Alternate care. Out of home placement. Congregate care. Institution. There are a lot of descriptors for my placement. I work at a Residential Treatment Center, aka an RTC.
In the alternate, out of home, foster care system, there are many levels of care. Starting from the least restrictive moving on up to the most, we have Foster Care, Treatment Family Foster Care (also known as Therapeutic Foster Care), Group Home (first level of congregate care), and Residential Treatment Centers. RTC is the highest level, the last stop. If a child is at risk at an RTC, they will more likely than not be moved to a OMH (Office of Mental Health) facility such as an RTF (Residential Treatment Facility – in my experience, they look pretty similar to RTCs) or a psychiatric hospital, either acute (usually fewer than 6 months) or state (long-term).
Ideally, the level of care is appropriate to the child’s need. Today is my one year anniversary of being a Caseworker in Residential Care. It took me less than a week to realize that within the foster care system, nothing is ideal. The past year flew by. I still feel like I don’t know how to do a lot of things. I still cry from the stress and I still struggle with prioritizing 25 tasks a day that are all urgently needed by someone somewhere. It doesn’t seem like it’s been that long. A year is a long time however, especially if you are a child in residential placement.
Recently, there has been a push away from residential care. Children’s advocates were concerned that children were languishing in group homes with no concern for their permanency, safety and well-being. As is often the case complications arise when good policy is put into practice. Ideally, the only children in RTCs would be children whose behavioral or emotional needs are so great that they could not be kept safe in the community but I’ve noticed several kids come in to the RTC who would have thrived in a group home.
Again, nothing is ideal in foster care. Far from it. When I think about my year, I think about a child who has been at the RTC for 9 months. I think about the fact that we have been trying to step him down to a foster home since the day he arrived. I think about how he has decompensated and I think about how sad he looks when he asks me if he’s ever leaving. He should have left 9 months ago. He never should have arrived.
The truth is, there is a paucity of foster homes who are willing and licensed for teenagers. Especially male teenagers. Especially male teenagers coming out of Residential Treatment. A child emergently placed at an RTC because there is no immediate family foster care bed often lingers in the RTC. The longer he stays the harder it is to step him down into a family foster home. Foster parents are familiar with the system and many have bitter memories of the disrupted placements of former foster children who had to be stepped up to residential.
When I started at my agency, I was asked why I wanted to work in foster care. I said that I felt a calling to service and was told that a calling isn’t enough. Working in residential care was described as being akin to being drafted into a war. I wage war against the system, against my children’s worst instincts, and against the worst instincts of their caregivers.
At first I was terrified of working with emotionally disturbed teenagers. I was scared they would vandalize my car (it happened), steal my wallet (also happened) and run away from me in the community (has happened multiple times). My boys are the highlight of my work day and also my biggest headache.
I saw The Dark Knight Rises this weekend. My boyfriend rolled his eyes when I starting talking about the foster children in the movie, as I do about any movie involving children in care (Moonrise Kingdom was the most recent). I cried at one scene in particular, when Officer Blake recounts his time in care and tells Batman the following:
Not a lot of people know what it feels like to be angry, in your bones. I mean, they understand… foster parents.. everybody understands – for awhile. Then they want the angry little kid to do something he knows he can’t do: move on. So after awhile they stop understanding. They send the angry kid to a boys home. I figured it out too late. You gotta learn to hide the anger, practice smiling in the mirror. It’s like putting on a mask.
Working in foster care you quickly become acquainted with the weaknesses of the human heart. You will eventually be impressed with the resiliency of your kids. Resilient is maybe the wrong word. Children recover from trauma, but their behavior often reflects their emotional scars. I see the scarred tissue of my boys’ souls every day and every day it pains me not to be able to do more for them. In Residential Care, there are no foster parents. My kid has an off campus appointment? That’s me. Criminal court? Also me. School meeting? Me. Discipline and clinical work intersect as you and the treatment team constantly tries to figure out how to help each child within the limited flexibility of a highly structured program.
Sometimes I feel like it’s all too much for me. When I first started, I cried multiple times a day from the stress and feeling like I was doing a terrible job. I later learned I was doing a fine job but simply didn’t know the minutia of case planning in residential care. I still cry a lot, usually from the stress (it should be noted that I am a crier: last week I couldn’t find my shoe, I was hungry and my cat declined to cuddle and I was reduced to tears).
Today I cried for a different reason. Today I cried because of the aforementioned child, a child for whom I have done everything I can think to do in order to get him out of residential care. It hasn’t worked. It hasn’t been enough. I hate the system for sending him to the RTC and I hate myself for not being able to get him out faster. To care about a child in foster care, especially residential, is to have your heart broken a thousand times in a hundred ways. Today’s tears were angry tears, because I am angry too. My mask is anger, because it’s easier than being heartbroken all the time.