Testimony of Nan Dale Before The House Ways & Means Subcommittee on Human Resources for the Hearing on Promoting Adoption and Other Permanent Placements
July 20, 1999
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My name is Nan Dale and, for nearly two decades, I have had the privilege of serving as President and CEO of The Children's Village, one of the nation's oldest child welfare agencies. The Children's Village is a member of the Child Welfare League of America (CWLA) and I am a member of the CWLA Board of Directors and I chair its National Advisory Council of Executives. My testimony today is intended to look broadly at the child welfare system of care for children - at how best we can achieve our collective aspiration of providing all children with a decent life - and, to the extent possible, with "permanency." Given the emphasis of the hearings on examining the role of adoption and of orphanages as permanent placements, I will include some critique of these issues in my comments.
Most people associate the name "Children's Village" with being an orphanage. It is not an orphanage. We're very prickly about that. Like many of the large group care facilities, we once were an orphanage. In 1851 we were known by the warm, fuzzy name of the New York Juvenile Asylum. Well over 1,000 children lived in a large building in the city, sleeping in row after row of metal beds, eating in a cavernous cafeteria, working, and attending school at the asylum. Then, at the turn of the century, the Asylum Board bought 250 acres north of the city and built a small town, changed the name to Children's Village, moved the children into houses in small neighborhoods around a central quad, constructed a school, recreation facilities and hired mental health specialists. They proudly pioneered in creating a therapeutic community - a safe, predictable, stimulating environment with an emphasis on treatment services.
Today, Children's Village operates as a residential treatment center (RTC), one among many of the institutional descendents of orphanages. Our RTC is the largest such child welfare institution in the United States. It is not the only program we run - in fact we provide a full continuum of child welfare and mental health services - preventive, foster/adoptive (including therapeutic and kinship foster homes), group homes and residential treatment. But, in the minds of many, Children's Village is synonymous with orphanage. There is, in fact, an enormous difference - a difference that is driven by the necessity of re-inventing ourselves over the last several decades to serve the highly disturbed and immensely difficult children and adolescents who are referred to us. We see those youngsters with serious emotional and behavioral problems. Our RTC, like most, functions more like a boarding school than an orphanage - more like a children's psychiatric hospital than an orphanage. Essentially, it is a highly structured, heavily supervised boarding school with intense treatment services for children and their families. Most importantly, it is very, very successful in working with a shockingly troubled and even dangerous population of kids. Our RTC is accredited by the Joint Commission on Accreditation of Health Care Organizations (JCAHO), as is a children's psychiatric hospital. No one requires that RTCs be accredited, an issue I'd like to return to later.
I'd like to make 5 overarching points and then to present some general comments and facts that bear on the question of whether or not we should be "bringing back the orphanage."
First, the five (5) overarching points:
I will take each of these in turn:
- The issues are complex
- We need a full array of services
- We need to expand our thinking about what "permanency" means
- There are some children who do best in long-term residential placements - especially seriously mentally ill children and those with early, dangerous criminal patterns of behavior.
- There is strong evidence that residential group care works well for that population
1) The issues are complex - I agree with H.L. Mencken, who said that, "For every complex problem there is a solution that is simple, elegant and wrong." Any one size fits all solution is doomed to failure. The idea that all kids are adoptable or that bringing back orphanages will solve our problems is, simply put, "wrong."
2) We need a full array of services for children - and for families. We need preventive services to help preserve families; we need foster families and supports for kinship family care; we need strong adoption services; and we need several different kinds of group care facilities (group homes, residential treatment, supervised apartments, etc.), along with after care and independent living services. If we skimp on any of these, we will have a system that doesn't work. We have been skimping.
3) We need to expand our thinking about what permanency means and include the notion that subjecting children to the fewest possible substitute care placements should be a critical consideration. Ideally, permanency should mean a permanent home in a family (biological, kinship or adoptive), but for a sub-set of kids in the child welfare system permanency is best achieved by long term care in a group setting - a boarding school or residential treatment center (RTC). And, let's face it, most RTCs function like boarding schools - albeit schools for very troubled kids from mostly poor families.
