Are some troubled children better suited to institutional care than to conventional family settings? If the answer is yes, as many child-care experts believe, then the fate of those children may rest on the outcome of a struggle now occurring between family advocates and advocates of treatment facilities, which rely heavily on public support
by Mary-Lou Weisman
Orphanages are not what they used to be. They aren't even called orphanages anymore. The residents no longer sleep in metal beds, twenty to a dormitory room. At the Boys Town campus, just outside Omaha, Nebraska, children live eight to a suburban-style home, two to a bedroom. Bureaus have replaced lockers. Uniforms and standardized haircuts are gone. So are the long wooden tables where, in the orphanages of legend, children sat awaiting their portions of cornmeal mush for breakfast, or bread and gravy for dinner. For instance, at the former St. James Orphanage, in Duluth, Minnesota, known since 1971 as Woodland Hills, young people wearing clothes from places like The Gap and Kmart push plastic trays through a cafeteria line, choosing baked chicken or shrimp and rice. The weight conscious detour to the salad bar.
In 1910 some 110,000 orphans lived in 1,200 orphan asylums throughout the United States. At the end of 1990, according to data from the American Public Welfare Association, there were approximately 406,000 children in out-of-home placements. About three quarters of these children were in adoptive and foster homes. About 16 percent, or 65,000, were emotionally disturbed children in need of therapy, most of whom lived in the group homes and residential treatment centers that are the institutional descendants of the orphanage. (The remainder, less than 10 percent, were cared for by a variety of temporary and emergency services.) What little research is available indicates that most of this smaller subset of "homeless" children have been physically or sexually abused, often by the adults charged with their care. At Boys Town, now a residential treatment center--and no longer just for boys--virtually all the girls and nearly half the boys have been sexually abused. The director, Father Val J. Peter, tells of a teenager who asked him on the day she arrived, "Who do I have to sleep with to get along here?"
Child-care workers agree that children in residential treatment today are likely to be far more disturbed than the children who were in need of protective services twenty years ago and who, in turn, were probably more disturbed than the good-hearted orphans with chips on their shoulders who preceded them. These kids have had it with parents--biological, adoptive, or foster--and the feeling is usually mutual. These kids do not trust adults, especially parents. They cannot tolerate the intensity of family life, nor do they behave well enough to attend public school. During a first screening at a residential treatment center a psychiatrist often asks a child, "If you had three wishes, what would they be?" Twenty years ago a typical answer was "I want a basketball," or "I wish my father didn't drink." Today, according to Nan Dale, the executive director of The Children's Village, a residential treatment center for boys in Dobbs Ferry, New York, one is likely to hear "I wish I had a gun so I could blow my father's head off." Child-care professionals call these young people "children of rage." Some of them take antidepressants and drugs to control hyperactivity. In addition to the behavior and attachment disorders common to children who have been abused and moved around a lot, some suffer from having been exposed in utero to crack and some from other neurological problems.
Most of the children who live in institutions are between the ages of five and eighteen. According to a 1988 study 64 percent of children in residential treatment centers were adolescents thirteen to seventeen years old. Approximately 31 percent were younger than thirteen, a percentage that has been increasing. According to the same study, the majority, about 70 percent, were male, a factor attributed to the more aggressive nature of the sex. Approximately 25 percent of the children were black, and eight percent were Hispanic.
A group home may house as few as four children, whereas a residential treatment center may be home to a hundred or more, although in either facility usually no more than eight to twelve are housed together, supervised by house parents or by child-care personnel working eight-hour shifts. At Woodland Hills an old three-story red-brick orphanage building has been renovated so that the first floor can be used for administration, classrooms, and the cafeteria. The second- and third-floor dormitory rooms have been divided into meeting rooms, staff offices, and apartments with bedrooms that sleep two.
Unlike the orphanages from which they are descended, most group homes and residential treatment centers are not meant to be long-term abodes. A typical stay at such a center lasts from several months to two years, after which most children return to their birth, foster, or adoptive families. A significant minority, those who either have no homes to return to or do not wish to go home, move on to less restrictive group homes or to independent living arrangements, also under the aegis of the child-welfare system.
The first orphan asylum in the United States was established in 1729 by Ursuline nuns, to care for children orphaned by an Indian massacre at Natchez, Mississippi. Thereafter the number of orphanages increased in response to wars, especially the Civil War, and to epidemics of tuberculosis, cholera, yellow fever, and influenza. (Contemporary epidemics such as AIDS, the resurgence of tuberculosis, and the rampant use of crack cocaine have the potential to create another orphan crisis in the twenty-first century. By the year 2000, it is estimated, 100,000 children, most of them from female-headed households, will lose their mother to AIDS. Senator Daniel Patrick Moynihan, among others, foresees the return of the orphanage as inevitable.)
In spite of the Dickensian reputation that outlives them, orphanages, which began to proliferate in this country in the mid-1800s, represented a significant social reform for their time, just as the group homes and residential treatment centers that took their place are now seen as reforms. Before orphan asylums were common, orphaned, homeless, and neglected children, if they were not living, stealing, and begging on the streets, were housed, along with adults, primarily in almshouses, but also in workhouses and jails. The Victorian conviction that childhood was a time of innocence influenced attitudes toward destitute children. People came to believe that even street urchins could be rescued--removed to a better environment and turned into productive citizens.
Most orphanages were private institutions, the result of the combined efforts of passionately committed "child savers," children's-aid societies, and a variety of mostly religious but also ethnic organizations that raised the money to build and maintain them. But even as the orphanage was becoming the nation's dominant mode of substitute child care, an anti-institutional effort called "placing out" was under way, setting the stage for a debate that continues to this day. By the mid-1800s children were being transported on "orphan trains" from crowded eastern slums and institutions to the West, where they were adopted by farm families in need of extra hands. By the late nineteenth century, in a further move away from institutionalization, cottage-style "homes," which more closely mimicked family life and each of which housed about twenty-five children, began to take the place of large orphanages.
In the twentieth century, psychology--first psychoanalytic theories and then behaviorism--has dominated the field of child welfare. Unlike psychoanalytic theories, which focus on the child's inner personality, behaviorism emphasizes the way the child interacts with his world. In this view a child is not "bad"; his unacceptable behavior is. By changing the behavior, so the thinking goes, one changes the child. Behavioral theories replaced psychoanalytic theories, which were used only to limited effect by Bruno Bettelheim and others in the "homes" and "schools" for emotionally disturbed children which appeared mid-century. The therapeutic hour remains important, but what goes on in the child's life during the other twenty-three hours of the day is seen as potentially even more valuable. (A book by that name, The Other 23 Hours, by Albert E. Trieschman, James K. Whittaker, and Larry K. Brendtro, is the classic text of residential treatment.) The goal of residential treatment is to create a "therapeutic milieu," an environment in which everyday events are turned to therapeutic use. Any activity in a child's day--from refusing to get dressed in the morning to answering a question correctly at school to picking a fight--offers the child-care worker an opportunity to teach, change, or reinforce behavior through therapeutic intervention. Residential treatment aims to seize the moment while it is happening and the child's feelings are still fresh.
