolerate.  The results from residential treatment, juvenile probation and youth correctional programs suggest that these costly interventions may do as much harm as good in the lives of troubled kids.  We've given remarkably little attention to the preparation, competence, retention, morale and supervision of the people whose job performance ultimately determines if these systems will be successful."
_
 
"O" Magazine September, 2001 
Two years earlier, the following quote appeared in the magazine published by Ophrah Winfrey.  "For many of its alumni, foster care proves to be a one-way ticket to failure.  Citing two studies, the article reveals that within two and a half to four years of leaving the system:
.     more than 50% are unemployed
.     40% have been on public assistance or incarcerated
.     less than 8% graduate from a four year college
_
 
Child Law Practice Vol.18, No.4, 1999
Two years earlier a report on Wisconsin study that looked at outcomes for teens 12-18 months after leaving foster care:
.     37% had not finished high school
.     Fewer than half (44%) had their driver's license
.     12% reported living on the street or in a shelter at least once
since discharge
.     Only 46% had at least $250
.     51% had no medical insurance
.     One-quarter of the males reported being physically assaulted
.     11% of the females reported being sexually assaulted
.     1 in 20 teen girls had a baby
(1991 Study found that two to four years after leaving foster care, almost two-thirds of the teen girls had a baby, compared with one-quarter of teen girls in the general population.)
.     18% of the sample had been incarcerated
_
 
Child Law Practice July, 1999 (Vol.18, No.5) 
Study sampling 21 homeless service organizations nationwide found 36% of the population served had a history of foster care.
_
 
Orphans of the Living. Jennifer Toth. New York:  Touchstone. 1997 
Two years earlier this author published these findings: 40% of children leaving the foster care system go on the welfare role or into prison, 54% complete high school, 49% become gainfully employed adults, 60% of girls who leave foster care become pregnant and give birth and continue the cycle of abuse and neglect. 
(Data collected from United States Department of Health and Human Services for 1990-1999.)
_
 
1986 Department of Health and Human Services: Independent Living Services for Youth in Substitute Care 
Findings:
.     2/3 of 18 year olds had no high school diploma
.     61 percent had no job
.     37 percent were emotionally disturbed
.     17 percent of the females were pregnant
_
 
Child Law Practice (July, 1999) 
An estimated 25,000 youth aged 18 through 21 are terminated from foster care services each year.
_
 
The California State Department of Social Services 
According to First Place (Oakland, CA) each year 4,000 young people are emancipated from foster care in California.  The States Department estimates that 60% of these face immediate homelessness (Youth Today, June 2007)
 
 
Lorraine Fox
...
 
Hi,
 
I'm just wondering how you would judge success? For the youth that we encounter in this field are successful in many different ways.
 
Jennifer Hines
Red Deer, Alberta.
...
 
Isabel
 
What do you define as successful.
 
Lisa
...

The "bad news" reports which Lorraine shared with us yesterday were indeed discouraging, but largely reflected a common habit of those who report on child and youth problems by treating "in care" or "foster care" status as the only antecedent of later life difficulties of kids with troubled backgrounds. I often read in a press report of some kid who has got into trouble which adds "She spent three years in care" as if that fact caused the problems. Completely ignored is the probability that a youngster who had to go into care had endured previous serious difficulties in life which resulted in their being placed in care! Such reporting is as brainless as a report saying that "children in hospital were found to be decidedly unhealthier that those who lived in their own homes" as if this were the fault of the hospitals!!
 
Brian Gannon
...
 
Maybe I'm being idealistic, but it's possible that the shocking figures shared by Lorraine could have been even worse if the young people had never received any services. Who knows how many of those children would have even survived to adulthood!
 
Jackie Winfield
...
 
There is a reason children end up in a treatment center. That may contribute more to what people see as "failure" rather than the treatment center itself.  It's much easier to blame a large institution on why a child has "issues" rather than point the finger at, oh I don't know, say: sexual abuse starting at infancy (including pornography), FASD (or other cognitive processing problems), and severe neglect (which apparently some say is worse than any other form of abuse).  Ohhhh no, that's not it at all.
 
For some of our kids, just keeping them alive is success.
 
Maslow's Hierarchy of Needs, most of our kids sit at safety and security for a long time, expecting them to move along according to our expectations of what is right for "normal kids" is tantamount to smashing your head with a brick every morning.  They are not normal, they are not like your kids, they will take a while longer to get to where everyone else is going.
 
Lisa
...
 
Reply to Brian:

While the events of abuse and neglect that bring children and youth into care cannot be discounted, using your hospital analogy, we accept that people being brought into hospitals have something wrong with them.  What if, however, hospitals had the same "record" of discharging medical patients with the same kind of negative outcomes?  Would those hospitals be relieved of their responsibilities because people came in "sick"?  Do we have a right to expect that facilities that claim to treat illnesses for which they were designed have at least a record of having more people leave them with better health than leaving them still sick?
 