4) Two categories of kids in the child welfare system should be provided with long term residential care as the best permanency plan those with multiple family placement failures who evidence severe mental health problems or those with serious anti-social, criminal behaviors. These are the kids who are repeatedly placed and replaced in foster homes and/or psychiatric hospitals - they are the "frequent fliers" - the kids who require an enormous amount of child welfare, juvenile justice and mental health resources.
These are kids who have been so traumatized by their early life experiences that they cannot tolerate the intimacy of family living, at least not until they get some long term treatment in an environment that is highly structured and in which they feel safe. These kids behave in ways that are so scary to foster families that they kick them out again and again. Not uncommonly they have numerous failed placements and/or have been repeatedly hospitalized. They are not candidates for adoption. It doesn't work for them - in too many instances they've been compelled to go to a pre-adoptive home, only to experience yet another placement failure. At Children's Village (CV) we've had kids come to us after 10, 15, or more placements. Our record is a boy who had 23 failed prior placements (including back and forth to various kin and in and out of the hospital). He was 10 years old. One kid who finally got to CV, refused to unpack - that is, he refused to unpack the few clothes he had from the green garbage bag the city had given him for his belongings. "Why should I unpack", he said, "you'll be sending me somewhere else soon."
Before describing these kids in greater detail, let me make my fifth major point.
5) There is strong evidence that residential group care works well for very troubled youth. Over the last 15 years, we have been researching one of our programs -- the WAY Program, an Independent Living Program, with a unique, long-term after care component. WAY is targeted at our older youth transitioning out of the RTC. The study examined the outcomes for those in the program who left the RTC between 1989 and 1995, all of whom were between the ages of 21 and 30 at the time of the study. These youth were nearly all from New York City's most impoverished communities, all had been special education students when they came to CV, 66% were African American; 27% were Hispanic - all had some constellation of the characteristics I've just described.
High school graduation rates are generally viewed as the single best predictor of adult success. Research showed that 80% of the RTC kids who had been in the WAY Program had graduated high school, earned a GED or were still in school. These results are dramatically better than graduation statistics on comparable groups.
High School Completion Rates:
Further, 80% of WAY alumni studied were employed with mean earnings for full-time workers of $23,000. The study also checked criminal arrest records of alumni and found that only 8% had been arrested for violent crimes since age 21. On average, these kids were in our RTC just over 4 years and roughly half were then able to return to live with a family member - the others moved on to live in one of our group homes.
- Children living below poverty level: 53%
- New York City special education students: 61%
- New York City Hispanic students: 64%
- New York City African American students: 68%
- WAY participants: 80% (all former RTC residents)
Let me describe for you in slightly more detail the two kinds of children who, I believe, should be provided with a different kind of "permanency plan." These kids need a plan that recognizes their need for a stable, long-term placement and that recognizes that they may never be able to live in a permanent family. We don't want to automatically dismiss the option of permanency with a family. However, we must not presume that permanency with a family is the only, or the right option. For these very troubled young people, graduating from a group residential facility and becoming a productive adult without serious problems - mental health or criminal - is a good outcome. For many, family contacts have been maintained while they have been in care at the same time that the youngster has come to accept that his family is not available to him on a permanent basis. He is not an orphan. He is a graduate of an RTC - cum- Boarding School. Can we not find a way to see this as "success", not a failure of permanency planning - both for the child welfare community and for the individual children who work so hard to overcome such overwhelming odds?
Youth with severe mental health problems: With the advent of Managed Care and the concomitant near elimination of long term psychiatric hospitalizations, the child welfare system is serving alarming numbers of serious emotionally disturbed children and adolescents. Funding from the state departments of mental health have not made the same journey across systems. More importantly, RTCs, the best-equipped programs to serve these kids, have not been given the freedom to develop new models of care for these kids.
Some of these children could be kept at home or prevented from a record of foster home failures if we could provide a combination of intensive, community-based services, with the back up of using RTCs as short-term treatment options for the whole family. Funding among and between systems must be flexible. Mentally ill children in the foster care system must be able to access services and resources under federal and state mental health programs.
Youth with a history of serious anti-social, delinquent behaviors: David Fanshel, whose work inspired the permanency planning revolution, also identified a "second stream" of children in child welfare, which he says should not be subject to the same rules. These kids, he estimates, represent about a quarter of the children in child welfare. For them the goal should be to "forestall the evolution of full-blown deviant careers," not to find them permanent homes quickly.
