Illustration by Robert Meganck
Photographs by Darrow Montgomery
“Have I shown you my pictures yet?” the teenage girl asks, bringing over three fat white envelopes stuffed with Polaroids. ¶ Plopping down on her bed, she pulls out a stack, which looks unwieldy in between her reedlike fingers. The girl (who has asked to be called Maria to protect her identity) doesn’t quite look her 17 years. She is thin, but her cheeks are holding on to a little baby fat. She looks even younger with eyeglasses. Perhaps she knows this: Even though Maria can’t see well without her glasses, she hasn’t been wearing them for a couple of days. She keeps her hair in a neat ponytail, except for two thin bands she has artfully separated out with tiny butterfly clips. The bands frame her face as she smiles at the sight of the familiar pictures. She quickly flips through them, offering brief explanations for each.
¶All the typical milestones of adolescence flash by in rapid succession. But there are some noticeable exceptions.
¶”This is from driver’s ed,” she says, pointing to a picture of herself sitting in the driver’s seat of a small car.
¶”This is when we went to Epcot.”
¶”This one is my prom,” she says, holding up a photo of herself wearing a black dress and sitting on a bench next to an older woman with blond hair.
¶”That’s my therapist,” she explains, pointing to the blonde.
¶”And this,” she says, pulling out a photo of a dozen teenage boys and girls huddled together in a hallway, “is from when I was at Riverside.”
¶Maria was in Riverside, a psychiatric hospital on MacArthur Boulevard, for four months while waiting to be sent to a more suitable residential treatment facility. She tells a story about having to change rooms while she was there because the kids on the floor below her kept setting fires. “The smoke made me sick,” she says.
¶Next, Maria flips to a picture of herself alone, standing outside a building surrounded by lush palm trees and streams of sunlight. The building is the residential treatment facility in Florida where she was finally sent for three years after she was charged as a truant in the juvenile delinquency system.¶”This is from the day I left,” she says.
The photo was taken last year, just before Maria returned home to her mother in Northwest D.C. In Florida, she was no longer the same girl who had once written “Fuck you” on the blackboard at school or who had thrown an eraser at a teacher. Or the girl who had frequently hidden out at a friend’s house for a day or two at a time, prompting her mother to call the police to bring her home. In Florida, she didn’t skip class as she had before; instead, she became a model resident and top student. She was even able to go off the antidepressants she had started taking just before her arrival.
But once she came home to Washington, in August 2000, life wasn’t much different than it had been before she left. Maria is the only child of a single parent. Despite weekly family therapy sessions by phone while Maria was away, she and her mother began fighting again frequently. Maria says that after four months, she couldn’t take it anymore and asked the judge in charge of her case to place her in a group home. He obliged. After five months at the group homewell beyond the three months or less that most of the other girls stayedMaria went AWOL. After a couple of days, she turned herself in.
Maria’s mother refused to take her back, so Maria was transferred from the juvenile-delinquency system to the abuse and neglect system. She was then sent to a different group home, for neglected girls. She didn’t stay there long. “It was like Annie,” she says, describing the home’s atmosphere. “I was like the oldest one there. I had a job, nice clothes. The kids there took my clothes and the staff didn’t like me, so I left.”
The D.C. Child and Family Services Agency, which is responsible for placing abused and neglected children, then moved her to yet another group home, where she lives today.
For more than 20 years, thousands of troubled District kids have gone on odysseys similar to Maria’s, to places as distant as Arizona, Colorado, and Florida, dispatched from chaos to stability and back to chaos again. They have been sent to various types of residential treatment centers, which range from secure psychiatric facilities to drug-rehabilitation centers to boot camps.
Residential treatment facilities are places of last resort, a final effort to save emotionally disturbed children before they self-destruct. Unlike group homeswhich temporarily house about a dozen or so kids at a time and provide more in the way of supervision than servicesresidential treatment centers offer a structured regimen of schooling, counseling, and regular activities. Yet there are few residential treatment facilities in the District. For children under age 12, there is the Episcopal Center for Children in upper Northwest and the Devereux Hurt Home in Georgetown. For adolescents, there is only Riverside Hospital, which has 60 beds in its adolescent residential program.
The needs and backgrounds of the children who go to residential treatment facilities vary. Most carry psychiatric diagnoses, such as depression or oppositional defiant disorderwhich is defined as negative, hostile, or defiant behavior that lasts for more than six months and that impairs social, academic, or occupational functioning. Many also have learning disabilities and substance-abuse problems. Some are sent to distant treatment centers after committing crimes such as carjacking and even murder; others are sent on minor charges such as truancy. Most have failed previous interventions such as counseling or probation and are seriously beyond the control of their parents or guardians.
Today, according to the D.C. Department of Mental Health, there are about 500 local kids in out-of-state residential treatment centers, at an annual cost to the city of about $33 million.
In theory, kids go out of state only when the specialized care they need doesn’t exist at home. For example, fire-starters and sex offenders are usually sent to a few highly specific programs around the country designed to address those problems. But in practice, critics of the city’s reliance on out-of-state residential treatment centers say, more kids are sent away than truly need to be. The reason, they argue, is that city officials have chosen to ship kids out rather than make sure better services are provided closer to home.
