At Treatment Centers, It’s Time to Adapt or Perish

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Des Plaines, Ill.—For 120 years, some of the most pained children in Illinois have come to the Maryville Academy for help and protection – orphans, neglect victims, juvenile delinquents and, increasingly, youth with severe psychological and emotional disturbances. Even as the kids’ problems grew more complex, the Rev. John Smyth, the executive director, almost never turned them away.

That, say some people who work with Maryville, helps explain why Smyth is out as executive director, and the state is emptying the 270 beds at the academy’s main campus here.

Observers and Maryville officials cite a variety of factors for the demise of the campus, once the largest residential treatment center for youth in Illinois: the increasing emphasis on moving youth out of institutions, inadequate staff training to handle the more challenging youth who subsequently arrived, a reluctance to fully embrace a clinical model of care and intense media scrutiny sparked by a youth’s suicide.

But one commonly cited reason (which Smyth disagrees with) was best summed up by Jerry Slomka, a former official with the agency that placed youths at Maryville: “Father Smyth did not know how to say, ‘No.’ ”

Maryville’s fate parallels challenges faced by many residential youth-serving agencies around the country, which are seeing more intensely troubled kids than they used to, especially from state placements. “You’re getting an almost exclusive club of children who have been traumatized by abuse or neglect. You have to have gone through some horrific things to be a member,” says Dr. James Guidi, program and clinical manager at Maryville, which operates 16 youth facilities that focus on issues such as pregnancy, physical disabilities and developmental disorders. Only the main campus is being emptied.

Many facilities have struggled to upgrade their staff training and treatment models, says Floyd Alwon, director of the Boston-based Walker Treischman Center, the training arm of the Child Welfare League of America.

“The state of the art … is pretty abysmal across the country with regard to the professional preparation,” Alwon says. “There are many where [training] is quite minimal – shockingly minimal.”

But other agencies are adapting to the change. Many people who have worked with or at Maryville say its fate illustrates what happens when that adaptation is slowed by an urge to hold on to an agency’s traditional values in serving youth.

Tougher Youth

Residential facilities in Illinois began seeing big changes in the mid-1990s, when the state Department of Children and Family Services (DCFS) shifted its emphasis away from housing children who were troubled but not in need of psychiatric care. That cut the agency’s overall youth population from about 50,000 to less than 20,000. Meanwhile, the population housed in institutional residential facilities like Maryville has dropped from 4,300 in the mid-1990s to about 1,500 last year.

Around the same time, DCFS decided to bring back to Illinois about 800 psychiatrically needy children who had been housed out of state in special facilities, asking in-state residential facilities to retool.

Illinois is hardly unique in emptying facilities of children who primarily need three square meals, a bed and someone to befriend them. “The reason kids are getting tougher in care is that the easier ones are being supported in their homes and in their communities – and they should be,” Alwon says. “Some [facilities] have been able to jump ahead of the curve to try to do the best job they could in taking care of these kids. It’s very, very difficult to do that and do it well.”

That’s one reason Girls and Boys Town U.S.A., based in Omaha, Neb., has rewritten its training manuals over the past two years. “Your kids change, and your staff need to be brought up to a certain level of proficiency,” says Associate Executive Director Jerry Davis. “You do have to tailor the tools with [an eye toward] which ones are going to be effective with different kinds of kids.”

Maryville had an especially tough time making the transition, says psychologist Ron Davidson of the University of Illinois-Chicago (UIC), who led staff retraining in 2001 at one Maryville facility, the Scott Nolan Center. “The place was literally going up in flames,” Davidson says of the Nolan Center when he arrived. “The fire department was there every other day. The police department was there every day.”

But in the eyes of many observers, the Nolan Center became a model for how to change.

Changing Staff Attitudes

Davidson was at Nolan because Maryville had agreed to a comprehensive review and to technical assistance from the UIC Mental Health Policy Program. His interim report to then-DCFS Director Jess McDonald in September 2001 pointed out deficiencies in staff training, staffing ratios and managerial oversight, as well as a clinical “mismatch” between Maryville’s nonclinical “family teaching” model for handling wards who acted out and the needs of the new population.

Family teaching resembles a typical parenting regimen in which rules are to be followed (at least most of the time), and acting out is accepted, within reason. Smyth says the strength of family teaching is that it makes the atmosphere less institutional. “It makes the home a very important aspect of the child’s life,” he says. “You can bring in therapy as part of that.”

The model’s focus on demonstrating appropriate behavior had little effect on the new, more troubled kids who had lost their ability to trust, says Dan Fallon, a clinical psychologist who worked at Maryville from 1996 until last October. “You can’t do that with kids who, candidly, have been butt-f------ and beat up,” he says. “They’re just too injured to respond to that, too nervous about trusting anybody else.”

Dr. Rocco Cimmarusti, hired last year as clinical director at the main campus, says family teaching’s focus on relationships can help therapy take hold, but he adds that recent research shows that people who have suffered trauma “biologically shut down” and can’t respond properly to typical parenting.

“If you treat them lovingly, they might just kick you in places you don’t want to be kicked,” he says. “Then you wonder why that happened – and that’s the piece that the front-line folks needed to learn. If he’s rejecting you or she’s running from you, you’re getting to them. You’re starting to make contact. And you need to be patient.”

That, however, requires a major attitude shift among staff. “Some of the staff perceived these kids as being evil,” says Guidi.

“Part of the first step is to educate them in terms of what mental illness is.”