- Who are they? They are kids who have been chronically and repeatedly abused or neglected - many have been sexually abused. At CV, there is evidence that nearly ½ the boys in our care have been sexually abused. Some have not been abused but have neurological and bio-chemical pre-dispositions to mental illness - and, often have been cared for under chaotic circumstances by a family member with serious mental illness or substance abuse problems. These children are nearly always far behind (or barely functional) in school, they have virtually no age-appropriate social skills. They have had no childhood. They are filled with despair - and, sometimes, with rage. About half have no viable family member willing or able to care for them; the other half do. With help and support, these families are eager to be good parents. Not all kids get into this kind of condition because of inadequate or dysfunctional families - sometimes it's quite enough to be living in a community of violence, with decrepit schools, no jobs and drugs everywhere you turn.
- What do they do? Mostly, they are terribly destructive to themselves and to others. At the mild end of the spectrum, they are so despondent, disoriented and distracted that they cannot learn. They don't know how to play or to ask for help. They wake up screaming at night, they wet or soil themselves - though they are long past the age that such behavior is accepted in the real world. They are volatile and seem to have little or no control over their impulses. They are wary of everyone - especially adults. The more seriously troubled kids are suicidal or seriously self injurious. One boy we had would stick pins in his scalp. Some eat objects like batteries and tacks and suck their skin raw. Some set fires, hear voices telling them to do bad things, act out in sexually inappropriate ways, torture animals, and lash out at others at the slightest provocation.
Now, here's the most shocking news of all. These kids are kids. They are afraid of the dark, afraid of themselves, and afraid of the world that has offered them so little protection and help. Underneath the despair and the rage there is a child who desperately wants our help. They are not all that difficult to reach or to turn around. But it takes time and it takes money. And, it requires that we take them out of the revolving door of foster home placement and replacement
out of the adoption failure syndrome
and provide them with a sense of permanency through long-term group care.
- Who are they? They are often kids who have been out on the streets and out of school for a long time, living by their wits or involved with a gang. Many regularly use drugs and alcohol - some are addicted. They often have a string of juvenile arrests for both petty and serious crimes. They may have been used and abused sexually (we've had kids who had been sold into pornography from the time they were babies - one boy had been dressed by his mother as a girl and sold to a porno ring). They've learned to steal and to con at an early age and they've been rehearsing those skills for many years before they come to us.
- What do they do? Sometimes they are indistinguishable from the group I've just described in that they often show tremendous depression but more of their actions are focused outward, at others. They steal, lie, and stalk victims. They hurt people. Some seem to have lost the ability to feel empathy. All seem to see the world as a hostile place and to behave in ways that reinforce their alienation from it.
Are Orphanages the Answer?
The question of whether or not to bring back orphanages has been lurking in the wings of child welfare for a least a decade. Unfortunately, people on both sides of the debate frame their arguments in such extreme terms that the best interests of children are being sacrificed to the controversy. If there is to be a thoughtful debate on the issues, we need to hear what each side is not saying.
On the one hand, most child welfare professionals - people like myself - cannot even bring ourselves to say the O-word, at least not in public. To us, bringing back the orphanage means dropping down a rung on the evolutionary ladder. But, here's what we're not saying. We are not saying that group care facilities are bad for kids or that no child should ever live in an institutional setting. We are saying that we are mighty skeptical because what we really think is that society is looking for easy, cheap solutions to immensely complex issues. We believe that if orphanages are brought back, no matter what you call them - they will be so poorly funded, like all other child welfare services, that we'll be back to talking about kids sleeping in rows of metal bunks, eating mush, and the like. Therefore, we reject out of hand any discussion about orphanages or any variation on the theme.
Most of us believe that the notion of orphanages is a cop out - a way of avoiding fixing neighborhoods and schools so that low income families can rear their own children in safe, thriving communities. Also, most child welfare professionals genuinely believe that foster homes (with their potential to become adoptive homes) are the best option for most children who must be removed from their families and cannot be placed in a kinship foster family home. We further believe that only those children who cannot be served in foster or kinship homes belong in residential treatment centers. Most of us believe that if the entire array of child welfare services - from preventive services to foster family and kinship care to residential group care were better funded, there would be no need to talk about orphanages.