And the scarcity of such services as therapeutic foster homes, intensive case management, and drug treatment plagues kids upon their return from those distant facilities. Once they are back home, they and their families frequently struggle with the rocky transition from institutional life, and the city has little to offer in the way of help. Often, whatever gains the kids made while away are lost once they are home. Some get into trouble with the law; many don’t adjust and are sent away again; a few even die.
These kids are part of a caravan of troubled children who make the rounds at residential treatment centers across the county. Almost every state sends some number of kids away. But for decades, the common-sense consensus among advocates for kids, social workers, and mental-health professionals has been that children are better served when they are treated closer to home and family.
“D.C. would be a rare place if every kid who is sent away needs to be there,” says Lindy Garnette, director of children’s primary care with the National Mental Health Association. “People get tired of fooling with certain kids. An agency thinks it’s done everything possible, but there are services and supports that, if they were available, would allow the kid to stay home. The kid has failed with what’s available, but that doesn’t mean he or she can’t live in the community.”
Tim Roche, a former deputy to the first of two court-appointed receivers for the D.C. Child and Family Services Agency, puts it another way: “The judges and even the lawyers [for the kids] are indoctrinated into a process that, once a kid reaches a certain point [of being out of control], everybody throws up their hands….There’s much, much more that could be done before we send these kids to locked facilities.”
District officials have been grappling with how to reduce the number of kids who go to out-of-state placements for as long as they have been sending them. But previous efforts to reduce the city’s reliance on distant residential placements have either never gotten beyond recommendations or proved as short-lived as a particular agency director’s tenure.
And in recent years, the major city agencies charged with monitoring the care of children in residential treatment centers and serving those children when they return home have been more preoccupied with reacting to crises than with reform. The D.C. Child and Family Services Agency and the Department of Mental Health are only now emerging from years of court-appointed receivership. The Youth Services Administration, which serves detained and adjudicated youth, as well as status offenderskids charged with truancy and the likeis still struggling to meet the conditions of a court-imposed consent decree. And the long-troubled District school system is on its third superintendent in five years.
Meanwhile, other cities have tried different ways of keeping kids closer to home. Some, such as Milwaukee, which in 1996 switched to a “wraparound” approacha system of individualized, intensive, round-the-clock community-based and in-home serviceshave had dramatic success.
This month, the Mayor’s Blue Ribbon Commission on Youth Safety and Juvenile Justice Reform, which has recommended widespread changes in the city’s juvenile-justice system, renewed calls to bring kids back from faraway residential placements. And city officials are boosterish about two new initiatives quietly launched within the past year, one spearheaded by the Department of Mental Health, the other led by Child and Family Services. A total of about 130 kids who are either headed for or returning from residential treatment are being targeted by both efforts for wraparound services.
While city officials may now have a game plan to keep kids out of distant residential treatment centers, carrying it out is not likely to be easy. From the top administrators to the line staff, the city’s troubled child-welfare, mental-health, juvenile-justice, and public education systems, along with the courts, will have to collaborate as never before. The city will have to juggle the costs of supporting kids who are still in residential facilities with the costs of building a new network of community-based services. And providers will somehow have to create more residential treatment options in the District without raising the ire of locals who have fiercely opposed new group homes and social service agencies moving into their neighborhoods. Until then, District kids like Maria will continue to leave Washington and hope that, when they return in a year or two, things won’t be the same as when they left.
On a Friday morning in early August, a boy of 15 (whom I’ll refer to as Mark to protect his identity) comes before D.C. Superior Court Judge Thomas Motley in Courtroom 112. Two of the boy’s aunts, one young and the other elderly, stand behind him, along with his grandfather. They are silent, hoping their mere presence will stir compassion in the judge who is about to decide Mark’s fate.
“Of the two facilities which have accepted him, a comparison shows that Devereux Georgia has more to offer than Riverside Hospital,” says Mark’s probation officer.
“[Mark] has expressed a willingness to live with his aunt. He has no disciplinary problems with this aunt as well as the rest of his family,” the boy’s defense attorney counters. “All other matters can be addressed in the District of Columbia.”
“It appears Devereux has a much more comprehensive education plan [than Riverside],” the probation officer persists. “He’s so far behind….If he doesn’t receive this help now, time could run out for him.”
“This is a very difficult decision to make,” says Motley. “I know the family has shown remarkable support. But I have a situation where [Mark] was involved in two cases, both robbery cases. I put him on probation, and very quickly, the second case came up. I will defer to the recommendation for residential.”
“I know you don’t want to go to Devereux Georgia,” Motley says, addressing Mark. “I know your family doesn’t want you to go. But if I look at what will help you most, I think Devereux in Georgia will meet those needs better.”
As Motley declares in a more official tone, “I will order him in the second case, and close out the first, for him to go to a residential facility until he is 19,” the boy’s elderly aunt buries her face in her hands and starts to cry.
“That doesn’t mean he will stay there the whole time,” Motley quickly explains. “He may come back in a year. We will monitor his progress. He may be back in a year.”
Mark doesn’t cry, but he looks restless.
“I hope you understand,” Motley says to the boy. “You may not agree with it, but give Georgia a chance.”
The clerk dismisses everyone, and Mark trails out behind his family, his arms folded.
