When Parents Are Not in the Best Interests of the Child
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
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
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
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
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
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
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
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
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
"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
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
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
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
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
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,
"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
Kate doesn't answer. She just looks at her shoes.
"Kate," Jane says, with some frustration, "we're trying to care about
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
"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
"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
"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
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
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
Copyright © 1994 by Mary-Lou Weisman. All rights
The Atlantic Monthly; July 1994; When Parents Are Not in the Best Interests of the Child.