So, on one side of the debate, you have child welfare professionals saying "before you do anything as drastic as bringing back the orphanage, why not fund what you have properly so that we can do our jobs really well - then you won't need orphanages." Our fear of a return to the bad old days is so great that we are unwilling to deal with the arithmetical fact that, in some areas of the country, there are simply not enough willing, able foster parents. Something must be done.
On the other side, you have people who say, "the child welfare system is broken beyond repair
there aren't enough decent foster homes to go around
let's bring back the orphanage." What proponents of orphanages are not saying is that orphanages are the best option. Rather, they are saying that "a good orphanage is better than a bad home" - a phrase that was much bandied about at the turn of the century when orphanages were in their heyday. But, when you really press most of the proponents of orphanages, what they are really describing is what might better be called "boarding schools" - facilities where kids from really horrible home situations - or no home situation at all - can live safely and get a good education, discipline, supervision and strong moral teaching.
What they are not saying is that this is cheap. To run a responsible "orphanage", with a good school, in today's economy is expensive. And, what they are not saying is that kids prefer orphanages. They, too, acknowledge that what most children, even those from really abusive homes, want most is "parents." What they are saying is that we've run out of parents - and, that they are skeptical, at best, that kinship families can fill the void.
If we are going to have a serious, realistic public debate, some of us will all have to overcome our reflexive revulsion to the word "orphanage" and others will need to give up their off-handed rejection of the child welfare system. We need to examine fairly and honestly what it is we believe kids need and whether we can fund and implement the best options. To do so, I'd like to divide the rest of these comments into two categories:
1) What are the real costs, practical considerations and options to rear productive citizens?
2) Can existing child welfare services and constructs be strengthened or better targeted to meet the need?
What are the costs, practical considerations and options? Most of those calling for bringing back the orphanages are talking about removing children from impoverished, high-risk communities and families considered unhealthy for children. Without debating who gets to decide what is "unhealthy," let's assume that ¼ of the children receiving TANF funds would be so designated - or some 1,372,296 children (as of 9/97), not counting the current 500,000 already in the child welfare system.
To provide around-the-clock care to children costs, at an absolute minimum, $100 a day (not counting construction of the facilities, schooling, medical or mental health care) - $36,000 a year per child or $49.3 billion to cover the cost of basic care for ¼ of those on TANF. By comparison, the cost of keeping a child in a foster home is roughly $25.00 a day, under $10,000 a year.
If one of the reasons for considering orphanages over foster homes is that there are not enough good foster families, there are other options worth considering. When there is a market shortage of needed personnel in a particular field, salaries go up and training programs are created to lure people to the profession. Nothing comparable has happened in the foster parent profession. In 1996, the average monthly board rate paid to a foster parent was $431 per month. Yet, the USDA Report on Expenditures on Children by Families in 1998 estimates $686.67 to $778.33 per month to cover the expenses of a child in a middle income family. Would it not be worth experimenting with increasing the reimbursement to foster families and providing training and other incentives to encourage more good people to pursue foster parenting as a full time vocation. If it worked, the savings would be enormous and kids would be able to experience family living as well as the possibility of adoption if they were not able to return to family in the long run.
Another option worth considering is the real boarding school model - possibly as a 5 day a week program. I have mixed feelings about this option, as I do about Charter Schools. We need to fix public schools so that they provide a good education to all children in a community but, like many people, I have grown impatient with those willing to sacrifice another generation of children while they wait in crumbling buildings for someone to fix that little problem. Providing underprivileged kids with boarding schools is a terrific idea but it is not cheap. There is the potential to combine pots of money - education and social services - in a way that can make it cost effective. One thing for sure is that in terms of kid's self image, it's a whole lot more acceptable to say you're going away to private school than that you're living in a orphanage. This is not small consideration. Boarding schools for high-risk kids is a terrific way to support families on the edge and to turn around a generation of under-educated kids.