Hearings like this one happen almost every day. But getting caught up in the juvenile-
justice system is only one of the ways children can end up in a residential treatment facility. A hearing commissioner might order a child placed in a residential treatment center if she thinks the school system isn’t meeting the child’s special-education needs. Child and Family Services officials might recommend that a judge send out a child who keeps running way from her foster home. Or a D.C. Superior Court judge might decide to commit a teenage robber such as Mark to a residential treatment facility as his sentence, so he’ll be sure to get counseling and finish school.
Before most kids are sent to residential facilities, they must go through a series of evaluations and reviews. Many start their journey with a visit to a little-known interagency panel known as the Residential Review Committee (RRC).
The RRC is made up of officials from Youth Services Administration, the D.C. Public Schools, the Department of Mental Health, Court Social Services, and the Residential Placement Unit (RPU), a division of the Department of Mental Health that oversees some of the local as well as distant facilities where children are sent. A psychiatrist on the RRC must certify that a child is eligible to go to a residential treatment center before Medicaid will pay for the child’s treatment. The RRC then looks at a packet of information that includes psychological and psychiatric evaluations, an educational assessment, and a social historya report that summarizes all the important background information about a child. RRC members also look at such factors as whether the child has had a hard time getting along with his family or others, is psychotic or suicidal, has suffered physical or sexual abuse, or has missed school. They also consider whether all community-based options have been exhausted.
Last year, 155 kids were referred to the RRC; 61 of those were placed in residential treatment centers in the same year, says Department of Mental Health spokesperson Linda Grant. (Some kids were turned down for placement, while others were not placed for other reasons, such as postponement of their hearing, explains Grant.) Over the past three years, 613 kids total were referred to the RRC, and 174 were placed.
Once the RRC makes its recommendation to send a child to a residential facility, and depending on the child’s circumstances, one of several agencies, such as Youth Services, Child and Family Services, or the RPU, will find the child a placement. Where the child goes depends on the child’s needs, which facilities the different agencies have contracts with, and which facilities are willing to accept the child. A judge can also order a child directly to a specific facility.
The city created the review process more than 20 years ago in the wake of a 1972 court decision, Mills vs. Board of Education of the District of Columbia, that required the schools to provide free education for children with special needs, including those who are incarcerated. As conditions at the District’s two secure juvenile-detention facilities in MarylandOak Hill and the now-closed Cedar Knollworsened through the ’80s because of overcrowding, and the number of children in the neglect and abuse system grew, attorneys for kids as well as judges soon realized that children could get better treatment if they were sent to residential facilities. As a result, the mix of kids going to residential placements changed, and the range of settings they went to expanded beyond the traditional secure psychiatric settings to include boot camps and “wilderness ranches.” By the ’90s, out-of-state residential placements had become, in the words of one social worker, a “default in place of services that should be provided in the city.”
In 1995, when Roche first came to work at Child and Family Services, sending kids to residential had become too routine, he says. “The truth is, kids were being tossed into that residential-treatment-center stream without sufficient oversight, review, or critique. If the kid was a real pain in the assboom!” says Roche. “It was a case-management strategy. If you have 150 kids on your caseload, you can’t deliver services to all of them. If one starts taking up all your time, you pull the case-management ripcord and [the kid] is gone for 18 months.”
Glenda (who is identified by her first name to protect the identity of her grandson) has seen the ripcord pulled more times than most parents or guardians. She’s had three grandchildren sent to residential treatment centers.
Last summer, Glenda dashed over from her job in the dietary office of St. Elizabeths Hospital to the Behavioral Studies Building on the St. Elizabeths campus in Southeast. Glenda wanted to be there for her grandson Alfred (not his real name), 15, who was going before the RRC. Police had picked up Alfred for riding in a stolen car. He was initially given probation, but he missed appointments with his probation officer. He had also been skipping school regularly since he was 13. A judge ordered him held at Oak Hill until the RRC could see him.
Gathering all the necessary assessments can take many weeks, but the RRC hearing itself is remarkably brief, no more than a half-hour. “They ask you what you think. You tell your story, if you want them home. Not that much. Twenty minutes, at most,” says Glenda. “They didn’t miss me at work, it was that fast.”
Because Glenda’s grandson was coming from Oak Hill, he arrived at his hearing wearing shackles on his wrists and ankles, and accompanied by three unarmed correctional officers. At the hearing, Alfred’s probation officer explained why he thought Alfred was a good candidate for residential placement. When the committee asked Alfred whether he wanted to be sent away, “he said he knew he needed help,” Glenda recalls. But, she adds, “he didn’t want to go. He looked really sad.” After the hearing, Glenda says, her grandson cried.
Later that day, Glenda learned that the RRC had approved her son for placement in Florida. He left in September 2000. “He called. He didn’t like it. He complained about the mosquitoes, about his asthma, that it was too hot,” Glenda says. “He didn’t make friends. He stayed to himself because he was afraid. I would be, toodon’t know nobody. I could hear sadness every time I talked to him.”