Policy versus Reality
Orphanages as such had virtually disappeared by the late 1970s as a result of a decrease in the number of orphans and a growing conviction that children belong in families. That every child needs parents and a home has become an article of faith and a guiding principle for social-policy makers and a matter of federal law as well. The philosophy of "permanency planning," as set forth in the Adoption Assistance and Child Welfare Act of 1980, considers the goal of the foster-care system to be keeping children in families. The law allows for but discourages "out-of-home placement" --institutionalization in group homes or residential treatment centers--and calls for the return of the children to a family, biological or otherwise, whenever possible and as quickly as possible. But for many practitioners in residential treatment the law has become increasingly irrelevant.
Richard Small is the director of The Walker Home and School, in Needham, Massachusetts, a residential and day treatment center for severely disturbed pre-adolescent boys. Writing recently in a professional journal with Kevin Kennedy and Barbara Bender, Small expressed a concern shared by many of his colleagues. "For at least the past decade, we in the field have been reporting, usually to each other, a worsening struggle to work with a much more damaged group of children and families, and a scramble to adjust our practice methods to meet both client needs and policy directives that may or may not have anything to do with client needs. . . . Those of us immersed in everyday residential treatment practice see these same guidelines as less and less applicable to the real children and families with whom we work. Many of our child clients and their families suffer from profound disruptions of development that we believe are likely to require long-term, multiple helping services, including (but not limited to) one or more time-limited stays in residential treatment. Despite a policy that seems to see clear boundaries between being "in care" (and therefore sick and vulnerable) and "reunified" (and therefore fixed and safe) our experience tells us that many of our clients are likely to live out their lives somewhere between these poles."
In keeping with the goal of permanency planning, institutions are supposed to maintain close communication with the parents of the children they treat. Many centers offer counseling for parents and for the entire family. The Children's Village runs evening and weekend programs especially for parents who have abused their children. At institutions that adhere most closely to the goal of reuniting parent and child, parents are encouraged to visit, and good behavior on the part of children is rewarded with weekend visits home. Green Chimneys, a residential treatment center that serves primarily inner-city kids, regularly transports parents and children in vans between New York City and its campus in Brewster, New York. Nationally, nobody really knows how many families are reunited, for how long or how successfully. Those who work with children in institutions complain that the pressure from departments of social service to reunite parent and child is so intense that the workers sometimes yield to it despite their better judgment.
The objective of residential care is to discharge healthier children into the care of healthier parents--an outcome that authorities agree is desirable in theory but not always likely in fact. In their recent casebook for child-care workers, When Home Is No Haven, Albert J. Solnit, Barbara Nordhaus, and Ruth Lord write that "one of the hardest tasks for a new worker is becoming reconciled to the inherent contradictions in the Protective Services worker's role. The worker is expected to aim for two goals, which in some instances may be mutually exclusive: reunification of the family, and protection of the child and the child's best interests."
Modern children who fall from the grace of their biological parents find themselves in what is known in welfare vernacular as the child-care continuum. Viewed simplistically, the continuum is a sequence of possible living situations, starting with the most homelike (adoptive and foster homes) and ending with the most institutional (residential treatment centers and psychiatric hospitals). Group homes, some for developmentally disabled children and others for dependent and neglected children, occupy the middle of the continuum. Generally speaking, children in group homes are less emotionally disturbed than those in residential treatment, but the continuum is far more complex and the boundaries between one option and another more porous than this description implies. For instance, children who are sufficiently emotionally disturbed to qualify for residential treatment are sometimes cared for in group homes.
In its desire to find a safe, loving, permanent home for every child, the system often becomes an unwitting abuser. The saga of Wendy, seventeen years old and living in The Villages in Topeka, Kansas, demonstrates the destructive potential inherent in the pursuit of permanence. Her experience at The Villages also illustrates a long-term institutional alternative for rearing some troubled children for whom parents may not be possible or desirable. (The names of children and some adults, along with a few insignificant details, have been changed, in order to protect the privacy of the children and their families.)
The Villages was founded by Karl Menninger in 1964, in response to homelessness, and now includes eleven group homes in Indiana along with the original eight in Kansas. (Menninger was one of the founders of the Menninger Clinic, which has no business relationship with The Villages.) The Villages is a nonprofit institution. Length of stay at The Villages is more open-ended than the two-year period prescribed at most residential treatment centers, as evidenced by the exceptional case of one young man who has been there since 1986. On the average, children spend about two and a half years at The Villages, although about 10 percent stay from three to five years.
Wendy was one of six children, no two fathered by the same man. "My mother," Wendy says, "was a slut." After their mother abandoned them, when Wendy was six years old, the state placed each of the children in a different foster home. Wendy was removed from her first foster home a year later, after being sexually abused by the older boys in the family. Because no new foster home was readily available, she was sent to a locked facility for juvenile delinquents, where the youngest inmate was fourteen years old. Two months later she was transferred to a foster home, where she lived for two months, until she returned from grade school one afternoon to find that her foster parents had moved, leaving no forwarding address. She moved in with one of her schoolteachers temporarily until another foster home could be found. This home, Wendy says, "was great," but the mother died and Wendy was transferred to yet another home. "It was pretty fun," Wendy says. "We lived on a farm."
At this juncture Wendy's mother turned up and asked to be reunited with her children, an experiment that was declared a failure within a year, whereupon Wendy was sent on to more foster homes and more sexual abuse. Wendy was placed at The Villages for the first time at the age of twelve. She remained there for three years, until an adoptive home was found. "The father tried to make it work, but the mother was never home," Wendy says. "She wanted me to clean. She wanted me to dress fancy. We had lots of verbal clashes."
A second attempt to find her an adoptive family failed when Wendy began surreptitiously to hit the couple's two-year-old baby. By that time Wendy was using knives and other sharp objects to make shallow cuts on the insides of her wrists--a behavior so common among abused children that those who engage in it have a name for themselves: "carvers." Wendy was sent to a psychiatric hospital for two months and then returned to the second adoptive home, where she again abused the baby. "I was afraid of getting too close," Wendy says. "I started trying to make things not work."
When Wendy was fourteen, child-welfare workers decided that she should spend some more time at The Villages before efforts were made to place her with another family. The day Wendy arrived, one of the house parents tempted the reluctant fourteen-year-old over the threshold with milk and cookies.
Once inside, Wendy set about reassuring herself about her most urgent concern: in this house of milk and cookies would she be safe from sexual abuse? "Is there a father in this house?" she asked one of the girls who'd been living there for several months. When she got yes for an answer, Wendy asked a second question: "Does the mother always believe him?"
Karl Menninger was convinced that a permanent home was the best therapy for troubled children. The job of house parent requires no training in advance, but by law house parents must attend at least thirty hours of professional workshops each year. The youngsters in The Villages seem to be kept on an even keel with such old-fashioned standards as church attendance, daily chores, clean rooms, neat dress, set bed times, and obedience to adults without fussing, plus, for some, the modest use of modern psychotropic medications and weekly visits to a therapist in the community. The Villages cares for many children who might otherwise be in residential treatment centers.