I think it is very hard to "know" how much later life adjustment is a reflection of the degree of harm done by maltreatment and how much reflects our inability to successfully address the harm done in ways that insure a better quality of life than if we hadn't "treated" them.
 
It's easy to get defensive.  It's hard to ask the challenging questions of whether we design our programs to help residents adjust to "the program" or to help them adjust to life, given that they will carry their wounds and scars into their life.
 
Lorraine
...
 
Hi all,
 
I have worked in Youth and Childcare for more than 20 years now, and I think we as servants in a system of "care" meet with successes and failures. I am uncertain as to which is the greater, however that being said I, during the 90's up to early 2000, worked with children in residential treatment and now I work with youth in the justice system and I often come in contact with youth who were children I worked with in the system in residential treatment. Make no mistake about it, at least in my part of the world we make a lot of decisions regarding care and treatment in the mental health sector based on a willingness to allocate resource, rather than to respond to a need just because it is the human thing to do. I want to leave on a positive and that is, it has also has been my experience over the years to see frontline people continue to push and advocate for the young people we serve, and that effort is paying off. Over the past 20 years I have seen change, positive change.  
 
God bless,
 
James Hartley
...
 
Query 2
 
Can anyone send me results of large-scale, empirical studies of formerly institutionalized children when they become adults?
 
David Macarov
...

Statistics indeed. 
 
I can only talk of my experience in Louisiana, but I have read, on CYC-net and elsewhere, things that lead me to believe that, while it is better in some other places, my experience in Louisiana is not unique.  Children in care apparently do not turn out so well as children raised in their own homes. 
 
There is a pervasive, although not universal, belief in Louisiana that institutions are bad for children and that all children deserve the right to grow up in a family.  This has contributed to two trends:
    1. A tendency to leave troubled children too long in family settings that cannot meet their needs, moving them from one foster family to another and yet another, hoping one will work out, with each move causing more harm.
    2.  A failure to develop a vision for residential treatment and invest sufficiently in such programs, including funding and providing a college-level specialization in the provision of residential care and treatment.
 
There is yet another problem:  No one makes a commitment to such children, taking full responsibility for providing for their needs, for raising them.  Foster families and residential programs are willing to 'give them a chance.'  Too often, these chances amount to little more than yet another chance to fail. 
 
While a loving family is certainly a worthy ideal, I believe that children have a more important need for security and stability, in both living arrangements and relationships.  How can we expect children to commit to their future and to their education when they don't know where or with whom they will be living next year, or next month, or next week?  And consequently, where they will be going to school? 
 
I think we can and should do better.  We place children in care to help them, but until we accept the need for providing each child with stability and security and improve our vision and expectations for group care, along with our investment, I  see little hope for improvement here in Louisiana. 
 
Someone needs to take full responsibility for raising a trouble child, no matter what.  For the most troubled children, group care may be the only way to do this.  
 
The older and bigger they get, the more difficult it becomes to provide what they need.  And the less time there is to provide for their needs before they age out of care.  After which there is little or nothing for them, other than psychiatric hospitalization or incarceration.
 
The belief that group care is bad and should only be used as a last resort has led to little support for group care settings.  Expectations for group care are minimal so that funding, and consequently pay, are minimal.  Our colleges and universities in Louisiana do little to train people in the provision of group care.  Consequently, administrators, managers, and therapists view group care as little more than a structured place for troubled children to live while they get an hour or two of therapy from a professional--individual, group, maybe family therapy.  And of course medication and behavioral therapy.  Little is expected from direct care staff beyond providing for basic needs, being consistent in managing the behavioral program, and being careful not to interfere with therapy.  Consequently, pre-employment requirements and pay for direct care staff are minimal and turnover is frequent.

John Stein
New Orleans
...
 
Lorraine/Brian... whoever...
 
A hospital would not release a patient who was still sick because they are too old for treatment; youth treatment centers do.  It is no longer the norm for kids to move out of their homes at 18 and have all the expected life skills they need for success, BUT... we have that expectation for children in treatment centers.  Children who do move out at 18 from "normal" homes can usually still have someone they can fall back on if things don't go so well (they can return to the nest); children who age out of treatment homes don't.
 
I would suggest that a lack of long term after care programs is also a antecedent to perceived "failure"
 
Lisa
...
 
I find it very fitting that this thread contributed to by Ms. Fox comes on the heels of a recent thread discussing leadership.
 
I believe the "youth care" profession is at a critical stage in its development.  When I became a youth care worker over a decade ago, I got the job because I had a BA, a love for working with young people and clean record.  Today there are diploma programs, university degrees and certifications to prepare workers to enter the workforce.  But what effect has this influx of higher learning had on day-to-day programming? 
 
