Listen to thisI am not writing to either criticize or endorse residential care as a way of serving children and youth who for whatever reason cannot live at home. Although I have been party to those debates as well, this month I am writing to express concern about developing system infrastructure out of despair, because this is very much what is unfolding in Canada, and I suspect elsewhere too. It is worthwhile going back a few decades to remind ourselves where residential care came from (at least in its mass availability), why it has been downsized significantly over the past decade or so, and what pressures are driving its comeback.
In Ontario, residential care providers appeared in large numbers during the late 1970s, grew dramatically over the course of the 1980s, 1990s, and early 2000s, and then held steady for about 10 years until the residential care system started to implode more or less 10 years ago now. It is important to note that during the growth years, residential care (and treatment) grew significantly across all three sectors that are associated with this type of service delivery: the publicly funded and regulated Child and Youth Mental Health and Child Protection sectors, as well as the private, usually for-profit, sector, which is publicly regulated to some degree (through a licensing regime) but it is neither publicly mandated nor publicly funded (although it is sustained through public funds indirectly).
Much of the growth during the 30-year period from the 1970s to the early 2000s was driven by two things: first, a complacent approach to child welfare that allowed for placements to unfold with minimal thought about the impact on young people, and secondly, the enormous amount of money associated with residential care and treatment in Ontario. The first of these drivers unfolded in the context of several other enablers during this time, including legitimation of residential care providers through an absurdly minimalist licensing regime that had no quality components whatsoever, the absence of any consideration of possible trauma-inducing experiences for young people placed at considerable distance from their families, friends, and home communities, and a deeply embedded racism that allowed for a throw-away culture of practice especially in the context of Black Youth and Indigenous young people, who were always and continue to be today disproportionately represented amongst residents in residential care settings, particular the private, for-profit settings. Further enablers included lacklustre attention to children’s rights, participation and voice and a very weak regulatory framework that allowed, for example, anyone to work at direct service and supervisory levels in these settings (and by anyone, I really mean anyone, including people convicted of serious and violent crimes, people with no pre-service education whatsoever, and, especially in supervisory and managerial contexts, people with familial connections to the owner of the service).
The second driver, the enormous amount of money associated with residential care and treatment then and now, enabled the rise of private, for-profit service providers of highly questionable merit. These included businessmen and women with no prior engagement with children and youth, those interested primarily in making money through the real estate associated with owning residential care facilities, and those for whom children and youth placed in their services was no different than running a meat packaging factory. In some cases, private for-profit services were established by individuals who had worked for many years in child welfare organizations and therefore knew how to exploit the placement needs of that system to the fullest. Over the past five years, several individual and class action lawsuits have been exposing the degree of abuse and inadequacy associated with such service providers, and the facts in those cases are truly shocking. Run as a business, residential care and treatment is characterized by a profit motive, and that includes spending as little as possible and maximizing revenue. To this end, many of the private, for-profit service providers were operating unsafe physical homes, inadequate food, minimal recreation, and programs that were built around control and surveillance measures and therefore that could be implemented with unqualified and untrained staffing more akin to security guards than to child and youth care practitioners. Not surprisingly given that most of the private for-profit homes were operated in rural and highly isolated areas across Ontario, one outcome of this was the criminalization of Black and Indigenous youth, for whom residential care and treatment, ostensibly as a supportive service, ended up as a pipeline to the youth criminal justice system.
The mayhem of residential care in Ontario did not unfold quietly or behind closed doors. Children and youth died in residential care, often in violent ways. Staff also died. Ontario had the highest rate of youth incarceration in the global north driven largely by the supply of young people to custody facilities through the residential care system (and not just the private, for-profit system; Children’s Aid Societies operating their own residential care were very much involved). Thousands of young people provided horrific narratives of their experiences. Youth homelessness in Canada included more than 50% of young people with prior residential care experience in the child welfare system. Suicide rates amongst young people within the residential care system or from that system were nearly double compared to the general population of youth, and even higher for Indigenous youth. There were public inquests, reviews, system transformations, re-designs, and blueprints for change. Despite all that, we lived with this residential care system for 30 years, occasionally perplexed but largely unbothered by the mayhem.
Around 2010, this system of residential care started to implode. This was not because we came to our senses, or we suddenly started caring about what was happening to young people. Several things transpired to make the change. First, child welfare underwent changes that resulted in a strong preference for family-based care (note that this did not mitigate mayhem for children and youth, who die, get injured, and are traumatized in family-based care too), and placements in residential care slowed significantly. Second, the cost of residential care placements resulted in constant deficits for Children’s Aid Societies, who were paying for those placements on a per diem basis, but who were not funded for these placements by the government. This resulted in government putting pressure on Children’s Aid Societies to curb spending, and most Children’s Aid Societies that had been operating their own residential care services closed these abruptly. Foster care and kinship care seemed like cheaper options, and these started expanding dramatically. Third, after decades of legislative neglect, a new legislation for child welfare was introduced in 2017 and took effect in 2018, which allowed for a much more thorough licensing system and enforcement practices where licensees were not meeting requirements.
