In 1985 when I began working in child welfare, the children referred into residential treatment were more behaviorally challenged than emotionally vulnerable. They were more at risk of incarceration than hospitalization for mental illness. The treatment was oriented around managing behavior and providing a structured environment where children could develop coping skills. Little attention was given to their families or the resources they would need upon returning to their communities.
Today the majority of children presenting with similar issues are mostly served successfully in the community with various services offered in their schools and supported by other neighborhood resources. Their families, though challenged, serve as a resource and benefit from a network of services focused on prevention and early intervention. This community-based service delivery system has been very effective in reducing the removal of children and youth from their homes.
As a result of the success of these community-based programs, children referred to residential treatment centers like Hillsides present with a greater level of need after exhausting the resources available in the community. They have significant complex emotional and educational challenges. In addition to a safe and structured environment, they require comprehensive services oriented at stabilizing them emotionally. While in care, the family and all other caregivers develop a long-term treatment plan. For these children and youth, the availability of residential treatment for a period of time is essential.
In spite of the demand for residential care, the benefits of that treatment is a growing debate within child welfare. Often the discussion makes little differentiation between foster families, group homes, and residential treatment, referring to them all as “out-of-home placements” that are quickly dismissed as ineffective in favor of prevention and early intervention.
Recently while in Washington, D.C., I met with the staff of Senator Ron Wyden (D-Ore.), who is the chair of the Senate Finance Committee. His committee is addressing federal finance reform for the child welfare system. My visit was prompted by reports that some members on the committee were considering limiting access to residential and other foster care services.
Such arbitrary limits on the care children require would be ill-advised. Children receiving child welfare services need sufficiently funded and proven effective treatments in order to provide an individualized approached to their care. The majority of these children have experienced traumas that require very specific services, often best delivered in a residential setting. Gone are the days when the approach was to remove children from their families and place them in surrogate communities. Although, we are advocating for an effective system of care that addresses issues early and favors the right of the child to grow up in a loving, caring home, we would be naive to think the solution is that simple. For the children and youth we serve, residential care is an important part of their treatment that requires an individualized approach.
What drives the negotiation process in Washington is not what may be best for children, but what might be most politically expedient and create the greatest cost benefit. I was encouraged by Senator Wyden’s commitment to salvage endangered entitlements or funding for residential treatment for children in foster care.
Years of working in this field has convinced me that what is needed is an adequately funded robust system of care and the flexibility to develop individualized treatment plans around the specific needs of children and youth. The investment of these resources now will pay great dividends in terms of successful lives in the future.