After Alfred came home for a visit last Christmas, he didn’t go back to Florida. Instead, he went to his father’s housewhich alarmed Glenda, who says that when she went to pick up Alfred and his siblings from their father 14 years ago, the children had maggots in their diapers. Glenda feared that her grandson would be left to his own devices there, so she called the police to report her grandson AWOL from his residential treatment facility. Soon, the police picked him up on a drug charge, and he went back to Oak Hill. Alfred again went before the RRC, which certified him for placement at another out-of-state facility. This time, Glenda says, Alfred didn’t cry.
In the back of the No. 42 bus on a weekday afternoon in August, a teenage girl stands gabbing loudly to her friend, who is sitting by the window.
“They told me if I ran away, they’d send me to residential. I said, ‘Fuck that!’” the teenager says. Overhearing her, I ask if she means a residential treatment facility, and she nods.
She offers her nickname: Elmo. She’s 17 and says that for several years she’s been in the neglect system, which placed her in a group home for runaway teenagers. “They just wanted to send me [to residential] because I have no parents,” she explains, snapping her gum loudly.
“How did you get out of going to residential?” I ask.
“Through the back door!” she replies. Strangers around her, who have been pretending not to be listening, break into chuckles.
Elmo, it turns out, ran away from her group home three months ago. She recalls that among the girls there, residential treatment facilities have a reputation for “being a place of refuge, but not a place of help.” The ones farther away have a better reputation among her peers than the ones here. “If you come back through a D.C. one, you get more fucked-up than when you left,” she says. “The security guards don’t care. You get robbed. Kids be smokin’ and drinkin’.”
Elmo says she also ran away because she detested living in a group home: “It’s like being locked up, with a little bit more freedom. I can do bad on my own.”
Among many kids caught up in the juvenile-delinquency and abuse and neglect systems, a stay in a residential treatment center is about as unpopular as a stint behind bars. According to one social worker, kids even refer to it as “‘doing their time’ in resi.” But to those charged with caring for these youth, residential treatment centers seem like just the opposite: an attractive remedy to the alarming problems of emotionally disturbed kids.
The facilities themselves have soothing names such as Island View, Red Top Meadows, and Aspen Ranch. The brochures are thick and glossy and feature photographs of beautiful sylvan campuses. The descriptions of programs are perfectly pitched to exasperated parents, judges, and caseworkers, who must be relieved to find a place that welcomes, as one center’s material proclaims, “multi-problemed children.”
Caring for troubled youth is, of course, a multi-billion-dollar industryone that derives much of its revenue from federal, state, and local governments, which spend about $50 billion annually on programs for at-risk youth. Many of the residential treatment centers the District contracts with are owned by the biggest chains of youth facilities, such as Cornell Abraxas, Devereux, and ValueOptions Inc.
ValueOptions is the country’s largest privately held behavioral-health managed-care company. It owns the Pines Residential Treatment Center in Virginia Beach, Va., where the District has sent kids for more than a decade. More than 300 kids live at the Pines. Many of them are from inner-city neighborhoods in places such as Chicago and Philadelphia. About 10 percent of the kids are from the District, which is about a four-hour drive away.
In early September, Debbie Goldstein, senior administrator of the Pines, leads me on a tour of the Kempsville Campusone of the three campuses that make up the Pinesalong with Dr. David Portner, clinical director of admissions and assessments.
The Kempsville Campus, which houses a pediatric as well as an adolescent unit, sits at the end of a shady driveway behind a medical office building not far off a busy interstate. One of the residential counselors, Winston Stewart, guides us through myriad locked doors. Disney characters painted by the kids and staff smile from the walls of the cafeteria on the first floor. Upstairs, just inside the door to the adolescent unit, is a framed picture of a tropical beach with the word “Relax” written underneath. About 10 kids sit around in boxy, wood-framed couches and armchairs. Some play cards while others watch.
Once we’re out of earshot, Portner shakes his head and says, with a pained look on his face, “If you could read their files, you wouldn’t believe what some of these kids have done.”
Stewart leads us down the hallway to the female unit, where a girl with blond hair and thick eyeglasses who looks no older than 14 invites us to see her room.
Inside, the odor of floral air freshener is overwhelming. A box of Crayola markers and an algebra textbook sit on a desk. On the walls are maps, pictures of Justin Timberlake, Levi’s ads, and photographs of a blond baby.
“Are those your relatives?” Goldstein inquires, pointing to the baby pictures.
“That little girl is my daughter,” the girl replies. “She’s 2 months old. I gave her up for adoption because I wasn’t ready for a baby.”
She moves on to hand-drawn pictures of leaves that are hanging below the photos. “Those were for an art contest,” she says cheerfully. “It was a seasonal theme.”
On the way out of the unit, Stewart opens up a metal cabinet filled with sundry items such as gum, deodorant, Pop Tarts, and bags of Doritos that the kids can buy with points they earn for good behavior. You need 350 points to earn a 45-minute phone card, which, Stewart says, takes about two weeks to earn.
The children, for the most part, look contented and well-behaved; the staff seems industrious and friendly. But it’s impossible, on a brief tour, to tell whether the kids are getting the help they’re supposed to. Figuring out whether the kids’ needs are being met and taxpayer money is being properly spent is the job of a host of monitors, from the inspectors sent by state licensing agencies to the caseworkers with the different agencies that place the kids here. But parents and advocates for children say monitoring is often inadequate, particularly when facilities are located far from the District. For example, a few years ago, there were not enough caseworkers for the RPU to oversee the care of all the kids it placed, according to its own documents.