"The essence of therapy at The Villages is paradoxical: it's therapeutic, but you should not feel as if you're in a treatment program--the family is the treatment," says Don Harris, who until recently served as acting director of The Villages. "Some children are too problematic to fit into this setting. The Villages is not a place for violent children or those who have been so badly turned off parents that they don't want to connect." Weekly private visits between children and their social workers provide a check against abuse from house parents, in addition to another positive relationship with an adult.
Married couples preside over all but one of the homes. The exception, a household of adolescent girls, is headed by a single parent, a woman. Depending on the talents and interests of the house parents, each household encourages different kinds of family activities. Some households take their children to the symphony and stage family skits and musicals. Other households emphasize sports, or arts and crafts. The children attend public school in the community, although they tend to have more friends at home than among their schoolmates.
After two years Wendy's emotional health has improved dramatically. She has become very attached to the house mother and is a "big sister" to the other boys and girls in the household, who range in age from ten to seventeen. Wendy has done increasingly well in the public high school and plans to attend the University of Kansas. State child-welfare authorities, taking note of her progress, want to move her to an adoptive or foster home, but Wendy has her own ideas on the subject and doesn't want to go. "I was always told that when I got my act together, they'd leave me in one place," she says. "I finally did get it together, and now they turn around and say, 'Well, you're too good to stay here. We need to move you again.'" The State of Kansas spends about $19,000 a year to keep Wendy at The Villages. (The real cost is $26,000, but the difference is made up by private donations.) Family foster care in Kansas costs the state about $4,500 annually per child.
Nan Dale, of The Children's Village, speaks for many others who believe that money, and not the needs of the children, drives the child-welfare system. "You've got to ask, after the second or third or fourth foster-care failure, when the child has set a fire, cut the cat's tail off, and attempted suicide, how come nobody has said, 'This kid needs treatment and not just another foster home'?" The fact that for the most part residential treatment receives its money from the same source as less expensive foster-home care does nothing to improve its image or encourage its use. In New York state, for example, where all forms of child care are especially costly, "regular" foster care costs about $39 a day per child. "Therapeutic" foster care, for which parents are trained and paid extra to deal with difficult children, costs $92. Stays in group homes cost $130 a day per child, residential treatment costs $135, and a day in a psychiatric hospital costs $800. Because psychiatric hospitals tend to keep children only long enough to diagnose and stabilize them--usually before sending them on to residential treatment centers, where they may stay up to two years--long-term residential treatment takes most of the fiscal heat. "No one sends a kid directly to an institution," says Sam B. Ross Jr., the founder and executive director of Green Chimneys. "You have to try everything else first. We don't do things by choice. We do things by finances. If you had funds, you would not let what happens to these children happen to your child."
In addition to the administrative and maintenance costs associated with any institution, $135 a day reflects the costs of room, board, clothing, round-the-clock therapy, medical and dental care, and recreational and cultural programs. Children who enter residential treatment are typically up to three years below grade level. Many have severe learning problems as well as behavioral ones. At The Children's Village, for instance, a local school district operates a special-education program for kids with emotional, behavioral, and learning problems. The student-teacher ratio is six boys to one teacher and an aide. Even though food for the 315 boys at The Children's Village is bought at bulk rates, it costs about $5 a day for the younger children and $8 for adolescents. Annual clothing costs for the younger children are about $500, and for adolescents about $1,000, including an outfit for Sunday best.
Money flows into residential treatment from a variety of federal, state, local, and private sources, and the amount any agency gets depends on a number of factors, including how assiduously and creatively it works the system. At the federal level the Department of Health and Human Services and sometimes the Department of Justice appropriate money to the states. Licensing, required in order to qualify for federal funds, is up to the individual states. States match federal money using formulas that vary from state to state. The states then reappropriate the funds to the agencies that provide the care. The agencies are about evenly divided between public and private. Money at the local level most often comes from private sources such as churches and the United Way.
The children who enter the child-welfare system are almost always from the bottom of the socioeconomic ladder and therefore at the mercy of bureaucrats, policymakers, social workers, and judges. Where do people with money send their emotionally disturbed children when they can no longer tolerate them at home? If they don't ship them off to a tough uncle who owns a dude ranch in Colorado, or check them into a psychiatric hospital, chances are they enroll them in boarding schools described in their brochures as suitable "for the child who has special educational and emotional needs." The cost? About $36,000 a year, the price of many residential treatment centers and group homes, although private boarding schools do not pay for a student's clothing, medical and dental treatment, vocational training, or other extracurricular needs. Private boarding schools also carry no social stigma.
In the postscript to her memoir, Orphans: Real and Imaginary, Eileen Simpson writes about learning as an adult that the convent boarding school of her childhood, the Villa, was actually an orphanage. She was grateful for the deception, because the truth would have been "a heavy burden to me as a child," she says. "As an adult, it would have interfered with my view of myself as having been lucky. An orphan who goes to an orphanage is far more orphaned than one who goes to a convent boarding school."
"Institutionalism is in the eye of the beholder," Lois Forer, a former judge of the state Court of Common Pleas in Philadelphia, and the author of books and articles about children and the court system, said before her recent death. "Call residential treatment centers boarding schools." Forer observed that even the word "institution" can take on a very positive connotation when the right people are in residence. "The tubercular rich were sure having a high old time on the Magic Mountain," she said, "while the poor were in the slums coughing their lungs out."
Institutional Family Values
In the paradoxical world of "child protective services," an institution may be the first home some children have ever known, providing their first chance to sit down to meals with other people at regular times, blow out birthday candles, and be taken care of by adults who do not hit or even yell. All but one of the staple ingredients of a happy home life are replicated in the best group homes and treatment centers. Intimacy is purposely missing. Love and family bonding may be what these children will need and be capable of having eventually, but for the moment the emotional thermostat must be set at neutral. These children are believed to be too disturbed to handle the intensity of real family life; that is precisely why they have been institutionalized.
The best institutions offer emotionally disturbed children a chance at a second childhood. They are given the opportunity to shed cynicism, develop self-esteem, and grow back into innocence and vulnerability. Candy will become a treat. This time they will be protected from harm. This time they will come to think of adults as kind and dependable. They will learn to play. They will learn to care about others.
Treatment communities teach Judeo-Christian values--the work ethic and the golden rule. Institutions offer vocational training and courses in computer literacy. At The Children's Village the best computer students teach their newfound skills to other children and adults in the surrounding communities, and The Children's Village has its own Boy Scout troop. The kids at Woodland Hills collect and pack supplies for national and international relief efforts. In addition, they split wood and deliver logs to the elderly in the Duluth community. Boys Town children host Special Olympics games.
