MASSACHUSETTS

The wrong way to reform child welfare

''THEY DIDN'T tear down the Central Artery before building the tunnel." This comment, about everyone's favorite public works project, was made by a colleague who, like me, is the CEO of a child welfare agency that offers residential treatment to severely abused and disturbed children. He was comparing the Big Dig with the massive restructuring of child welfare now underway in Massachusetts, and his message was simple: Don't destroy the infrastructure that is out there before you have a better one to replace it.

Those responsible for complex government agencies are, of course, mindful of public perceptions. So when initiating change, they try to proceed at the right pace. Moving too slowly can make change appear tentative and lacking in clear purpose, perceptions that can actually compromise its success. Moving too quickly can make the process seem impulsive, risky, and heedless of potential dangers.

It would be nice to say that the present restructuring is going at the right speed, but it is not. After discussions with providers of foster care, residential treatment, and community-based mental health services, the Department of Social Services is now rushing to transform in months a system that has been in place for decades. By summer, the ''Family Networks" system will be inaugurated, and strong efforts will be underway to reduce reliance on residential schools and group homes, and increase dependence on intensive foster care and community services for children in need.

It is difficult to quibble with the philosophy driving this restructuring. It is rooted in some sound child welfare thinking. The prologue to the DSS document shares one of the agency's goals: ''We believe that we must align the child welfare system to dramatically increase the proportion of children who maintain or achieve a permanent family or other lifelong connection with the support and guidance of the child welfare system."

Who would dispute that children are better off in biological or foster homes than in congregate living situations? Who would argue that the child welfare system should not be as ''child-focused," ''family-centered," and ''community-based" as possible, or that it should not capitalize on the strengths of families rather than their weaknesses? And in more cold-blooded terms, who would not like to see cuts in ''costly" residential care?

The only real argument against any of these fine principles is that the tunnel is not yet built. In its haste to dismantle the existing system, DSS is ignoring the needs of the most deeply hurt and troubled children and adolescents. There will always be a small proportion of young people who need intensive care in a secure residential placement, owing to the horrors they have experienced and the damage that has been done to their bodies, minds, and spirits.

The DSS cannot help but be aware of such cases. Indeed, the department argued in favor of a residential placement for Haleigh Poutre, and because that argument did not prevail, DSS had to deal with the horrific results. Had DSS been able to place Haleigh in a residential program, she would not have ended up on life support, and the department would not have become mired in the question of its removal.

In a comprehensive residential treatment environment, the process of sorting out whether Haleigh's injuries were self-inflicted or the product of abuse by adults might have begun. More significantly, healing would have begun. A child who had experienced more misery than any child should bear could have experienced some respite. She could then have begun the course of treatment needed ''to achieve a permanent family or other lifelong connection." That step just needed to happen.

Residential treatment provides a safe, secure, and nurturing environment for children who need it most. At the moment and for the foreseeable future, comparable services are simply not available in most community-based settings regardless of the euphemisms or professional jargon employed to suggest otherwise.

Severely abused, neglected, and mentally ill children need intensive care, treatment, and therapy to recover. For the moment and the foreseeable future, there exists neither an adequate system of community-based mental health services nor a cadre of trained foster parents to serve these young people. To assert otherwise is to deny what we all see every day.

Charles P. Conroy
25 February 2006

http://www.boston.com/news/globe/editorial_opinion/oped/articles/2006/02/25/the_wrong_way_to_reform_child_welfare/
 

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