“The RPU has limited staffing (five case managers for 265 children and youth) to provide case management for all children/youth in placement as well as monitor the facilities providing care treatment to the District’s children and youth,” reads an undated document titled “Guidelines for Referrals to Residential Placement,” put out by the Department of Mental Health before it went into receivership in 1997. “It is expected that the [parents] of non-wards, (in conjunction with personnel from the Public School System of the District of Columbia,) will assume a major portion of the oversight authority for their children in residential placement.”
Once a kid is sent to a residential facility, no matter how far away, his D.C. caseworker “is supposed to have direct, ongoing contact with the child,” according to one experienced social worker. But in reality, caseworkers have many other kids to visit in the District and court dates to make. The social worker says that when she was working for the city a few years ago, the reality was that “you put [such a child’s folder] in the back of your files.”
Not surprisingly, children and parents interviewed for this story say they have rarely seen their D.C. caseworkers and have been lucky to hear from them regularly by phone. Citing the difficulty of getting in touch with kids at facilities, caseworkers say it is often easier just to speak to staff.
Attorneys who represent children at review hearings may not offer much help, either: Often, they don’t have the time or inclination to check on their clients. Even a diligent lawyer might make it out only once every three months. As for maintaining family ties or changing the environment at a child’s home, caseworkers and attorneys say therapy by phone isn’t enough. The city pays for visits by families, but some parents say they still have trouble affording the costs of keeping in close contact. For example, one parent says her phone service was cut off after she racked up high long-distance phone bills talking to her son, who was in treatment in Colorado.
There have been some signs of improvement. There are now more RPU workers overseeing fewer children and youth in a smaller number of facilities, according to the Department of Health’s Grant. And both caseworkers and advocates for kids say that the RPU does the best monitoring of residential treatment centers of any city agency because it sends a team of specialists to inspect each site every three months. Youth Services officials say that within the past two years, they have also tightened monitoring and case management of kids in residential facilities by increasing the minimum amount of contacts their workers must have with out-of-state kids and turning some residential cases over to workers in a special unit.
Nonetheless, critics say, oversight of kids in residential facilities leaves a lot to be desired, even when those facilities are in town.
Mary Gardiner Jones, who sits on the citizen advisory committee of the Devereux Hurt Home in Georgetown, says that she hasn’t been impressed with the work of city monitors. The RPU contracts with Devereux, and its workers are supposed to oversee their clients’ care there. “There’s a lot of paper going back and forth between the Residential Placement Unit and [the Hurt Home],” says Gardiner, referring to the numerous reports that administrators on both sides have to file. “What’s not clear is if anyone is really reading it.”
The District, like many other cities and states, has grappled with its share of troubling incidents at residential treatment facilities. The city stopped sending kids to the Arizona Boys Ranch, a boot camp in Oracle, Ariz., after a 16-year-old Arizona boy died there in March 1998, of an untreated respiratory infection. In 1990, a 17-year-old District girl died in the Seguin Community Living Center, about 100 miles from Austin, Texas, while being restrained with what the facility called a “five-man basket hold.”
But the need for such facilities is so great that the city has resumed sending kids to programs that have had disturbing incidents in the past. And advocates for children often support such moves because they say problems with facilities can be cyclical.
That was certainly the case with the Pines. In October 1996, three residents in the Pines’ now-defunct Phoenix program for male juvenile offenders escaped and committed a carjacking, abduction, and robbery. That same month, a deranged former employee took two staffers hostage for several hours before killing himself. In 1997, a 16-year-old boy committed suicide there. The Pines has not had such problems in recent years. Pines administrators say that they are now more selective about whom they will treat. They’ve also revised their procedures, increased the ratio of staff to residents, and brought down the use of physical restraint from close to 100 times a year to about 20, according to Goldstein.
But District officials have sometimes not responded adequately to reports of abuse, as in the case of the High Plains Youth Center, a facility for juvenile offenders in Brush, Colo., where the city sent Yusuf Bush.
In 1994, Bush, then 14, shot a boy in the back, saying the boy had tried to kill him first. A judge sentenced him to a residential treatment facility until he turned 21. Youth Services placed him at High Plains. Rebound Programs LLC, the company that ran High Plains, charged the District $180 per day for each youth sent there.
While Yusuf Bush was there, his mother, Elaine Bush, says that she rarely heard from her son’s caseworker. Then one day, the caseworker called to tell her that her son had been abused and that a staff member had been arrested for the assault.
Bush did her best to stay in touch by phone, but she had no idea what was really going on at the facility. She didn’t find out, for instance, about the 1995 report by clinical psychologist Ronald Davidson. Illinois sent Davidson to High Plains to see how the facility was treating the 20 boys the state had sent there. Davidson reported that there was “a consistent and disturbing pattern of violence, sexual abuse, clinical malpractice and administrative incompetence at every level of the program.” In the facility’s records, Davidson also found evidence that a resident had kept a 13-year-old West Virginia boy as a “sex slave” and serially raped him for a year. Illinois eventually pulled its kids from High Plains, but the facility remained open.
Yusuf Bush returned to the District in the fall of 1996, when the city pulled him and several other boys out ahead of schedule in light of what happened to him.