A highly controlled environment is required to create a second childhood for severely disturbed children. Safety is the key issue. Keeping these children from harm involves more than keeping them safe from sexual abuse, physical abuse, drugs, and crossfire; they must be kept safe from themselves and their peers. Newly institutionalized children often try to run away. When a young person at Woodland Hills forgets to bring the appropriate book to class, two peers accompany the student back to the dormitory to retrieve it, thereby minimizing the possibility of an escape attempt. At The Children's Village burly guards equipped with walkie-talkies and trained in firm but gentle techniques of physical restraint stand ready to intervene should fights or tantrums develop beyond the regular staff's ability to control them. Children are never left unattended, not even when they sleep. In every one of the twenty-one cottages at The Children's Village one staff member remains awake throughout the night. The children in these cottages are sometimes suicidal. The bedroom doors in all the cottages open into the corridor, so that youngsters cannot barricade themselves in their rooms. Sexually abused children sometimes become sexual predators. At The Villages in Kansas some young girls will not allow anyone to comb their hair; for girls who have been sexually abused, even grooming can be too threatening.
This antidotal second childhood must be highly structured and predictable as well as safe. Treatment communities impose rules, chores, and schedules, and emphasize neatness, cleanliness, and order. "Everybody wakes up at 7:30 in the morning," writes eleven-year-old Robert, describing his day at The Children's Village, where hairbrushes, combs, toothbrushes, and toothpaste tubes are lined up with military precision on bureau tops. "The first thing we do is make our bed, wash our face, brush our teeth, last but not least put on some clothes. We eat our breakfast by 8:15 and do our chores. At 8:45 we go to school. In school the first thing we do is math, then reading and spelling. We go to lunch at 12:00 noon. . . ." Homer, the orphan hero of John Irving's The Cider House Rules, thrives on the routine of orphanage life. He enjoys "the tramp, tramp of it, the utter predictability of it." "An orphan," Irving writes, "is simply more of a child than other children in that essential appreciation of the things that happen daily, on schedule." A well-structured day serves the child as a kind of armature within which to build a new, less chaotic, inner self. "How to succeed and how to fail is very clear here," says Daniel Daly, the director of research at Boys Town. "These children are looking for consistency and for an environment they can understand."
Often institutions for children, like religions, have their own belief systems. What the faith is may not matter as much as its function as an organizing principle for its adherents. At The Villages the organizing principle is a belief in the therapeutic value inherent in family life. Woodland Hills is committed to a behavioral model called "positive peer culture." Any surrogate who remotely resembles a parent, or any scenario that draws its inspiration from a Norman Rockwell dinner-table tableau, is presumed anathema to this population of disturbed teenagers. Instead the kids confront one another in group therapy, and the staff gambles on its ability to turn the potentially destructive power of the peer group into a positive force. The Walker School, which adheres to a "cognitive behavioral model," has as its article of faith the conviction that every child can learn. As a result Walker places an unusually strong emphasis on academics, although "learning" at Walker can mean anything from solving math problems to practicing sitting still to running in the right direction in baseball. Green Chimneys is well known for using animals to encourage children to love and trust. Through "farm therapy" children learn to be care-givers even if they have not been cared for themselves, thereby helping to interrupt the cycle of abuse.
When it was an orphanage, Father Flanagan's Boys Town put its faith in God and the work ethic. Now that it's a residential treatment center, it also believes devoutly in science and technology. Father Val says, "Boys Town has embarked upon a program of basic research in microbehavioral analysis," the goal of which is to develop practical, replicable techniques for changing the behavior of emotionally disturbed children. These techniques are explained in a 250-page manual that is used to train the "family teachers" who head up each Boys Town "family." So "micro" is the behavioral analysis that the manual breaks down what Boys Town calls a "teaching interaction" into nine component parts: initial praise, empathy, or affection; description of the inappropriate behavior; consequence; description of the appropriate behavior; rationale for (benefits of) appropriate behavior; request for acknowledgment; practice of new, appropriate behavior; feedback; praise throughout the interaction.
Boys Town: The Teaching Family
Boys Town is the most complete and controversial realization of the prevailing belief that a residential treatment center should look as little like an institution and as much like a home as possible. Indeed, Boys Town is much more than a happy home; it's a happy village. In fact it is a number of happy villages. Boys Town has cloned itself; by next year as many as seventeen little Boys Towns will be in operation in several states.
"We have a plan to change the way America takes care of her children," Father Val says. By saying so he sticks his finger in the eye of the child-welfare establishment, which considers Boys Town a bit overzealous, too lax in its efforts at family reunion, too independent, and too rich.
With net assets of $514 million, Boys Town is the Abu Dhabi of residential treatment centers. The place has its own schools, churches, town hall, firehouse, ZIP code, and two Olympic-sized swimming pools. A neighborhood of seventy-five variously styled houses, any one of which would sell for more than $400,000 in Fairfield County, Connecticut, is tucked behind flower gardens on 400 acres of specimen trees and dense, cushy lawns. Another 900 acres is farmland under cultivation. A man-made lake is stocked with bass and bluegill. Whereas other residential-treatment-center campuses have the slightly scruffy appearance common to boarding schools with meager endowments, Boys Town has the finely calibrated utopian look of an architect's rendering. The brick houses, with their picture windows and slate roofs, are set well back on generous lots and are furnished with plush wall-to-wall carpeting, Tiffany-style chandeliers, TVs, and Monopoly games. Clusters of "family" photographs decorate the walls and are displayed on mantelpieces. Bikes are parked in back yards, near handsome sets of lawn furniture. For the 100,000 tourists who visit each year, never mind the 556 boys and girls who live there (girls were first admitted in 1979), Boys Town evokes nostalgia for a Cleaverish community and home they probably never knew. The effect is intentional, if a bit surreal. All that comfort, all that beauty, all those possessions, says Father Val, a great believer in first impressions, send the children a message they may never have heard before: "You are valuable."
During dinner at a "family" home in Boys Town butter is requested with a smile and a "please" and acknowledged with a "thank you," and the presiding "parents," Linda and Geoffrey (not their real names), lavishly pass out praise along with the chicken enchiladas, rice, and mixed fruit. "I like the way you made eye contact with Judy when you asked for the butter," Linda says.
Linda and Geoffrey sit at either end of an oval table. The eight girls seated between them, four on each side, are clearly not their natural children. They are too close in age--eleven to seventeen--and not all of the same race. What they do have in common, besides histories of sexual and physical abuse, is a set of learned behaviors that they show off with obvious pleasure. These girls greet a stranger with a big smile and a firm handshake. They also accept nonstop instruction in how to acknowledge criticism and take no for an answer. A child who six months ago would have turned the table over rather than respond to a request to set it now complies promptly and cheerfully.
Tonight, while the girls are learning table manners good enough for dining with Rockefellers, they will also be practicing their problem-solving skills. Jasmine, the youngest member of the family, has requested and been granted the privilege of presenting the evening's problem. Jasmine is nervous. She takes a deep breath and states her case. Jasmine is unhappy because her night to help prepare the family dinner is always Thursday, which also happens to be leftovers night. This means she never really gets a chance to cook.
"That was good, Jasmine, very good," says Linda, maintaining eye contact with Jasmine. "You did a good job of stating the problem clearly."
Jasmine smiles and blushes with pleasure. (Because a stranger has joined them at the table, tonight's problem and the ensuing discussion are trivial and tame. Under normal conditions the problem posed could have been "My parents don't care what happens to me." Such a statement might have prompted Linda or Geoff to help the child to clarify her problem for herself and for the other children: "Did something happen on your visit home last weekend?")
