Confronting Social Disparities

One of the most troubling realities of the struggling teens industry is that many of the youths with the greatest needs have the least access to high-quality services.  The hard, cold fact is that low-income teens are overrepresented in many, although not all, risk areas.  The teens who are enrolled in expensive, private-sector schools and programs, however, are overwhelmingly from families with sufficient financial resources or loans to pay for costly care.  Although some specialty programs and schools offer scholarships to low-income teens, the slots are few.  Such disparities permeate children’s and teen’s mental health services and behavioral health care across the United States.

Addressing poverty, discrimination, and their correlates must be critical elements in any serious, earnest attempt to help struggling teens.  Efforts designed to prevent poverty among teens, and the problems that we know flow from it (such as delinquency, violence, substance abuse, and pregnancy), require substantial and sustained investment of national resources.  We should do so not only because we owe this to our nation’s youth but because such investment is also cost effective.  Underwriting the cost of high-quality community-based services for families, after-school programs, mentors, crisis intervention and counseling services, and, when necessary, wilderness therapy programs, emotional growth boarding schools, therapeutic boarding schools, and psychiatric hospitalization is likely to prevent more costly expenses as teens grow older.  The costs associated with community-based, preventive services for teens pale in comparison with the long-term costs of teenage pregnancy, dropping out of school, addiction, and incarceration.  The math is not complicated.  Investment in social capital for teens and their families pays off in dollars saved and suffering avoided.

However, despite the best, most skilled prevention efforts, some teens will struggle.  For a variety of reasons—including the impact of poverty, genetics, biochemistry, and family dysfunction—some teens are going to face a variety of behavioral and emotional challenges.  Sadly, relatively few families of struggling teens can afford the staggering costs associated with the best care available.  Families without adequate health insurance and mental health coverage have difficulty paying the per-hour fee for community-based counseling.  Families with modest incomes and assets find it nearly impossible to pay for wilderness therapy programs and specialty boarding schools. The annual costs associated with residential schools and programs are at least as expensive as the cost of an elite private college education.  Many programs and schools, especially those with built-in therapeutic services, cost far more than that.

Teens of low- and moderate-income families need the same access to services and programs as teens in more affluent households.  The needs of lower-income teens are no less compelling.  Ideally, public funds, insurance, and support from philanthropic foundations would make this possible.  Realistically, some form of public financing is necessary to reduce access disparities.  The current state of affairs amply demonstrates that the private sector cannot generate enough money to provide services to all the teens and families with need.   At the very least, public child welfare agencies and school districts and departments must increase their commitment to struggling teens who require specialty services.  In communities across the United States parents of teens with special needs fight for access to school district resources for their children who need care from specialty schools and programs.  Many of these parents have to hire lawyers to advocate, and sometimes litigate, on their behalf.  These adversarial confrontations waste vital resources.  Federal, state, and local governments must do their part, through public financing, to ensure that vulnerable teens’ needs are met.

In addition, public child welfare and school officials need to learn about the full range of programs and schools available to help struggling teens.  Limiting one’s thinking to the least expensive options is shortsighted.  It takes persistent, earnest effort to view teens’ needs through different and newer lenses.  Professionals must use a different template, one that incorporates creative options that are supported by solid research evidence.  Governmental and insurance funding for an effectively regulated, comprehensive continuum of care for all teens and families who struggle is essential for the nation’s economic and social well-being.  A chaotic, disconnected patchwork that favors families of means is unacceptable.

There is no question that many specialty programs and schools are administered by principled, skilled, and dedicated professionals who get up each morning to change teens’ lives for the better, and they do it well.  Regrettably, the industry is also fraught with too many incompetent, abusive, unenlightened, and arrogant administrators and staff who either do not know about or refuse to abide by widely accepted standards in the field, evidence-based practice principles, and ethical guidelines.

Going forward, our task is clear. The struggling teen industry needs further study of what works, with whom, and under what conditions.  All programs and schools must empirically assess the extent to which the teens and families they serve feel helped and move toward intervention goals.  A carefully articulated, adequately funded national policy creating a coherent continuum of care is critical.  The struggling teen industry must be adequately monitored by effective regulatory and accreditation agencies.  Verbal, emotional, and physical abuse of teens in programs and schools must end.  A respectful, humane perspective that focuses on teens’ strengths, resilience, and developmental stage should permeate relevant policies and practices.  Quality community-based and residential services must be financially accessible to all families with struggling teens.  A two-tiered, bifurcated scenario that provides more care for the haves and less care for the have-not’s is unacceptable. Pursuing these tasks requires continual, passionate public education and advocacy.

The reality is that some teens will struggle. It is a fact of life. Fortunately, an impressive array of helpful professionals and resources exists that can make a difference. We need to be steadfast, compassionate, and purposeful as we guide these teens to adulthood.

Frederic Reamer Ph.D. Bio

Dr. Reamer is a professor in the Graduate Social Work Program at Rhode Island College.

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