Finally, in 1998, after Colorado officials investigated the suicide of a 13-year-old Utah boy at High Plains, the state closed the facility for good.
Back in Washington, Yusuf Bush struggled to readjust. Elaine Bush says that she and her son had little help upon his return; she didn’t hear from the caseworker who was supposed to be overseeing her son’s transition. Yusuf Bush quickly got into trouble again: His mother says that he was arrested a couple more times for fighting. Then, in 1998, he was arrested for allegedly pistol-whipping a man. Elaine Bush says he used his fists, not a gun. Nevertheless, a judge sentenced Yusuf Bush, then 18, to five years in adult prison. Today, he is an inmate in the Sussex II maximum-security prison in Waverly, Va.
By the time many kids are sent to residential, their problems have persisted for so long and become so urgent that it is easy to see why parents, attorneys, caseworkers, and judges regard intensive treatment in a secure facility as the only solution, especially when compared with the alternative.
“I consider a residential placement a success when kids are facing serious adult time,” says a longtime juvenile-defense lawyer. “A residential [facility] is better than an adult penitentiary any day.”
“When I send a child away, I feel, at least that child won’t be shot and killed for the next eight months,” says one veteran social worker who has worked in both the juvenile-justice and neglect systems.
Local judges, attorneys for juveniles, and social workers can also offer a stream of testimonials about kids who have thrived while away and programs that they say are particularly successful, such as the Glen Mills Schools, a residential program for boys in Pennsylvania.
Yet the complexity of the problems troubled kids have suggests that a year or two at a treatment center isn’t likely to reverse a lifetime’s worth of neglect and abuse, untreated mental-health problems, or poor schooling. Even for those kids who do well in the highly controlled environment of a specialized program, the time and distance away from home can ultimately prove counterproductive. “The longer [kids] are out of the home, the harder it is to bring them back,” says the National Mental Health Association’s Garnette. “Most kids don’t generalize skills well. Kids who are sent to residential treatment may do well in that setting. They learn the skills to get through that program, but they may not be the same skills that work in their community.”
Stanley Covington, who runs Alternative Solutions for Youth, a program in Northeast for boys coming back from residential placements, has a firsthand look at what impact such placements can have. “Often treatment is not done. The family situation is the same. Sometimes, I wonder, Why did that agency discharge them? What did they learn?”
Indeed, everyone from parents to attorneys to caseworkers agrees that coming home is the most difficult leg of the journey. In the words of one veteran juvenile-justice attorney, “after-care is nonexistent.”
Caseworkers with the various agencies responsible for kids in residential facilities are supposed to work with treatment center staff, kids, and families to come up with after-care plans. But parents and advocates for kids say there is often not enough communication between the different players. In one case, an RPU caseworker who was charged with overseeing a facility brought the youth home without telling the kid’s regular social worker. In another, an attorney called to find out about a client’s after-care plan only to learn that her client’s caseworker didn’t even realize he had that child’s case.
“[The kids] may have worked hard in that environment to make everyone proud of them,” says Kristin Henning, deputy director of the Georgetown University Law Center’s Juvenile Justice Clinic. “Then they may come home to a caseworker who hasn’t taken the time to get to know them, who may not have even talked to the caseworker who had their case while they were in residential, who does know them.” Add to all that a family situation that may have improved little since the youth left, a dearth of appropriate servicesin particular drug treatmentand the usual stress of trying to fit in again after being gone for a while, and it’s not hard to see why so many kids quickly lose ground again.
There is not much information on children who are sent to residential treatment centers and what happens to them after they leave, but what little there is doesn’t say much for the effectiveness of such placements. The most comprehensive data come from the 1996 National Adolescent and Child Treatment Study. The U.S. Department of Health and Human Services and the U.S. Department of Education funded the seven-year study, which profiled 812 children in publicly funded residential treatment facilities and special-education programs in six states. The children in the study were being served within their home states, notes Dr. Robert Friedman, one of the authors. But the outcomes were still not great. By the study’s end, 66.5 percent of the children had had run-ins with the police, 43.3 percent had been arrested at least once, and 34.4 percent had been adjudicated delinquent or convicted of a crime.
“What it demonstrates is that residential treatment is not a magic cure for kids with serious problems, and that by the time their problems have progressed to a serious point, even with residential treatment, the outcomes are not encouraging,” says Friedman. “If anything, it shows that the problems of kids are not just temporary, that they have serious, long-lasting effects on many domains of a kid’s life.”
No one knows this better than one District grandmother (who asked to be called Sara to protect the identity of her grandson). Sara took over responsibility for raising Gregory (not his real name) when he was a preschooler because the boy’s mother had substance-abuse problems. Sara made sure that Gregory saw a psychiatrist from the age of 6. She sent him to private schools, where he did well enough to skip a grade.
But around age 12, Sara says, the boy became “downright obstinate.” He didn’t get along with the other kids at school; at home, he was increasingly difficult to manage. Because Gregory was always performing at grade level or better, he wasn’t eligible for special-education services. One night, during a tantrum, he broke a mirror. Sara says she decided to call the police and bring charges against her grandson in the hope that he would finally get the help he needed. A judge eventually ordered that Gregory be sent to a facility in Brandywine, Pa., and later to another facility in Connecticut. When he left, he was 14.
