Care of troubled kids at crossroads

Chicago Sun Times/July 21, 2003
By Chris Fusco

The state spends about $10,000 a year to keep one child in a foster home.

At Maryville Academy and other large multi-bed institutions, the yearly per-child cost averages more than nine times that--about $96,000.

This price gap between foster care and Maryville-style residential treatment is playing out not just in Illinois, but nationally. As a result, child-welfare officials in several states are scaling back the number of kids they're sending to big facilities, instead using that money to place them with foster families and surround them with daily help tending to their social, educational and, in many cases, psychiatric needs.

Kids--even severely troubled ones--are responding well to that home-based form of treatment, generally known as "wraparound," experts say. A program in Milwaukee County, Wis., for example, has reduced the number of youths in residential care there from 375 in the mid-1990s to fewer than 60 now. A Bush administration mental health commission praised it in December for cutting juvenile crime and saving taxpayers millions of dollars.

"There's mounting evidence that [troubled] kids are not being well-served by being treated in residential care," said Patricia Chamberlain, a clinical psychologist with the Oregon Social Learning Center who has helped get 16 programs nationwide similar to Milwaukee County's up and running. "They learn more about escalating their problems than they do from the adults trying to mentor and control them."

Her statement echoes what critics have been saying about Maryville's 270-bed main campus in northwest suburban Des Plaines, where fights, sexual activity and attacks on staff have caused the Illinois Department of Children and Family Services to take a hard-line stance with the Roman Catholic institution.

DCFS is threatening to move the 160 youth it now houses at Maryville to other facilities if conditions there don't improve within 60 days of the institution signing its new contracts. The old ones expired June 30.

Maryville's executive director, the Rev. John P. Smyth, says his staff is well on its way to meeting the state's demands. At the same time, the well-known priest is looking to new DCFS Director Bryan Samuels for direction as to exactly what the state wants from the 638-bed child-care empire Smyth has built over the last four decades.

"Residential care is at a crossroads. Not only Maryville, residential care," Smyth said during a recent interview. "The costs of residential care have escalated tremendously with Medicaid and everything else. . . . You have to really know what you want in residential child care. I'm not too sure what DCFS wants right now."

Samuels, picked to head DCFS by Gov. Blagojevich in April, said taking a fresh look at residential care will be a priority during the coming months. He expects a slight drop in the number of residential beds the state uses this year--a trend that's been going on since Illinois had about 4,200 wards in group homes and institutions in 1995. That number is around 1,600 now.

Despite that decrease, housing, feeding, clothing and providing medical treatment for kids in residential care is expensive. Institutions, group homes and shelters in Illinois consume nearly 32 percent of DCFS' substitute-care budget while serving only about 8 percent of the 21,000 wards in state care.

Residential treatment providers counter that the type of severely troubled youth they serve justifies their costs.

"At the end of the day, we're a nonprofit agency. We're here because we're serving a need," said Jordan Luhr, vice president of development for Allendale Association, based in Lake Villa. "We'd be happy to go away, but for that to happen, mental health needs to be vastly improved for kids."

Samuels wants to see if the state can do just that.

"We're going to use this next year to figure out if we have the right composition of residential beds," Samuels said. "If we don't, we're going to make some changes. Do I anticipate that there may be some [cases] where we will have different forms of care than the ones we currently have? I think that's highly likely.

"We expect that over time, we'll have a better integration of residential, group homes and foster care."

Integrating the programs, however, likely won't mean the end of residential institutions. But if programs winning national praise are implemented here, it could mean a substantial reduction in the number of institution and group-home beds that the state uses.

"There is clear recognition of the need to use residential care only to meet special needs of clients, and not as a place to raise children," said Ron Davidson, a DCFS deputy director.

As in Illinois, child welfare systems nationwide have experienced vast funding differences between residential and foster care, said John VanDenBerg, a national child welfare consultant based in Colorado. California, Arizona, New Jersey and Michigan are among the states where family-based wraparound approaches to care are replacing the Maryvilles of the world, he said.

In Milwaukee County, "We've been able to serve thousands more kids--1,000 to 1,200 per year--on the same exact amount of money that used to serve 370," said Mary Jo Meyers, deputy director of Wraparound Milwaukee, the program praised by President Bush's New Freedom Commission on Mental Health.

Elements of wraparound programs exist in Illinois now, but experts say officials here must make sure the state is providing the right mix of services to treat severely troubled youth in foster homes before moving them out of residential treatment centers.

"If you make a big sweep in the other direction" too quickly, Oregon's Chamberlain said, "you're going to have just as big a mess."