George Miller introduces:
H.R. 5876: STOP CHILD ABUSE IN RESIDENTIAL PROGRAMS FOR TEENS ACT OF
Proposed Bill -
Committee Hearing -
GET INVOLVED! Children and Teens
Bazelon Center's Fact Sheet
Click here for a summary of a
bipartisan compromise Mr. Miller reached with Mr. McKeon
Tens of thousands
of American children and teens each year are placed into residential
treatment programs. Many have been abused, neglected, and worse,
some have died at the hands of those who were supposed to be there
to care for them. Unscrupulous programs often hire unqualified,
untrained, uncaring, misinformed, and often mean-spirited staff who
do not have the qualifications to care for them.
George Miller has introduced the H.R. 5876: Stop Child Abuse in
Residential Programs for Teens Act of 2008. The bill is intended
to help prevent child abuse and deaths of children in residential
treatment settings, and to hold those who abuse, neglect, or
otherwise mistreat a child or teen accountable for their actions.
aware that the passing of H.R. 5876 is not a cure-all, end-all to
the issue of children and teens abused in programs.
We also know,
however, that IT’S A GREAT START! And we support it wholeheartedly.
for CAICA's letter of support to Congressman George Miller
for his efforts!
GET INVOLVED! CHILDREN AND TEENS
Get Involved! This important bill
has passed the Committee, now it goes to the House!
1. Write your letter of support to
Congressman George Miller:
The Honorable George Miller
Committee on Education and Labor US
House of Representatives
Washington, DC 20510
Re: H.R. 5876 Stop Child
Abuse in Residential Programs for Teens Act of 2008
your Representatives in Congress and ask them to vote in favor of
H.R. 5876. Representatives can be reached
through the Capitol switchboard at (202) 224-3121; or
3. Educate your state
representatives about this issue and why it is important that they
support it, as there is much
continued work that needs to be done:
or electronically forward the "Growing
and Strengthening America's Middle Class: Keeping
America's Kids Safe:
Stop Child Abuse in Residential
Programs Act of 2008" Pamphlet.
summary of a bipartisan compromise that was reached.
I believe all advocates, parents,
lawyers, government officials, and anyone else who reads this and
who care about the safety and wellbeing of children and teens should
take a few moments to research this very important Bill and to help
by showing their support. There are plenty of things each of us can
do that only take a few moments out of our busy schedules.
Three years after enactment of H.R.
5876, the legislation would provide certain federal grant money to
states if they develop their own licensing standards for public and
private residential programs for teens. Those standards must be at
least as strong as national standards. They will need to implement a
monitoring and enforcement system, including conducting unannounced
site inspections of all programs at least once every two years.
Deaths of children in programs will continue to be investigated on a
Our work, folks, has really only
just begun! We need to not become complacent that this Bill will
solve the problems.
of thousands of children with mental health needs are being placed
in expensive, inappropriate and often dangerous institutions.
Fact Sheet: Children in RTC's From
the Bazelon Center for Mental Health
Law and Policy
The number of
children placed in residential treatment centers (or RTCs) is
growing exponentially. These modern-day orphanages now house more
than 50,000 children nationwide. Children are packed off to RTCs,
often sent by officials they have never met, who have probably never
spoken to their parents, teachers or social workers. Once placed,
these kids may have no meaningful contact with their families or
friends for up to two years. And, despite many documented cases
of neglect and physical and sexual abuse, monitoring is inadequate
to ensure that children are safe, healthy and receiving proper
services in RTCs. By funneling children with mental illnesses
into the RTC system, states fail—at enormous cost—to provide more
effective community-based mental health services.
A. RTC placements are often inappropriate.
RTCs are among the most restrictive mental health services and, as
such, should be reserved for children whose dangerous behavior
cannot be controlled except in a secure setting.
Too often, however, child-serving bureaucracies hastily place
children in RTCs because they have not made more appropriate
community-based services available.
Parents who are desperate to meet their kids’ needs often turn to
RTCs because they lack viable alternatives.
To make placement decisions, families in crisis and overburdened
social workers rely on the institutions’ glossy flyers and
professional websites with testimonials of saved children.
But all RTCs are not alike.