Altogether, Gregory was away for nearly three years. His progress was uneven. Sara says he would earn privileges for good behavior, then act out and lose them all, then earn them back, and then lose them again. While Gregory was at one of the facilities, Sara says, she found out that he had begun smoking marijuana. She complained to administrators. When they didn’t believe her, she says, she showed them pictures that her grandson and his friends had taken of themselves smoking pot. “There was nothing [the administrators] could say except shake their heads and say, ‘It is clear we do have some problems, but we do the best we can,’” Sara recalls. “The District social worker was saddened, but mumbled something like ‘We don’t have enough people to monitor these folk, and we have nowhere else to send these kids.’”
When Gregory came home, Sara enrolled him in a private school for special-education students in Maryland. The D.C. school system paid the cost of tuition. But the school expelled him for being disruptive. “He’s disruptive? Oh, really?” says Sara. “These places kick the kids out for the very problems the kids go there for in the first place.” She moved him to a school in Virginia.
Besides the schools, Sara says, she and her grandson had almost no help. “I had nobody to call on when he wouldn’t do his homework, or when he would use pot,” she says. A D.C. agency, the Center on Juvenile and Criminal Justice, was supposed to send a social worker to their home, but Sara recalls that when she tried to reach the worker during a crisis once, she couldn’t, because the worker didn’t have a pager. After Gregory spent a miserable half-semester at the school in Virginia, he went to the residential program at Riverside Hospital, which offers special education. “That was the worst experience he or I ever had,” Sara says. “They did nothing. They didn’t even feed [him] well. There was no schooling.”
Gregory eventually enrolled in a public high school in Maryland and graduated. He now lives on his own and plans to go to college. Yet he continues to struggle, and he has passed in and out of drug-treatment programs. Sara notes with some apprehension that he will “age out” of the system in December. “He’ll either make it,” she says, “or die.”
For much of the past 20 years, D.C. kids in residential treatment centers have largely been forgotten by administrators, caseworkers, policymakers, and the public.
Harvey Schweitzer, a veteran child-welfare attorney, remembers the last time the number of District kids in residential facilities was a focus of concern. “It was a really hot issue in the late ’70s,” he says, referring to the years following the Mills decision. “It’s been simmering on the back burner ever since.”
In 1986, Ira Burnim was the legal director of the Children’s Defense Fund, a national advocacy organization for children. He was new to Washington and its troubles. So when he was asked to join a committee looking into ways of reducing the number of kids the city sent to out-of-state residential placements, he was delighted. But after he spent weeks researching and writing reports, city officials politely accepted the committee’s recommendations and did nothing about them.
Two more committees and 15 years later, Burnim, now the legal director of the Judge David L. Bazelon Center for Mental Health Law, says he’s exhausted. “These days, if I get a call to be on one of those committees,” he says, “I don’t return the call.”
In 1990, after the death at the Seguin Center, the then-director of the D.C. State Health Planning and Development Agency, Carolyn Graham (now a deputy mayor), declared that expanding residential services for emotionally troubled youths in the District was “a priority.” But little real reform followed, and the stream of kids sent to residential treatment centers continued to flow largely unabated.
In 1996, Jerome Miller, Child and Family Services’ first court-appointed receiver, formed an internal committee to screen kids going to residential facilities. He says that by doing so, he cut the number of kids his agency sent away by more than half. But within a couple of years after Miller’s 1997 departure, that effort became less of a priority, says one former top agency official, and the number of distant placements began to creep back up.
Meanwhile, other jurisdictions set out to reduce their reliance on expensive residential treatmentand succeeded. The most prominent example has been Milwaukee. In 1996, Milwaukee’s human-services and mental-health departments launched “Wraparound Milwaukee.” Under this program, Milwaukee County has tripled the number of services for kids and their families, offering everything from a mobile crisis unit that is always on call to housekeeping services and respite care for families.
As a result, in the past five years, Milwaukee has cut its use of residential treatment facilities by 60 percent, and the monthly cost of care per child has dropped from $5,000 to less than $3,300 per month. That savings has allowed the county to serve 650 kids, as opposed to the 360 who were previously sent to residential treatment centers. The children who received wraparound services have scored better on clinical measures of their ability to function in the community, and recidivism rates for juvenile delinquents receiving wraparound services have also declined.
Local agencies have tried wraparound-type services before, but in the District, the approach has so far proved to be, in the words of one parent, “a joke.” Says one social worker: “I hear ‘wraparound’ and I just laugh. What does it mean? It’s a bogus concept.”
Nonetheless, inspired by the success of places like Milwaukee, a new generation of District officials insists that it’s going to succeed where its predecessors failed.
The Members’ Old Dining Room inside the Cosmos Club, an ornate private social club off Dupont Circle, is an unlikely place for a revolution. But with much fanfare, this is where Washington Behavioral Health Care, a network of private mental-health providers, has chosen to officially launch “Project Homebound,” its “unprecedented” collaboration with the D.C. Department of Mental Health, the D.C. Department of Health, and the mayor’s office, to reduce the city’s reliance on out-of-state residential treatment facilities.
