Today's RTCs have roots in orphanages
By DWIGHT R. WORLEY
THE JOURNAL NEWS
(Original publication: June 23, 2002)
They went from feeding and housing destitute immigrant children to treating the behavioral problems of adolescents, to reforming and educating emotionally troubled teen-age delinquents.
The history of residential treatment centers ? the foster care system's most restrictive level of care ? is one of good intentions leading to unintended consequences.
They have become the last resort for abandoned, neglected and abused children. The nonprofit centers rival psychiatric hospitals in caring for some of society's most mentally disturbed children. Courts see them as an alternative to juvenile halls.
In contrast to their present-day responsibilities, when the prototypes for these institutions were founded nearly two centuries ago they had a much more modest mission.
The roots of today's RTCs lie in the orphanages of the 1800s. Most of these institutions were founded in New York City to care for destitute children of immigrants from Ireland and Russia, Germany and other eastern European countries.
"Admission to these institutions closely followed waves of immigration," said Linda Stutz, head of fund-raising at Children's Village in Dobbs Ferry, the largest RTC in the country and one of the area's oldest. "Whoever was on the bottom rung at the time in the city used them."
Many people who came to this country succeeded in their new lives, starting businesses and finding jobs. However, economic hardship, family dysfunction and bad luck left others unable to feed their children.
The children of such families were often left to fend for themselves. Their parents were unable to keep or find work. Some parents were addicted to alcohol or committed crimes and wound up in prison.
The hundreds of children left behind roamed the streets of Manhattan begging for food.
"They weren't all orphans," Stutz said. "About half didn't have parents. But for many reasons, some parents just couldn't care for their children."
Reform groups and wealthy benefactors set up orphanages and other residential institutions in large buildings in lower Manhattan and provided food, clothing and shelter to children. Since many were run by churches, there was an emphasis on moral training and discipline. However, the children also learned vocational skills from mechanics to tailoring.
The Children's Aid Society, founded in 1854, routinely shipped some of these children to homes in the South and West. The "orphan train," as it was known, carried children to waiting foster families.
Some of the children were later adopted by their sponsoring families. However, many were exploited as free labor and put to work in family businesses, usually farms.
"They'd take care of them in the spring and kick them out in the fall," said Elizabeth Fuller, the librarian at the Westchester County Historical Society. In the early 1990s, the society researched the development of children's institutions before World War II.
"There are a lot of stories where kids find wonderful families. And then there are stories that aren't so happy," she said.
During this time, Westchester began housing destitute children in its almshouse ? a home for people too poor to support themselves ? in Eastview. Opened in 1828, the almshouse mainly cared for indigent adults and the elderly, and children shared space with them.
Several facilities in Westchester catered exclusively to children, but most were run by churches and accepted only children of particular religions, Fuller said. Others cared for children temporarily, say, over the summer.
In 1880, the first move to create New York's modern-day RTCs occurred. The state passed a law that ended the practice of housing children in almshouses with adults, unless they were born there. Legislators also declared that public funds could be used to house and care for children at private facilities.
Westchester-Temporary Home for Destitute Children in White Plains, the first year-round facility open to all children, was opened in 1885. During the next 50 years, dozens of institutions, many of which would later become RTCs, were founded.
As foster care expanded in Westchester, the institutions in Manhattan were being forced northward by rising real estate prices. Many of the agencies, growing weary of increasing crime and social problems in the city, decided an urban environment was not conducive to their mission. They moved to Westchester because of its country atmosphere, relatively inexpensive land and lower crime rate.
The wide-open spaces allowed for a living arrangement still used by RTCs today ? the cottage system. Developed in Germany in the early 1800s, the cottage system places small groups of children together in two- or three-story homes where they are cared for by "cottage parents."
They received vocational training, learned to repair equipment and mended their clothes and shoes. Living in farm country, they also were taught to grow crops and raise animals.
The orphanages expanded their mission in the early 1900s. They began to care for more children with behavioral and emotional problems, while still caring for poor children. At the same time, juvenile courts began sending delinquent children to these facilities.
In the 1980s, crack became a dangerous epidemic. RTCs were now expected to treat emotionally troubled kids and reform delinquents guilty of crimes from drug abuse to robbery and assault. That's a dual mission that not everyone says they are able to handle.
"They've been forced to take on the responsibilities, but don't have the resources," said Edith Holzer, a spokeswoman for the Council of Family and Child Caring Agencies, a Manhattan-based advocacy group. While acknowledging that only 5 percent of children in RTCs were remanded by courts, she said RTCs are treating hundreds of children who should be in psychiatric hospitals.
"It was never expected that they would work with violent children," she said. "It's making it very difficult for them to provide quality services for kids that belong there."
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http://www.nyjournalnews.com/rtc/rtc062302_02.htmlIn Westchester, Rockland and Putnam counties, more than two-thirds of the 2,000 children housed in 13 residential treatment centers, or RTCs, are treated with drugs. Many are on multiple medications despite rising concerns that prescription drugs are replacing psychotherapy and damaging developing young brains.
An analysis of U.S. Food and Drug Administration data on 12 of the most common medications used in local residential centers revealed that they have been classified as the primary suspects in the deaths of at least 71 children nationwide between 1997 and last year, and were a factor in thousands of life-threatening injuries, disabilities and hospitalizations.
The statistics represent a fraction of the suspected deaths and injuries; government officials acknowledge that because the database for reporting adverse effects from drugs is voluntary, the numbers may represent as little as 7 percent of the actual incidents.
http://www.nyjournalnews.com/rtc/27part1.htmThe choice of which drugs to use and at what level rests almost entirely with the residential treatment center.
"There's huge pressure," said Dr. Martin Irwin, a psychiatrist hired by Graham-Windham. "If you talk to any psychiatrist who works in an RTC, there's huge pressure from staff to do something about the behavior."
http://www.nyjournalnews.com/rtc/27part3.htmInterviews with dozens of psychiatrists and officials at residential treatment centers in the three area counties reveal a pattern of increasing use of drugs defined as psychotropic ? medicines that act on the brain. Most centers have between 60 percent and 90 percent of their children on such medications. Some claim as little as 16 percent, but medical experts with knowledge of residential care questioned such a low figure in a modern-day institution.
"I've seen kids walk around basically stuporous," said Dr. Martin Irwin, a psychiatrist and expert on residential care who was recently hired to monitor medical practices at Graham-Windham Children's Services in Hastings-on-Hudson.
"The residential centers are pleased, because they're behaving better. They are way over-sedated. I don't think any of these people would tolerate their own children being treated like that."
RTCs were designed primarily to house and educate children with no place to go. During the past decade, their mission has radically changed, although the state laws governing the centers have remained largely unchanged. They have, in fact, become quasi-medical facilities whose stated mission is now to provide therapy and care for children diagnosed with severe mental health disorders.
http://www.nyjournalnews.com/rtc/27part2.htm