A federal fix we don’t need for troubled kids

Last week, Paris Hilton was on Capitol Hill to tell her harrowing tale of being sent to the Provo Canyon School in Utah, a kind of behavioral reform school. She shared the details of her experience — being locked in rooms, physically abused, restrained and forced to take medications — as part of her effort to lobby for greater restrictions on all congregate care facilities. She is pushing for passage of the federal Accountability for Congregate Care Act and the yet-to-be-introduced Stop Institutional Child Abuse Act.

But there is no evidence that the wealthy socialite experience is representative and, though it may seem counterintuitive, passing such legislation could put more vulnerable children — primarily those in the child welfare system — into harm’s way.

For kids who have nowhere else to go — whose behavioral or mental-health problems prevent them from living with their own parents, extended family members or even foster families — congregate-care facilities may be the last and best option. These facilities in most cases are not what Hilton has experienced or described. Some are collections of family cottages with houseparents attempting to rehabilitate kids after the trauma they have suffered at home. Others are medical facilities for children with severe behavioral and mental-health issues. Others are safe homes for teens who have been victims of sex trafficking.

Both pieces of legislation suggest that too much federal funding is going to such organizations and there is too little federal oversight of them. Of course, most of the oversight for congregate-care facilities comes from states, not the federal government. There are certainly instances of abuse in these settings, but there is no evidence that they are the norm.

And as for the funding, well, many of these organizations have already been defunded out of existence. The use of such settings for children whose parents cannot or will not care for them has decreased steadily in the past few decades. Today, of the 425,000 children in the foster-care system nationwide, only about 55,000 reside in institutional settings — a significant drop since the early 2000s. In New York, the number of kids in congregate-care facilities decreased by 47% from 2002 to 2008 alone. New York City’s rate dropped 19% from 2015 to 2019.

The Family First Prevention Services Act, which passed in 2018, offered states more funding for prevention services in return for reducing federal contributions to states for group-home care. And now a prohibition against the use of Medicaid for care provided to most patients in mental-health residential-treatment facilities larger than 16 beds could soon apply to foster children who have serious mental-health challenges unless Congress passes a law excluding such facilities from the rule.

All of this combined with rising insurance rates and skyrocketing labor costs have meant that operating these facilities is all but impossible. Large foster agencies that include congregate-care homes find that their other services are used to subsidize those homes.

And the results are clear across the country. In Texas, hundreds of children slept in child welfare offices last year as placements for older kids especially have become impossible to find. In Illinois, the director of the Department of Children and Family Services has been found in contempt of court 10 times because he has no appropriate placements for children in the state’s custody. In some cases, kids are being kept in more restrictive settings than are necessary. In another case, one was sleeping in a closet.

The problems have reached New York as well. A shortage of beds in foster homes has created a situation where we have nowhere to send kids who need to be removed from their families because of safety concerns. At the end of last year, New York had around 11,000 foster homes, but more than 16,000 kids in foster care. A recent story in the Albany Times Union described kids with mental-health crises spending weeks in hospital emergency rooms or even being pushed into the criminal justice system because there is such a severe shortage of beds in mental or behavioral health facilities.

Where exactly do we expect these children to go? If anything, we should have more than enough beds in a variety of congregate care and foster care settings to ensure that there is always a space for children who have different needs and whose needs will change over time.

As a country, we have done the heavy lifting of ensuring that kids who can be with their families — or in any family setting — are placed there. The kids who are left need either long-term or short-term stays in institutions to ensure their rehabilitation. It is nothing more than wishful thinking to imagine that starving these institutions of funding will help kids in desperate situations.