The crowd on this warm muggy evening in June is high-powered, and the mood in the room is practically celebratory. District agency heads, mental-health advocates, doctors, and elected officials all mingle. Even the mayor’s mother, Virginia Williams, who is a member of the Project Homebound Advisory Committee, is here, on her birthday, no less. Waiting for the evening’s program to begin, the assorted guests munch on Saga Bleu cheese, Camembert, and figs, and sip sparkling water from tall wine glasses.
Much pep talk and many promises follow. “Project Homebound will not let you down,” declares Washington Behavioral Health Care’s executive director, Renee Lohman. “Project Homebound will be the impetus for providing for the successful re-entry of affected youth with the support and involvement of their families.”
“We’re going to do things that nobody else has been able to do,” says Martha Knisley, the D.C. Department of Mental Health’s acting director and the evening’s keynote speaker. “I promise you, we will do everything we can as policymakers in this community to put our heads together, roll our sleeves up…We will be back here in not too long to celebrate bringing every child home.”
Dr. Ivan Walks, director of the D.C. Department of Health, brings the evening to a close by leading the crowd in a rousing “commitment to kids ceremony.”
“If you are willing to make a commitment, I want you to shout it out now!” Walks says.
“I commit to making sure we do everything to bring our children home and make sure there are services when they get home!” offers Ward 8 Councilmember Sandy Allen.
“I’m committed to trying to have more school-based mental-health services so we can reduce the number of children who have to go to residential treatment!” pipes up Anne Gay, assistant school superintendent for special education.
“I commit to bring to the District a residential treatment facility for kids this year!” shouts Dr. Larry Siegel, the director of the D.C. Addiction, Prevention, and Recovery Administration.
Project Homebound is actually one of a handful of new efforts to reduce the city’s reliance on distant residential treatment centers. Separately, Foundations for Home and Community, a local social service agency, with help from the Casey Family Foundation, plans to target 30 kids under the care of Child and Family Services for diversion and return from residential placement. Caseworkers will work with only seven kids at a time and will be able to deal more closely with their clients and their families than agency caseworkers, according to Foundations Director Rose Bruzzo.
Youth Services officials are also in the process of contracting for more wraparound and residential services in the Washington area for the kids they serve. Early next year, Jos-Arz Academy, a charter school for children with special needs, is supposed to open its much-anticipated residential treatment program; that program will serve up to 70 kids at a time.
Money is part of what is attracting renewed interest in finding a solution to this decades-old problem. Although Project Homebound is supported in part with grants from foundations, some of its members, such as the Psychiatric Institute of Washington, are private, for-profit hospitals. And Foundations for Home and Community is a subsidiary of ValueOptions, the company that owns the Pines.
Providing services for troubled kids used to be less attractive to private companies as well as nonprofits, because public funding for community-based services was more limited. The District didn’t finance more community-based services because it never tapped into Medicaid dollars that would allow it to do so. In the past, confusing and often conflicting rules in federal Medicaid law complicated efforts by states to get funding for intensive community-based services. Medicaid generally will pay for only certain types of services, such as nursing-home care or visits to a doctor’s office. But many of the services integral to a wraparound-type approach are funded under Medicaid’s “Rehabilitation Option.” It’s still up to states, however, to apply for the funds.
“In the past, the District didn’t take advantage of the rehabilitation option. We used a hospital outpatient option because the world revolved around St. Elizabeths for so many years,” Knisley acknowledges. “We used much more restrictive, very office-, clinic-oriented treatment and diagnostic services and did not use what Medicaid had available.”
But Knisley, who has helped institute similar reforms in several other states, says she is changing that. This month, the Department of Mental Health began certifying agencies, starting with those affiliated with Washington Behavioral Health Care, to provide wraparound-type services and get paid for them with Medicaid dollars. City agencies will have to kick a portion of their budgets into a pot of money designated for services for kids. The idea is to maximize the funds the city can use to serve kids and to make sure that agencies not waste energy fighting over resources or turf.
By June 2002, the Department of Mental Health and the school system also plan to put mental health professionals in 16 schools across the city. “We’ve been in the mode where we wait until kids fracture and break until we give them the services they need,” says Gay. “The idea is to give them services to mitigate the need later on.”
Gay and others cite the high degree of collaboration among the heads of the city’s child-serving agencies as their main reason for optimism about the District’s new efforts to reduce the number the kids in residential facilities.
“The stars have to be aligned to make this happen,” says Knisley. “The No. 1 thing is, you have to have leaders who work together and not hold resources to themselves. If we change turf and resources, we can change the way we do business and give up the things bureaucracies do after a while. No. 2, we have to deal with the big systemic problems that have kept us from dealing with this in the past. We have to sit down with judges and give them other alternatives [than out-of-state residential treatment].”
If Project Homebound succeeds, Washington Behavioral Health Care will eventually take over the duties of the RRC and decide where to place kids and assign them caseworkers, says Lohman. The caseworkers in turn will coordinate with parents, judges, attorneys, teachers, and social workers at city agencies. The Department of Mental Health’s newly created Office of Accountability will be responsible for overseeing this process as well as the children’s care.
But many advocates for children remain skeptical that the city’s new efforts will pan out. “I don’t have much confidence after all these years,” says Covington. “It’s like crying-wolf syndrome.” CP