"Can you think of a way to solve the problem?" Linda asks Jasmine.
"Well," Jasmine says, "we could make Wednesday leftovers night."
"Good for coming up with a suggestion, Jasmine," Linda says. "That's one option. I can see you're really trying to figure this out. Can anyone else think of another?"
Over chocolate pie and milk, after a few more options have been raised and praised, the group turns to an eager but orderly discussion of the disadvantages and advantages of each of the options offered. "Can you think of any problems if you do that?" Geoff asks. "Can you think of any benefits?"
This is not a Stepford family. Although one might be tempted to see them as genial robots, rehearsing therapeutic dialogues from the Boys Town manual, they are also having a good time. David Coughlin is the second-in-command and the youth-care director at Boys Town. He acknowledges that behavioral psychodrama can sometimes look pretty stilted and silly, but says that it does only until the children have mastered the behavior. In this, their second childhood, these kids have to practice being normal. They are conscious that their behavior is being manipulated. They choose to play the game. The doors are not locked.
After dinner the girls move to the den, where they record on index cards the points they've accumulated throughout the day. Every day is parent-teacher-conference and report-card day at Boys Town. Point cards from school are carried home and compared with home cards so that everyone who works with a child knows how that child is doing. (At The Walker School communication and coordination are facilitated by a computer network. Throughout the day child-care workers and teachers feed in and retrieve information about individual children.) The object of all this attention, the child--whom Boys Town calls "the consumer"--also has ready access to the files. Some institutionalized kids can tell you exactly how many points they have the way some grown-ups can tell you to the dollar how much money they've got in the bank. Jasmine may have been awarded 10,000 points for her dinner-table presentation, but she may also have been docked thousands of points in school that day for failing to finish her homework. "Behavioral points are a lot like Catholic indulgences," Coughlin says. "We've got little sins, big sins, confessions, and plenary indulgences."
Points, awarded as flamboyantly as praise, translate into privileges and purchasing power. Thirty thousand points entitles a child to listen to a story on a cassette tape; a comic book costs 50,000 points. Adding and subtracting high numbers adds drama to the game and hones mathematical skills.
The Problem With Parents
When parents treat each other and their children with patience, love, and consistency, they are making a "happy home." When child-care workers do the same, they are modeling parental behavior and creating a "therapeutic milieu." When parents instinctively intervene from dawn to dusk to impart information or to comment on or calm a child's behavior, that informal activity is called child rearing. When child-care workers do it on a twenty-four-hour basis, it's called therapy. The good child-care worker, like the good parent, sees every event and encounter in a child's life as an opportunity to discourage destructive attitudes and behavior and replace them with healthy alternatives. Whatever particular philosophical model an institution may follow, all institutions agree that the most significant influence for change in a troubled child's life is the institutional parent or child-care worker.
Children's institutions must handle the issue of noninstitutional parents with the utmost delicacy. To some extent a natural hostility exists between parent and institution. Mistreatment by parents is one of the reasons that many children end up institutionalized. Nevertheless, the institution depends on the cooperation and rehabilitation of the parent to effect the ultimately desired family reunion.
Children typically enter a period of mourning when they are placed in a treatment center. No one insists upon loyalty to parents more than the institutionalized children themselves. In the introduction to Love Is Not Enough (1950), a book about his experimental school at the University of Chicago, Bruno Bettelheim wrote about a child named Emily who learned to handle conflicting loyalties to her parents at home and her counselors at school. "Asked what love meant, Emily answered, 'Love means to hug me and kiss me and carry me and put me down.' After a pause she added, 'Parents do it. Counselors becare you.'"
At The Children's Village a list of house rules written by the boys is tacked to a dormitory wall, along with posters of Magic Johnson, Michael Jackson, and Malcolm X. "No talking about a peer's parents" is rule No. 1, followed by "No stealing," "No lying," "No cursing or fighting," and "No damaging property or playing with fire extinguisher."
The eight girls who live with Linda and Geoff at Boys Town do not call them Mom and Dad or refer to them as "parents." Most intentionally, Boys Town calls the married couples who head up their seventy-five households "family teachers," a less intimate and more apt description. Even at The Villages, where exposure to healthy family living is the primary therapy, ten-year-old Melissa calls her house parents by their first names. Melissa, who starved while her parents dined, still clings to a family snapshot years after the court severed parental rights. "My parents locked me up in a closet and forgot about me," she says. "I miss them."
The critical challenge at Boys Town, as at all institutions for emotionally disturbed children, is to provide the child with a remedial childhood and remedial parental role models, within a remedial community, without challenging the child's loyalty to his real home or parent.
At the swearing-in ceremonies that take place nearly every Friday at Boys Town, Father Val is careful to tell the new arrivals, "You don't lose your own family, but you gain another family, a bigger family. You become part of the Boys Town family." When students gather in the assembly hall at Boys Town's Wegner Middle School to recite the Lord's Prayer, salute the flag, and sing the national anthem to heavy handed accompaniment on an upright piano, they stand beneath a large computer-generated banner that reads "We Will Not Give Up On You." Even the concept of unconditional love--once associated exclusively with parents--has been institutionalized.
Institutional parents are too good to be true. They teach but never lecture. They praise but never blame. A child who has just thrown a chair through the bay window, hurled curses at the family teacher, and then slumped down on the sofa will be docked 50,000 points for the chair and the bad language, and then given 10,000 points for regaining control. "Look! You've already earned back ten thousand points. You'll be out of the hole in no time." These parents are upbeat. They are rational. They never say "Because I said so." What makes the good ones effective is the very fact that they are not real. These kids have already had real parents.
Woodland Hills: Positive Peer Culture
A female black bear is pawing through the Dumpster behind the old orphanage building at Woodland Hills. Some of the staff and a few of the kids have come out on the driveway to watch. Sixteen-year-old Kate cowers with fear, although she is about 300 feet from the bear and just one foot away from the back door. Six months ago Kate was a tough gang member. She stole a car and drove it through a store window. It was not her first offense. The judge gave her a choice between jail and Woodland Hills.
If Boys Town's style is "please" and "thank you," Woodland Hills's is "in your face." This is no corporate headquarters for family values; it's boot camp for juvenile delinquents. Forty-eight boys and girls, aged thirteen to seventeen, pound up and down the three flights of stairs that form the crooked spine of the old St. James Orphanage, founded by Catholics in 1910. The large, stern, Federal-style building, remodeled within to create smaller spaces, functions as a school, dormitory, cafeteria, and administration building. No attempt has been made to make the place look like anyone's home, real or imagined.
"When I got here, my hair was spiked," Kate says. "I was wearing combat boots, and my makeup was nasty. I liked my reputation, because nobody messed with me." Today she's wearing jeans, a T-shirt, running shoes, and no makeup. She proudly points to the pile of wood she has split. Then she walks over to a rabbit hutch, unhooks the door, and scoops up a big gray rabbit. "There's no drugs here and nothing to sniff," she explains, while the rabbit nestles in her arms. (Most of the kids at Woodland Hills have been substance abusers.) "They don't let us have anything that has drugs in it, like bleach or gas, nothing that we could sniff and get high. We got to get trusted even before we can use the lawn mower."