Local, state and national exposés and litigation “regarding the
quality of care in residential treatment centers have shown that
some programs promise high-quality treatment but deliver low-quality
custodial care.” As a
result, parents and state officials play a dangerous game of Russian
roulette as they decide where to place children, because little
public information is available about the RTCs, which are
under-regulated and under-supervised.
To make it worse, far too many children are placed at great distance
from their homes. For example, most District of Columbia children in
RTCs are placed outside the District—many as far away as Utah and
Minnesota. Many families,
especially those with limited means, find it impossible to have any
meaningful visitation with their children.
B. Evidence is limited on the effectiveness of RTCs.
Children frequently arrive at RTCs traumatized by the process that
delivered them there. They are often forcibly removed from their
homes in the middle of the night by “escort companies.”
Other times, children are placed in RTCs not by their parents or
doctors, but by overburdened child-serving state agencies, who know
little about the children’s individual needs.
Even more appalling, many children’s conditions do not improve at
all while at the RTC. In
fact, there is little evidence that placing children in RTCs has any
positive impact at all on their mental health state
and any gains made during a stay in an RTC quickly disappear upon
discharge, creating a cycle where children return again and again to
There are many reasons why RTCs fail to deliver the results they
promise, but most center on the type of services provided, the
environment they are provided in and the lack of family involvement.
First, the reality of what occurs within an RTC is often quite
different from the highly individualized, highly structured programs
that are advertised. The RTCs often provide less intense services
and the staff are often under-trained.
Children spend much of their day with staff who are not much more
qualified than the average parent and they spend less time
face-to-face with psychiatrists than they would if they were being
served in appropriate community settings.
The environment is also problematic because children in RTCs enter a
situation where their only peers are other troubled children—a major
risk factor for later behavioral problems.
Research has demonstrated that some children learn antisocial or
bizarre behavior from intensive exposure to other disturbed
Children are usually far from home in RTCs, often out-of-state.
Removed from their families and natural support systems, they are
unable to draw upon the strengths of their communities and their
communities are unable to contribute to their treatment. Few
children thrive when they are hundreds or thousands of miles from
their parents, friends, grandparents and teachers. Few can flourish
without the guidance of consistent parenting. Yet, we expect that
our most vulnerable and troubled youth will miraculously turn around
in just such a situation. Instead, this isolation further reduces
the efficacy of treatment and increases its cost.
The fact that children and their families are far from one another
creates a host of problems. For one, it makes family therapy
difficult or impossible. As a result, when children leave the RTC,
they return to an environment that has not changed. Also, because
the RTC environment is inherently artificial—children are not asked
to negotiate the obstacles that occur within their family setting or
deal with the difficulties that trigger their behaviors in their
neighborhoods or schools—the child does not gain new skills to
better negotiate life outside of an institution. As a result,
neither the children nor their parents learn better ways to overcome
the obstacles that led to the RTC placement. Without family
involvement, successes are limited.
Among the rare children who are able to overcome these obstacles,
few can sustain the gains they have made. In one study, nearly 50%
of children were readmitted to an RTC, and 75% were either
renstitutionalized or arrested.
C. Children suffer because there is no watchdog.
The RTC industry is largely unregulated.
RTCs need only report major unusual incidents (or MUIs), but the
interpretation of what constitutes an MUI and the reporting
requirements vary widely.
Some RTCs fail to report MUIs at all—with little consequence.
Vulnerable kids are placed far from home where parents, social
workers, or the state can offer little oversight or protection.
Worse, many of the facilities limit children’s ability to have
contact with their parents for extended periods, further restricting
the parents’ ability to monitor the facilities.
D. Children are abused in RTCs.
Children placed in RTCs have been sexually and physically abused,
restrained for hours, over-medicated and subject to militaristic
punishments; some have died.
The following are just a few documented examples of tragic
occurrences at RTCs:
is often used (and overused) to control behavior.
Children have been permanently disfigured because of
programs, the children’s shoes are confiscated to keep them from
been reports of behavioral ‘therapies’ being misused. As one
author noted, “Such therapies do little more than systematically
punish children, all under the guise of treatment . . . .”
by staff members and other residents is all too frequent.
In one case, a 13-year old girl performed sexual favors for
staff members in return for snacks and carryout food.