When people come to visit Children's Village, their most frequent observation is that it looks and feels like a private boarding school. I've even had government officials say to me, "We ought to close those institutions and open more places like this." Then, I explain we are an institution, by government designation. But, in every way that matters, we function like a boarding school, albeit one for extremely troubled kids - and, because our students are so severely troubled, it is a school with intense staff supervision, small classes and intensive mental health and medical treatment services. As I've already mentioned, any private school for disadvantaged kids would be proud of our school success. But, what they don't want to hear is that such success comes at a high cost, some $50,000 a year, without counting the school costs.
There are those who argue that the cost to run an orphanage-like program is much lower than the $100 a day I've estimated. I don't believe it. The model they are talking about involves hiring "moms and pops" to care for kids and using the kids to do much of the work at the facility. I don't believe such a model is realistic today, except on a very small scale, for two reasons. First, if the "mom and pop" you hired don't work out and you need to fire them, it is like firing the kids' parents - and hitting the kid in the gut with yet another traumatic loss. I used to run such programs but stopped because they rarely work for long. Mom and Pop teams burn out quickly and they have a nasty habit of wanting to go to sleep at night. That brings me to the second reason this cheaper model rarely works. Kids - especially adolescents - need awake care at night. The kids, even the less troubled ones, often have night terrors, and some kids victimize others at night. With a house full of adolescents, someone always is out past curfew, needs hand-holding and the like.
My experience is that having a core group of approximately 6 people per home, around the clock, works best. The kids become attached but if one person leaves or is fired, their world doesn't collapse. Facilities must be open 24 hours a day, 7 days a week. When you factor in social work services to work with the family, to maintain sibling contacts and to ensure appropriate case planning plus food, clothing, recreation and other essentials, it costs over $100 a day.
Further, the days of teaching kids to farm or to be a cobbler and then placing them in apprentice positions are long gone. We need to teach them computer skills and how to use high tech equipment, along with work ethics, if they are to have any real chance of success in their future.
There are two other practical considerations:
a) Site-ing is an enormous barrier. Finding available sites for large facilities or even group homes, and getting local zoning board approval, is extremely difficult and lengthy - as in years and years of work. NIMBY (Not In My Back Yard) is alive and well. It is always an ugly and lengthy battle to get all the required permissions to open even one group home for 6-10 kids. I've been turned down for ideal locations. I've often tried to imagine the scene that would ensue if I tried to open Children's Village today in the small, picturesque town we're in - with our 40 buildings and 150 acres - and 325 seriously troubled, inner city kids. It wouldn't happen. I'd lose. No doubt about it.
b) Assuming land or facilities are acquired, who will pay the construction or renovation costs? Currently, most states do not provide capital funding for facility renovations, much less construction. At Children's Village, our 100 year old buildings were falling apart because there was no mechanism for acquiring public funding for restoration and major repairs. Ultimately, we sold land, took out loans and raised private dollars to acquire the $23 million needed just to repair the 21 houses in which some 300 children reside. Where would the funding come from for orphanages? One proposal being whispered about is to convert defunct military bases to orphanages. Now there's a step forward. What makes places like Children's Village work is that the environment is home-like and children live in as close to a family like environment as any institution can provide. Most of the large residential facilities opened long ago, when there was land near to the urban areas. It has been a happy coincidence that as agencies have recognized the need to maintain family contacts, most residential facilities are within easy transportation reach for regular visiting. Building such facilities today would be astronomical. If they could be built at all, the locations would likely be far from family contacts. Kids need to maintain those contacts even when they are unable to live with their family - there are costs associated with maintaining these contacts.
Can existing child welfare services and constructs be strengthened or better targeted to meet the need? Broadly speaking, the child welfare system needs to be far more adequately funded to prevent the need for out of home care of any kind. Too many families are struggling to rear their children in communities that resemble war zones, with inadequate and under-funded schools, little or no health care, lack of adequate and affordable housing and lack of community recreation or work options. That families find it nearly impossible to reverse the odds and make a solid future for themselves and their children should come as no surprise to anyone.
Removing children from homes where they are not being abused and neglected is no solution to the problems that plague America's families. Rather, it is an abdication of our responsibility. To renege on the future for entire communities by pouring money into orphanages - or boarding schools - instead of providing decent neighborhood schools, affordable housing and general preventive counseling services is unjust.