No child-care worker is likely to be able to sell Kate on charm-school manners or a point system. Parental role models are out of the question. So, one would think, is getting these kids to give up street gangs for membership in teams with nerdy names like The Pioneers and The Trailblazers. But it's not--not any more so than getting an alcoholic to stand up that first time and declare. The power of Alcoholics Anonymous is well known, and getting former gang members to help other gang members go straight is also possible.
Positive peer culture is based on two simple Judeo-Christian principles: anything that hurts any person is wrong, and we are our brothers' keepers. The essence of peer culture is helping others. "No matter how troubled a person is, it always helps to get him off his ass and go do something for someone else," says Richard Quigley, who heads up Woodland Hills. "There's plenty else you've got to do for a real troubled person, but caring for someone else is the therapeutic ingredient you can't do without." The trick is getting these supremely careless children to care, first about someone else and then about themselves.
A newcomer to Woodland Hills gets placed in one of several pre-existing groups, each having about ten members. Young people of the same age, size, sex, and degree of sophistication are put together, although passive or aggressive kids are not likely to be concentrated in any one group. Unlike the teaching parents at Boys Town, who intervene all day long, correcting and reinforcing the behavior of their charges, group leaders at Woodland Hills intervene as infrequently as possible in the peer-group process. It is the kids who continually engage one another in therapy. Newcomers, who are used to defending their behavior with fists and knives, freeze like deer in headlights when veteran peer-group members gently ask them, "What are you gaining? What are you losing? Whom are you hurting?" Often the delicate balance of a group is upset from within by the charismatic presence of a "negative indigenous leader," or NIL in psychologists' shorthand. Even then a good group leader will not intervene directly. Such recognition by and confrontation with an adult leader would only enhance the NIL's status. Instead the adult leader attempts to disturb the NIL's social equilibrium by pulling the NIL's victim aside and confiding, "Take a look at how that guy is trying to influence you; watch how he's trying to get you off track."
"Working with a group is like practicing jujitsu," says David Kern, Woodland Hills's program director. "What am I doing? I'm taking your weight and your energy and your force, and moving it in the direction that you need to go. I'm not in fear of you coming at me. As a matter of fact I look forward to it, so that I can direct you."
Practitioners of peer-group therapy speak jujitsu English, using the delinquents' own words for and against them. Caring behavior is referred to as "strong," "cool," "powerful," and "mature." Hurtful behavior is relabeled "cowardly," "weak," and "childish." First you "talk the talk," they say at Woodland Hills; then you "walk the walk." If a kid hears and sees nothing around him all day for months but male and female group leaders modeling both strength and caring, after a while the message begins to sink in: "You are valuable."
Unlike most residential treatment programs, in which a stay may last as long as two years, the peer-culture program takes just eight months to complete. Kate spent the first two weeks at Woodland Hills in a stubborn state of resistance known as "casing the joint"--the first of five designated states in the peer-group process. "Nobody was going to tell me what to do," she says.
The language at Woodland Hills tends to be rough and to the point. At Boys Town teaching parents precede each corrective "teaching interaction" with an expression of appreciation, praise, or empathy for the child. At Woodland Hills group leaders also praise before they correct, but they call the procedure "bump and burp."
After she calmed down, Kate was invited to participate in an initiatory rite, the recitation of her "life history" before the girls in her peer group. Like the rest of them, she had been sexually abused. Like many of them, she had received counseling in her community and had lived in two foster homes, a therapeutic foster home and a group home, before Woodland Hills. Like most of them, she had been cared for by a single parent, her mother. Her troubles had started when she was thirteen years old and escalated quickly from skipping school to fistfights to drugs to breaking and entering to car theft.
Her peers listened to her story and offered their diagnosis, chosen from a prepared list of possible "problem labels." "My problem labels are 'authority,' 'inconsiderate to self,' and 'easily angered,'" Kate volunteers, rattling them off like name, rank, and serial number. "Inconsiderate to self" is a label applied to anything one does that is damaging to the self, such as putting oneself down or resisting help from others. In Kate's case the damage is literal. Kate is a carver.
Kate spent the next few weeks in stage two, "testing the limits." She refused to get out of bed in the morning. She would not attend school. "All I wanted was to get out," she says. She ran away twice. Both times staff members went out in the middle of the night to look for her rather than call the cops. That display of unconditional institutional love impressed her. "I didn't know that people who didn't know you could care about you," she says.
Then Kate entered the third, honeymoon stage of peer culture, "conformity." She behaved, but only because behaving was the thing to do. "I kissed butt" is how she puts it. "She really looked good," David Kern says, "but she still wasn't buying into the reason for behaving; she still didn't believe that she, or anyone else, was worthwhile."
Now Kate is in stage four, "value conflict." It's the critical stage. She wants to try the new way--to move on to the final stage, "change"--but the old way comes so much more easily. "I've got a lot of anger built up," she says. "I'm like a volcano or a time bomb. When I get angry, my old values come back. I, like, turn over."
Kate turned over in a big way at a group meeting when she got the news that the staff had decided not to grant her request for a weekend pass to visit her mother. She had carved on herself just a week earlier. They didn't think she was ready for a home visit. When her two best friends in the group tried to comfort her, she turned her fury against them, zapping them with exquisitely customized racial and sexual insults, making crude references to Peg's preference for black men and calling the promiscuous Georgia a "whore."
Today, after bullying the group for a week with silence, Kate, in classic peer-culture tradition, has asked for and been awarded a meeting of which she will be the subject.
"You built up all that trust with Peg and Georgia," a girl named Jane tells her, "and then you destroyed it in five minutes. Was it worth it?"
"My brother used to call me a whore," Georgia says. "You knew that."
"You shouldn't tell me stuff, 'cause when I get pissed off, I'll use it," Kate says, pulling a tissue from the box on the floor at her feet and wiping her tears.
"What would have happened if you'd let Peg and Georgia in?" another girl, Theresa, asks.
"I've tried before, and I've gotten hurt," Kate says. She kicks the tissue box toward Georgia. Georgia yanks out a tissue and blows her nose.
"She's vulnerable," Peg says.
"So it's 'I'll get you before you get me,'" says Lucie, the group leader. "Who else does that?"
"I do it, big time," Peg says.
"What's it gonna take," Georgia says, "to get you to start doing something for yourself?"
Kate doesn't answer. She just looks at her shoes.
"Kate," Jane says, with some frustration, "we're trying to care about you."
The meeting goes on like this for an hour and a half, until Lucie brings it to an end by complimenting the quality of the help given to Kate by her peers. She also credits Kate for working hard.
The questions asked of Kate are more important than the answers she gives. "A lot of people miss the point," Kern says. "The most important thing that goes on in a meeting is not whatever changes may or may not take place in the person who's getting help; it's the changes in the self-concepts of the nine people who are giving it. They deal with their own problems as they see them more sympathetically projected onto the youth who is the subject of the meeting."