At one RTC, four boys were accused of trying to sodomize another
with a cucumber. At
another, a 19-year-old woman was charged with sodomizing a
abuse is also too frequent an occurrence. For example, a
13-year-old boy was forced against a wall and slammed to the
floor by employees of an RTC.
often restrained—sometimes for hours on end. The overuse of
restraint has resulted in child deaths.
E. Tragic outcomes at great public expense.
grown to a billion-dollar, largely private industry.
Residential treatment care is exorbitantly expensive—costing up
to $700 per child per day.
Annual costs can exceed $120,000.
Most of the time, the public foots the bill for these services.
In fact, nearly one fourth of the national outlay on child
mental health is spent on care in these settings.
II. Other Interventions Work Better for Less
community-based services are much more therapeutically effective
than institutional services, and are also markedly more
cost-efficient. As the Surgeon General reported, “the most
convincing evidence of effectiveness is for home-based services
and therapeutic foster care" and not for RTC's. A comprehensive
system of care would dramatically reduce the number of children
Community-based alternatives produce better short- and long-term
results and are less disruptive to children and families. These
alternatives provide intensive mental health treatment, mobilize
community resources and help children and their families develop
effective coping mechanisms. Some models endeavor to “wrap
services around” the child, while others emphasize
multi-systemic therapy and crisis intervention. Randomized
clinical trials found greater declines in delinquency and
behavioral problems, greater increases in functioning, greater
stability in housing placements and greater likelihood of
permanent placement. In Milwaukee, a wraparound project that
has served over 700 youth involved in juvenile justice has
similar promise; use of residential treatment has declined 60%,
use of psychiatric hospitalization has declined 80%, and average
overall care costs for target youth have dropped by one third.
 According to the Surgeon
General, a RTC is a “licensed 24-hour facility (although not
licensed as a hospital), which offers mental health treatment.”
U.S. Department of Health and Human Services. 1999. Mental
Health: A Report of the Surgeon General. Washington, DC:
Author. Available at:
In 1982, when Jane Knitzer wrote the seminal book, Un
claimed Children, the growth in the RTC industry was only
beginning. Ms. Knitzer wrote that: “In contrast to the minimal
efforts to create nonresidential services, 18 of the 44 states
responding to our survey were working to increase residential
care.” Knitzer, J., Unclaimed Children: The Failure of
Public Responsibility to Children and Adolescents in Need of
Mental Health Care, Children’s Defense Fund, 1982,
at 45. By 1986, the number of children in RTCs had grown to
25,334, an increase of more than 30% over a three-year period.
Rivera, V.R. & Kutash, K. (1994), Components of a System of
Care. What Does the Research Say?, Residential Services:
Psychiatric Hospitals and Residential Treatment Centers, at
8, Tampa , FL: University of South Florida, Florida Mental
Health Institute: The Research and Training Center for
Children’s Mental Health. This growth in continuing. See
infra, at note 3.
 Reports to staff
attorneys at the Bazelon Center for Mental Health Law. For
example, in Washington, D.C., children are certified to go to
RTCs by a “Multi-Agency Planning Team” process (or MAPT
process). The MAPT meetings often do not include the voices of
the people who know the child and family best.
Ohio Rights Service Review of Fifteen Children’s Mental Health
Facilities (October 2004) (on file with the Bazelon Center)
 Lou Kilzer, Desperate
Measures, Rocky Mountain News, July 2, 1999, available at:
July 2, 1999, available at: .
Health: A Report of the Surgeon General, supra note 1,
(“Settings range from structured ones, resembling psychiatric
hospitals, to those that are more like group homes or halfway
houses.”); Rivera, V.R. & Kutash, K. (1994), Components of a
System of Care. What Does the Research Say?, Tampa , FL:
University of South Florida, Florida Mental Health Institute:
The Research and Training Center for Children’s Mental Health.
 Scott Higham and Sewell
Chan, District Reexamines Out of Town Centers, The
Washington Post, July 16, 2003, available at:
See also, D.C. Department of Mental Health Data from
2003 Children in Residential Treatment Centers (on file at the
 Client reports to
Bazelon Center staff attorneys.
 Id. Further,
the Bazelon Center has been contacted by federally funded
Protection and Advocacy organizations who never or rarely
received MUIs from the RTCs serving children within their
 Reports to staff
attorneys at the Bazelon Center for Mental Health Law.
Id. The Surgeon General suggests that RTCs are often
utilized because of the under-availability of community-based
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