When home is a residential treatment center
Westchester Journal News Editorial June 23, 2002
"These are throwaway kids. These are the kids people don't want to think
about.''
— Robert Lieberman American Association of Children's Residential Centers,
Washington, D.C.
When is home not a home? When it must simultaneously be hospital, psychiatric
center, juvenile detention hall and group shelter to severely mentally and
emotionally ill children, adolescents, teens.
"Throwaway Kids" we are being asked to think about.
Residential treatment centers are modern society's answer to what to do with
homeless young people who are too ill for their own homes, too ill for
traditional foster care in other people's homes, too ill for "just" medication
and day-treatment programs, but not quite ill enough for psychiatric
hospitalization. They largely hail from urban centers. Increasingly, they suffer
from serious psychiatric disorders unforseen even five years ago. Many have
parents who were, and are, substance abusers. Many have suffered from years of
physical, emotional and psychological abuse.
Residential treatment centers have evolved to collectively form one kind of
"treatment intervention'': state-licensed, 24-hour facilities, each with widely
diverse settings and mental-health services.
According to a 1999 report by the U.S. surgeon general, "residential treatment
centers are the second-most restrictive form of care (next to inpatient
hospitalization) for children with severe mental disorders. Although used by a
relatively small percentage (8 percent) of treated children, nearly one-fourth
of the national outlay on child mental health is spent on care in these
settings.''
It bears repeating: A staggering one-fourth of what the nation spends on child
mental health is spent on residential treatment centers.
As The Journal News' extensive investigation, "Throwaway Kids,'' quantifies —
and humanizes — the impact on New York state, these children, taxpayers and
society at large is mind-boggling. It is likewise for Westchester, Putnam and
Rockland counties, home to the highest concentration of residential treatment
centers in the state.
Among the findings in today's five-page special report:
• Nearly 2,000 children are in 13 RTCs in the three counties, at a cost of $200
million a year.
• The annual cost to house, treat and educate a child resident of an RTC can be
as high as $128,000, funded by a bewildering flood of funding "streams,''
largely from taxpayers.
• Yet the mechanism for paying local centers varies wildly, with the report
showing that one local center receives as much as $45,000 a year more per child
than another.
• Staffing such centers — which means consistently working around the clock with
young people who often have unimaginable behavioral and psychological problems —
is the key to treatment and progress. Yet workers often are paid less than
$20,000 a year, with a resulting statewide turnover rate of 42 percent.
• The state acknowledges that at least 100 of the most problematic children in
RTCs need a higher level of care in more specialized facilities, yet it is
unwilling to provide openings for them.
It has taken the horrible, high-profile attack on an RTC counselor in February
by several teen girls at the Pleasantville Cottage School to spur scrutiny by
some in the Legislature, including Sen. Nicholas Spano, R-Yonkers, former head
of the Senate's Mental Health Committee. A separate Commission of Quality Care
for Children and Families promises to investigate complaints about public and
private child welfare agencies.
One place to start: the money, and accountability for how it is spent. We agree
with Elie Ward, executive director of Statewide Youth Advocacy Inc., who told
The Journal News: "I think the way to run things is to assess the (individual)
child and set a rate, and have the money stay with the kid.''
Another place deserving the closest scrutiny: the efficacy of the New York State
Office for Children and Family Services. It was formed in 1998 to unite the
former state Department of Social Services and the criminal justice Division of
Youth. Has it streamlined services? Is it the "child-centered'' oversight agency
that was promised?
A spokesman tried to deflect criticism, saying "the agency was never intended to
be the only agency that serves children.'' No, but it was supposed to be the
agency that oversaw and ensured the delivery, and quality, of such services.
Finally, we object to suggestions that residential treatment centers, their
administrators and their staffs who cry out for less bureaucracy and more
support are only in it for the money. Surely, there are easier, far less
heartbreaking ways to make a buck.
Yes, there very well may be waste and even fraud in a system as enormous and
complex as the one that has evolved to provide care and a home for such
disturbed young people. And that waste and fraud must be rooted out.
But the focus for reform — beginning with thinking, really thinking about the
enormity of this problem — must be on the kids. The ones who have been thrown
away
Source:
http://www.thejournalnews.com/newsroom/062302/23edrtc.html
This "Mental Health E-News" posting is a service of the New
York Ass'n of Psychiatric Rehabilitation Services, a statewide coalition of
people who use and/or provide community mental health services dedicated to
improving services and social conditions for people with psychiatric
disabilities by promoting their recovery, rehabilitation and rights.
To join our list, e-mail us your request and, where
appropriate, the name of your organization to
NYAPRS@aol.com.
Save these dates!
September 10 - 13, 2002
NYAPRS 20th Annual Conference Celebration
'Now More Than Ever: Hope, Healing and Recovery'
at the Nevele Grande Resort, Ellenville New York
contact: Mary McLaughlin, NYAPRS
1 Columbia Place Albany, NY 12207
(518) 436-0008; fax: (518) 436-0044