Even so, Kate seems to have benefited from the meeting. "This place is really caring," she says. "They were crying because they were feeling empathy for me. They stuck to me like glue."
Are Institutions Successful?
"It doesn't matter that a kid behaves well in front of you in a residential treatment center," says Earl Stuck, the director of residential services for the Child Welfare League of America. "We've only begun to use the power of residential treatment when we use it to help kids apart from their families. The real power of the tool is in figuring out ways to create the same kinds of change in families." What counts is what happens to children like Kate after they leave the cocoon of the institution and try to get along in the real world. Kate hopes that if she makes it through all five stages of the peer-culture program, she can go on to a career in the Army. That would be a resounding success. (Military service is a frequently chosen career among institutionalized young people, who find the continuation of a highly structured life appealing. Twenty years ago a career in the armed services was a more realistic goal. Today, because many of these young people are more disturbed, the military is out of reach for a lot of "graduates.")
Very little solid research is available on the subject of whether or not institutionalizing children does them any lasting good. Researchers and child-care experts say that this lack of public accountability is due to a shortage of funds for research, which existed especially during the Reagan and Bush years. Indeed, experts disagree widely about what the criteria of success might be, let alone to what extent success may be achieved. Nevertheless, Stuck estimates that most residential programs do a good job. But Ira M. Schwartz, the dean of the University of Pennsylvania School of Social Work, discounts all claims of institutional success. Any studies conducted without a control group he calls "unsound." Even those few studies that have used control groups, he insists, are suspect and inconclusive: "No credible evidence shows that institutions are more effective than other, less expensive options."
Since 1964 American child-care institutions have been living uneasily with the good-news, bad-news results of a highly respected research project known as the Cleveland Bellefaire follow-up study. The bad news is that the benefits of residential treatment tend not to last once a child returns to society. Samuel Kelman, the present director of Bellefaire, which has a residential treatment center, doesn't think the bad news is altogether bad. "If a guy breaks his arm, and the doctor sets it, and the guy breaks his arm again, do you say the original intervention was not successful?" The good news, which attracted less attention at the time the results of the study were reported, is that institutions could improve success rates by working more closely with parents and with the community into which the child was being released.
Kelman takes the positive and negative findings of the Bellefaire study seriously. "We try to make the life experience of the kids while they are in our program conducive to learning what they are going to need to do when they leave the program. We teach them how to negotiate the system. We teach vocational skills, problem solving, and how to manage money. We do a lot of group work and give them a lot of feedback. Bellefaire is very aggressive about parent involvement. Our goal is to try to help them to increase their responsibility for rearing their own children. We plan home visits; we involve parents in decision-making while their kids are still in the program. But partly what we have is an attitude that we hope reflects respect for parents." A Bellefaire study completed in 1990 showed that 78 percent of children followed were still living at home three years after leaving treatment. Seventy-six percent were working or in school.
"Success" is defined modestly, even by those who run what are considered to be among the best residential programs in the country. Many, like Woodland Hills, gauge success in terms of recidivism. Eighty percent of the 160 young people who graduated from its peer program from 1989 to 1991 were not sent to other institutions during the year following their release. One year, David Kern says, is a reliable indicator of future success.
"When I was a kid," Sam Ross, the executive director of Green Chimneys, says, "my teachers used to say to me, 'If you don't pay attention, you're going to end up being a truck driver or a garbage collector.' Now I pray each night that my children will end up being truck drivers or garbage collectors." Ross has no studies to prove that Green Chimneys's program is successful, but he has confidence in his own informal research techniques. He compares the numbers of grateful alumni who attend annual reunions with the number of requests for records he receives from community agencies, indicating that one of his graduates is in jail or other serious trouble, and he comes up with a positive assessment.
In 1984, with funding from an anonymous grant, The Children's Village initiated a pilot scholarship program called the W-A-Y (Work Appreciation for Youth). To qualify, boys had to have been at The Children's Village for at least six months and be able to read at a third-grade level. In the same year researchers established a comparison group composed of equally qualified students from The Children's Village who would not participate in the scholarship program but would follow some less intensive course. To date 155 children have participated in the W-A-Y program. Participants must prove their mettle by performing nonsalaried chores and community service before moving on to salaried jobs on the campus, such as working on the gardening crew or at the Village Store. As the kids progress from chores to real jobs, they are taught to fill out job applications, negotiate salaries, conduct interviews, and accept criticism, and become subject to real-life consequences, such as being fired, for poor performance. In the final stages of the program, participants enter into a contract with The Children's Village--and with their parents, too, if they are available--in which the young person agrees to work part-time and save a percentage of earnings for a college education or job training. Savings are matched by private donors. Evaluations of the W-A-Y program made in 1993 indicate success. Twice as many scholarship students as young people in the comparison group had either graduated from high school or earned their high school equivalency degree. The dropout rate among scholarship students was 13 percent as opposed to 33 percent in the other group. For purposes of comparison (if severely emotionally disturbed children can be compared with children in the general population), the New York City public high school dropout rate from 1988 to 1992 was 16.2 percent.
In 1990 Boys Town concluded a longitudinal study that had begun in 1981, comparing the attitudes toward education and the attainments of a group of residents with those of a sample group of young people who had applied to Boys Town but did not attend. Among other findings, which included that the Boys Town residents estimated more highly both the importance of going to college and their own potential to complete college, the study demonstrated that the Boys Town kids did better academically and were far more likely to graduate from high school than the sample group.
Paradigms and Politics
Two years ago legislation called the Family Preservation Act was vetoed by President George Bush. The bill asked for about $2 billion to strengthen families. About half of that amount was earmarked for "family preservation"--programs to preserve troubled families before they broke up, so that fewer children would enter the foster-care system in the first place. Families in crisis would be assigned a licensed social worker, who would be available to them around the clock for a period of about three months, for help with problems ranging from substance abuse to landlord-tenant relations. Parents in imminent danger of abusing their children could find relief in a "respite program." Last year's budget legislation provided $1 billion for similar purposes, with a substantial portion also to be spent on family preservation. It had the backing of leading child-advocacy groups, including the Child Welfare League of America, the Children's Defense Fund, and The National Association of Homes and Services for Children. The Edna McConnell Clark Foundation has produced media kits claiming that family-preservation programs cost less per family ($3,000 for one family for a year) than family foster care, which it says costs $10,000 per child, or institutional care, which costs $40,000 per child.
Directors of some children's institutions are convinced that "family preservation" will take money directly out of institutional pockets. Sam Ross likes to point out that the family, theoretically the best way to rear children, also happens to be the least expensive. He calls this coincidence good news for advocates of family preservation, whom he calls "the liberal-conservative conspiracy." The way Ross sees it, liberal family preservationists believe that residential treatment centers are warehouses for children who could best be served in homes in their own communities. Conservative preservationists are horrified by the cost of residential treatment and are looking for a cheaper alternative. "For once in their lives," Ross says, "they agree on something: let's get rid of residential treatment."
"It makes about as much sense as closing down emergency rooms and intensive care units in order to lower hospital costs," says Brenda Nordlinger, the executive director of the National Association of Homes and Services for Children.