We already have a system for removing children from their families who have been abused or neglected. The major problem with child welfare is that as the needs of kids have changed and as their problems have been made all the more serious with the three headed monster of Crack, Homelessness and AIDS at their doorstep, the system has not kept pace. There has been a steady erosion of available resources.
The entire array of child welfare services is needed - along with some new approaches - so that we can tailor the help to the needs of individual families and children. What follows are some specific suggestions on how existing services can be strengthened followed by two new, proposed approaches to using group care differently, no matter what you call it. First, the overarching recommendations:
New approaches are needed to address the needs of the two specific, poorly served populations mentioned above: the youth in the child welfare system who seem to be headed for a life of crime and those with serious mental health problems. These two populations cost us the most in child welfare budgets. The first might be better served by longer term care akin to a boarding school; the other, by highly targeted stays in RTC to preserve placements in their own, foster, kinship or adoptive homes - or, for some, with long-term residential care.
- Every community must be expected to provide the full array of services: prevention, foster care, kinship care, boarding homes care, adoption, residential treatment, group homes (and related community support programs), and independent living services. These must be adequately funded.
- The federal payments to states through the Title IV-E Foster Care and Adoption Assistance must not be capped. It must be maintained as an open-ended entitlement.
- Congress should pass this year, the Foster Care Independence Act, H.R. 1802, which doubles the federal funding for the Title IV-E Independent Living Program.
- Federal funds for prevention should be drastically increased. The Adoption and Safe Families Act reauthorized and made some increases in funding for the Promoting Safe and Stable Families Program (Title IV-B, Subpart 2) which states use to provide services to children and families so that children will not need to be placed in foster care.
- Congress should provide the authorized level of funding of $325 million for the Title IV-B Child Welfare Services Program and $2.38 billion for the Title XX Social Services Block Grant. These two programs provide major sources of discretionary funding for states to protect and care for abused and neglected children.
- After-care services must be mandated. The work of this committee on the Independent Living bill was magnificent and I thank you. The only thing missing, in my opinion, was the expectation that every child leave care with long-term after care services, especially with the help of a paid professional mentor. Our own research bears out the importance - and the cost effectiveness - of such a model. This can't be left to the states - they're not doing it. You must make it happen.
- Child welfare services in general, and residential treatment centers in particular, must be required to meet certain national standards and be accredited. We would not think of sending our own child to a hospital that wasn't accredited but we expect poor people to send their children to facilities that aren't. This is an easy, low cost improvement.
- We need increased resources in order to make better initial assessments so that children are quickly placed into the most appropriate service. Kids shouldn't have to fail to get to residential treatment. Everywhere there are long waiting lists of extremely troubled youth waiting too long for the help they need. Now, while they wait, they bounce from home to home, often ending up on the streets, further victimized, or in the criminal justice system, having committed some heinous crime. To meet the needs of these children and young people, residential services that can respond to their complex problems must be increased.
Arguments for "permanency" and shortened length of stays for all children must fall when confronted by the actualities of troubled children, whose current problems cannot be adequately resolved and whose future potential cannot be adequately realized within such wooden standards.
In summary, there is a clear need for more residential services - but not for kids who are simply disadvantaged, but for super, at-risk kids and for those who require intensive treatment. Now a-days, the Residential Treatment Centers are more or less filling that role. They are serving a very, very troubled population - kids who have been repeatedly abused, physically and sexually - kids who are filled with incapacitating despair and/or frightening rage. Even with these kids, who almost no one argues should not be in a group care facility, we are fighting constantly for the funding we need to run such facilities effectively.
At present, there is little evidence that we, as individuals and tax payers are willing to do what it takes and pay what we must, to have the full array of good child welfare services - or, good orphanages. Indeed the record shows, over and over again, that we are not willing to pay more than lip service to the welfare of our children. And that is why nobody who really cares about children wants to say the O-word.
Thus, we bridle at any discussion about bringing back the orphanage. Secretly, we admit - only to one another - that there are many, many other children who ought to be in some kind of group care facility if we are to achieve the best possible outcome for them. We worry that if such facilities are built and funded, then the essential services to the most needy will be further shredded. Nonetheless, when we talk about it, we envision places that are well run, well funded, residential schools - the B-word - Boarding Schools, not the O-word. Never the O-word.
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