If you believe the numbers put forth by Ms. Fox, I'd say there is still lots of work to do.  I have collected many newspaper and periodical articles over the years that reflect the same sentiments outlined by Ms.
Fox;  the idea that we can be working more effectively should not be totally foreign.  I'd like to point out three leaders in this field.  One is Larry Brendtro.  If you are familiar with any of his writings, Mr. Brendtro says that we need new fresh approaches and intervention strategies to deal with our young people. The second is Ms. Fox herself.  The article The Catastrophe of Compliance from back in 2001 spells out where the problems in this field originate.  And the third is Bruce Perry.  Mr. Perry believes we are just on the cusp of learning how to work more effectively with kids that have faced trauma early in life.
 
We are at the point in this profession where we can really start to serve the needs of the individual child.  We need to be developing programs that are strength-based and focus on every child's individual needs.  
 
"There is a crack in everything, that's how the light gets in." L. Cohn 
 
Mr. Gannon's comments may be factually correct, but they leave much to be desired.  Are we going to be a profession that is content with:  Oh well, the damage was already done to this one, it's not our fault, it was the crowd before us that shagged him up.  Or are we going to become a profession that aims beyond the status quo?  Where will the new leaders emerge?
 
I wouldn't leave it to the teachers, the profs, or the brass of the group homes and treatment centers; it's too hard to teach old dogs new tricks. Take Brian for example, I bet he's a manager of some sort.  To really put a dent in the numbers outlined by Ms. Fox, I'll put my money on the students out there in the universities and colleges.  And if I could recommend one author, one article, one story for every new youth care worker (and maybe some of the old ones) to read,  I'd recommend The Elephant's Child by Rudyard Kipling.  This is the place to start.  There wouldn't be anyone forcing this beast to do five hours of school work! 
 
Barry Smith
CBS, Newfoundland
...

I want to respond directly to John but also to the many others who have made a similar argument.  It is absolutely true that many family carers (bio families, kin families or foster families) are unable to manage the behaviours of some children or youth, and as a consequence, these children and youth experience multiple placement breakdowns and placement moves.  It does not follow logically from this, however, that these children or youth would be better placed in group care settings, or institutional settings.  I am not anti-group care, and I believe that it is, theoretically at least, possible to provide children and youth with valuable experiences within a group format (although I do believe that this actually happens almost never). However, I also believe that our approaches to supporting families caring for children and youth are, frankly, absurd.  The various terms used to describe 'supported foster care', (treatment foster homes for example) are little more than window dressing.  In reality, at every step of the 'family-based care' industry, we shortchange the enormous resource offered by professional or semi-professional carers.  In my view, it is entirely possible to re-produce the most useful aspects of residential group care within the context of family-based care communities that really do provide meaningful support and respite and encouragement and material assistance on a on-going basis. I might point out that child and youth care as a discipline has evolved from its group home roots to one that can use all of the knowledge gained from the discipline's long standing association with group care and transfer it to various types of family-based care settings, ensuring that children and youth are supported through relationships, and that family-based carers of any kind don't feel abandoned and ultimately like failures for having to request that a child or youth be moved.
 
I certainly don't disagree with John that residential group care is under-funded, resulting in many of the more disastrous aspects of this kind of service.  I do want to ensure, however, that residential group care is not held up as the obvious, or logical response to what John has described quite accurately as an ever-growing trend in the field, especially in North America.  It doesn't have to be either/or, but both types of care are currently not being supported in particularly meaningful ways, and therefore neither should be judged based on current outcomes.  What we really should be doing is ensuring our (CYCs) presence in the child's life space, and then supporting the child within that space.  We have recognized some time ago that this will require giving voice to the child or youth, but it also requires giving voice to the carers, including foster carers, kinship carers and parental carers.
 
As a final thought I would like to venture out there with this point:  while funding issues are indeed troublesome these days, the well-being of children and youth should never be reduced to the availability of money.  Well paid CYCs are not necessarily better than poorly paid ones; resources are just as easily squandered as they are put to good use.  Money, in other words, buys appearances, but not results.
 
Kiaras Gharabaghi
...
 
You certainly have done a fine job of summing up the many problems we face in producing better outcomes for our vulnerable clients John!

Lorraine Fox
...
 
Hi John,
 
A dismal but fair assessment of the state of play. I would accuse those the policy makers of willful negligence in terms of perpetuating the conditions of poverty which then 'force' the state to intervene. You know this only too well in New Orleans. They are also guilty of either staggering ignorance or again willful disregard for the evidence of successful outcomes in many therapeutic residential projects over the years.
 
For too long we have allowed the power structures to 'own' the evidence base and manipulate it to suit their short term political goals.
 
We must keep the recipe for success on the agenda and challenge the politicians at every turn with the evidence of our experience "would this be good enough for your child" should be the standard riposte to their glib sound bites.
 
Peace
Jeremy Millar
_______

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