"Family preservation? Who can be opposed to that?" says David Coughlin, of Boys Town. "But," he warns, "some kids are going to be in trouble all their lives. These kids are always going to need help. You can't just blow across the top of a family for three months and expect their woes to go away."
As of this year The Villages in Kansas will be responding to pressure from the state, which provides 78 percent of its operating expenses, to institute a family-preservation program in addition to its group-foster-care program. One of the eight Kansas residences will be rededicated as a ninety-day "home away from home" for abused children. Meanwhile, therapists trained by The Villages will work with the abusing parents and the abused children in an effort to reunite the family. "We want to provide the services that the state wants to purchase. We'd be foolish not to," says Mark Brewer, who has been the executive director since last June.
Nan Dale, of The Children's Village, thinks that the fervor to reduce the numbers of children in residential treatment is reminiscent of what is now generally considered the disastrous policy of de-institutionalizing adult mental patients in the 1970s. Program directors are very skeptical about whether preventive-intervention programs are really as successful as their advocates claim. Those who believe that family preservation is being oversold see an ally in John Schuerman, a professor of social work at the University of Chicago. Schuerman has studied preventive intervention programs and believes that many of the families that were treated and did not split up were not likely to split up in the first place.
Nan Dale is feeling the anti-institutional heat and resenting it. "We're as pro-family a place as you can find. The fact that we serve a child who has been removed from a family does not make us anti-family. We involve parents." Nevertheless, she says, "the lines have been drawn. When the words 'preventive service' got applied to everything up to the doorstep of residential care, some of us had apoplectic fits. We all would have told you that what we did here was preventive. We prevent lifetimes in mental hospitals, lifetimes in prisons. All of a sudden some bureaucrat in Washington defines preventive service as preventing placement outside the home, and we become the thing to be prevented." For the first time in anyone's memory The Children's Village, one of the largest and considered one of the best residential treatment centers in the country, has no waiting list. Dale says that children who might once have been sent there are being diverted to less restrictive, less expensive, and less appropriate options, such as foster-home care, on the presumption that a family setting is always better.
"What's in vogue right now is family preservation," says Father Val, of Boys Town. "Just follow the trend. Watch the little lemmings dashing toward the sea. They will tire of family preservation the way they tired of de-institutionalization. It's as if they just discovered that it's a good idea to try to keep kids in families. It's an exegesis of the obvious." Father Val thinks that the need to frame the debate as either anti-family or anti-institution is inevitable, given the longing that human beings feel for simple answers to complex questions. Certainly the people who make child-welfare policy, as well as those who carry it out, believe that the either-or approach is self-defeating. Nevertheless, it persists. Earl Stuck, who was one of the supporters of the Family Preservation Act, acknowledges the problem. "When you try to sell something politically, you have to oversell your case."
David Fanshel was until his recent retirement a professor at the Columbia University School of Social Work. A leader in the field of social work, and foster care in particular, Fanshel was the principal investigator in two major longitudinal studies on foster children in homes and institutions. At a time when many experts are questioning the value of residential treatment and promoting family preservation, Fanshel is going against the tide. He foresees a greater need for residential care in the near future. In fact, Fanshel, for decades one of the leading proponents of permanency planning, has modified his views. He now believes that permanent placement with a family is not an appropriate goal for about a quarter of the older, more seriously damaged and criminally inclined children in the system. He would like to see foster care reorganized into a two-tiered system in which permanent placement would remain the goal for the larger group, and the forestalling of criminal behavior through treatment would be the goal for the other group, which he calls "Subsystem B." He sees institutions playing a significant role in treating such dangerous children. The creation of two subsystems, Fanshel argues, "might help to avoid the inappropriate underfunding of Subsystem B now taking place in the interest of permanency planning."
The debate between family preservationists and those who advocate the wider use of institutions has been going on for decades. Until as late as the 1920s pro-family reformers used the "orphan trains" to place children with farm families. Today their anti-institutional counterparts, in their determination to provide a home for every child, sometimes resort to "adoption fairs," where difficult-to-adopt children are viewed by prospective parents. The social worker who organized one such event told a reporter from Vogue that although these fairs can result in the adoption of as many as half the children, "it felt like a slave auction."
Richard Small tells prospective adoptive parents, "If you're going to adopt a child from The Walker School, you're going out of your way to ask for trouble." Small is uncertain about whether it will be possible to find parents for six of the eight children at the school who were recently freed for adoption. One is a very disturbed twelve-year-old boy who has already suffered two failed adoptions. Small is faced with the opposite of King Solomon's conundrum: this time no mothers want the child. How hard should he try to find another adoptive family?
"Another adoption with this boy would be likely to fail," says Small, who also knows that another rejection might harm the boy more than a lifetime without parents. On the other hand, can he consign the child to such permanent and profound loneliness? "He has no one," Small says, "absolutely no one."
Small talked at length with the boy about the pros and cons of risking another adoption. Together, they had just about made up their minds in favor of life without parents when the boy wondered out loud, "Then who will take me for my driver's license?"
"I wish," Small says, "that there were a place, a group home, where kids could live at those times when they couldn't live at home. We've got a number of youngsters in this society--who knows how many?--who are capable of being connected to people, who wish to be connected, who should be connected, but who can't live full-time with the people they're connected to. When they do, terrible things happen to both sides, the kids and the caretakers. These kids get placed in families repeatedly and they repeatedly fail. What are we going to do with these children? Right now we either put them in an institution or we put them in a family."
A good children's institution is a hard place to leave. In the institutional world the child has the advantage; in the real world the child does not. The experts consult. Parents and children consult. Is the family ready? Is the child ready?
Twenty-five years ago 80 percent of the children who "graduated" from The Children's Village went home to some family member, most likely the mother. But starting about five years ago the percentage began to drop. Today only 55 percent go home to family. Nan Dale, citing her own subjective standard of measurement, the "GFF" (gut-feeling factor), estimates that half of that narrow majority are returning to a home situation that is fragile. At Woodland Hills, where most of the kids are released to the care of their families, David Kern says he feels uneasy about the prospects for success almost half the time. He calls sending vulnerable children home the worst part of the job. While he was at The Villages, Don Harris felt uneasy about returning kids to their parents about 80 percent of the time. "The reality is we can help these kids build some bridges to their families, but they probably will never be able to live with them."
Not sending vulnerable children home can also be the worst part of the job. People who work with institutionalized children continually face a quandary to which they have no satisfactory solution: What should they do when, in spite of everyone's best efforts, family seems not to be in the best interests of the child? What the system has to offer is life in a group home followed by independent apartment living, and then nothing.
Life without parents is a difficult sentence to pronounce upon a child, but it's happening more and more often. "Sometimes children have gone beyond the opportunity to go back and capture what needed to be done between the ages of three and eight," says Gene Baker, the chief psychologist at The Children's Village. "Sometimes the thrust of intimacy that comes with family living is more than they can handle. Sometimes the requirement of bonding is more than they have the emotional equipment to give. As long as we keep pushing them back into what is our idealized fantasy of family, they'll keep blowing it out of the water for us."