As a result of these dynamics, many private for-profit agencies no longer saw the insane profit they had been reaping, and many decided to get out of residential care and treatment services. Some were aware of their sub-standard approach to service provision and got out before criminal charges could be laid. Some were shut down by government licensing specialists. Even in the publicly mandated and funded Child and Youth Mental Health sector, many agencies decided to close or reduce their residential treatment centres. To be clear, many private businesspeople who had for so long profited from children and youth placed in their services did not get out of the business of placement. They simply adapted, and many began offering private, for-profit foster care as well as intensive services (group homes with two or three children where every child is on a one-on-one staffing arrangement). Those who were especially compromised because of stories of abuse and neglect in their services switched their attention to the much less regulated elder care sector, and indeed, many of these businesspeople are now running nursing homes for profit, and stories of abuse and neglect in those settings are plentiful.
Fast forward to today. A new challenge has emerged that is pushing Children’s Aid Societies to desperate measures. Specifically, in recent years child welfare has experienced an influx of young people who are often labeled as having ‘complex needs’, which serves as a euphemism for neuro diversity. Family-based supports for such children and youth are limited, often feature many years of wait lists, and not infrequently are simply not meeting the needs of families. The Child and Youth Mental Health sector has been hesitant (and sometimes simply refuses) to provide services to these young people, because the specific needs of the young people fall outside of this sector’s self-generated mandate and procedural practices. Although in many cases the circumstances of these children’s lives are not really congruent with child protection criteria, families are often forced to surrender their children to Children’s Aid Societies because they cannot access services on their own, or because while they are waiting for services, they cannot assure the wellbeing of their children. Children’s Aid Societies, in turn, are entirely unequipped to provide services to these children. As a result, there has been an incredible increase in the placement of children and youth in low budget hotels, Airbnb’s, and even in makeshift bedrooms built into agency office buildings.
As a result, today we are once again subject to the child welfare system’s desperate cry for resources, and specifically residential resources. The system is already doing what it did in the 1970s and beyond. It is relying on and enabling the rapid emergence of private, for-profit businesses that claim to provide safe and meaningful service to this group of young people. In fact, this time the profit margins of residential care specifically designed for neuro diverse young people is even higher than it was in previous eras of rapid for-profit expansion. Some children are placed in these settings at a cost of well over $1000 per day, subject to not only one on one staffing, but sometimes two on one and even three on one staffing. Such settings are frequently not licensed, again hire staff without any need for qualifications, and again are concentrated in far flung rural areas with limited oversight and accountability. Once again, some children have died in these places, staff and children have been injured, and families have been forever ripped apart.
I am not against residential care placement options for neuro diverse young people. But I am against and very concerned about placing young people in residential care operated by for-profit private businesses, knowing that every one of these children is worth a lot of money to the operator. We have been here before. Once again we are embarking on a planless, short-sighted, economically driven, and politically expedient random experiment on the backs of children and youth to respond to the inadequacies of child and youth services more broadly. This time, the children and youth we are talking about are even more vulnerable to exploitation and abuse than their predecessors stuffed in residential care and treatment settings for 30 years. And their voices are less heard, their participation is more curtailed, and their families are more desperate for help than ever before. It won’t be long before we see the same patterns of racist disparities in services, with Indigenous and Black communities especially impacted (there is lots of evidence that this is already the case).
It seems that we learn nothing from the past. It also seems that families and their children are worth nothing, expendable, and easily trivialized as cases and numbers. This is most unfortunate (a euphemism for criminal neglect, ethical bankruptcy, and professional incompetence). We need a serious change of mind and heart that re-centers children’s rights and the responsibilities of the public sector to respond to evolving social needs and circumstances. What is clear is that our child and youth serving sectors are unprepared to evolve along with these social needs and circumstances. Our institutional fragmentation, accompanied by a profound professional stagnation, is precisely what enables smart, nimble but also ruthless and singularly profit-minded businesspeople to move in and silence this issue as they have done in the past. Commodifying children and youth is not an answer.
Now is the time to design (and implement) a system fit for the 21st century. Let us not create more infrastructure of abuse and neglect simply because we are desperate. Let us instead think more deeply about what is needed to move forward, and although the answers almost certainly will be very different from what we currently have (siloed and ineffective sectors), now is the time to show the courage to change our ways.