“You start off by teaching staff to think in a slightly different way about these problems, and then afterward you start giving them tools,” he adds. Those tools include points-and-levels systems in which children earn rewards for behaving well – rather than focusing on punishing every infraction – setting individual goals for children and creating more daily structure.

Davidson says staff members were skeptical when they visited the inpatient adolescent clinic at UIC as part of their training.

“Many of the kids had bounced out of Nolan directly to UIC in psychotic episodes, completely out of control,” he says. “So they had the experience of walking into the UIC inpatient unit and seeing these kids looking, walking and talking like normal kids.

They realized, ‘Here, they’re not lying. … You can work with those kids.’ That was kind of a religious epiphany for these staff.”

Maryville eventually doubled the number of clinicians at Nolan, reduced the average caseload from 22 to 11, and shifted from the family teaching model, which Smyth had instituted three decades earlier, to a more clinically based treatment model.

Guidi says the UIC training increased staff competency and improved staff attitudes. The latter change was reflected in an opinion survey that UIC conducted in May 2002. (See chart.)

Taking All Kids

That success was not replicated at Maryville’s main campus, which had been housing between eight and 10 youths in each of 27 homes, with a married couple staffing each one.

“Maryville was basically under the assumption that they were running an orphanage,” says Irene Nelson, supervisor of the Cook County Public Guardian’s incident review team, which monitors such facilities. “They did very well at the Nolan Center. I think it’s a pity that they didn’t choose to [change more quickly] at the main campus.”

Maryville’s leaders say they were committed to retraining their staff. But people inside and outside the academy point to several impediments ingrained in the way the institution did business.

Some believe Smyth did not mind changing the methodology at a specialized, satellite facility like Nolan, but bristled at doing so on the main campus. “That was too close to Smyth,” Fallon says, reflecting the thoughts of several other observers. “He lived on the main campus, and he considered that his domain.”

Smyth says he “had no reluctance” about bringing the clinical model to the main campus, but believed family teaching could still play a part. “The teaching parent model is not the answer to everything. Neither is the clinical model,” he says. “You’ve got to look and see what works, and keep an open mind and be willing to change.”

Some observers say Maryville was hampered by Smyth’s policy of accepting virtually every child. “DCFS and Jess McDonald dumped a lot of kids on Father Smyth that he had no right taking and they had no right giving him,” says Cook County Public Guardian Patrick Murphy.

Slomka, DCFS deputy director of operations and community services until last May, credits Smyth for being especially generous, but adds, “Did that put him at a disadvantage, and did the department take advantage of it? In all probability, in some cases, yes.”

“Probably, they did,” Smyth agrees. “But we had a very, very fine relationship. We did help them with a lot of problems. I don’t think that was the downfall of Maryville.”

Nelson, of the county guardian’s intake review team, credits other facilities for knowing when to say no. “They have an intake committee; they demand to have the paperwork; they look at the issues kids bring; they look at whether they can meet those needs,” she says. “At Maryville, it was not unusual for DCFS to bring a child with no paperwork, no nothing, and Maryville would accept the child.”

The Rev. David Ryan, who took over as acting executive director after Smyth resigned in December, says Maryville tries to take in every child, in part because of its mission as an agency of the Catholic Church. “We do this because we do see this child as a child of God,” he says, “not just as a client, not just as a Medicaid number, not just as a state ID number.”

Bad Mix

Once youth were admitted, some observers and former staff say, the next problem was with intake and assignment.

Fallon, who was clinical director at Nolan from 1999 to 2001, says he tried to establish formal intake procedures during his tenure at Nolan, but the process fell apart.

“We started getting kids showing up with a Hefty bag with their clothes, saying Father Smyth sent them there,” says Fallon, who also served as clinical quality assurance director for Maryville before leaving last fall for private practice. “We had 15-year-old gang-banging sexual predators put in the same unit with 11-year-old kids who had been victimized.”

That eventually changed, Fallon says, when DCFS’ McDonald and UIC’s Davidson “got hold of Father Smyth and said, ‘This can’t continue.’ ”

But the problem continued at the main campus until as recently as last year, says Art Dykstra, CEO of Trinity Services in Joliet, Ill., who served as DCFS’ independent monitor for the facility starting in December 2002: “We would say, ‘Does it make sense to put kids who are 8 feet tall with kids who are 2 feet tall? Why are you putting sociopathic kids with kids who are depressed and can be preyed upon? Why are you putting 18 1/2-year-olds with 6-year-olds?’

“Father Smyth was very adamant that that was not a problem, that they were staying true to their mission of serving all kids.”

Smyth says he never received specific recommendations from the monitors. “If he [Dykstra] pointed out a child who was wrongly placed, we would have moved them,” he says.

A Suicide And the FBI

Then some of Maryville’s problems became public in a tragic way.

Davidson says Smyth had agreed to implement the Nolan model on the main campus, but the momentum abruptly halted when the Chicago media, including the Chicago Tribune and the Chicago Sun-Times, ran a series of stories in September 2002 focusing on the suicide of a youth at the main campus. While Smyth told reporters that the incident was not particularly symptomatic of larger problems at the facility, Davidson says he gave reporters a more downbeat assessment that contradicted Smyth’s comments.

“He thought we had ratted him out to the media,” says Davidson, who believes he simply told the truth.

“One day, they [UIC] said everything was fine. The next day, it wasn’t,” Smyth says. “The foundation of truth broke apart.”

UIC and Maryville parted ways. Slomka says his agency, DCFS, gave Maryville plenty of time to continue training at the main campus. “They were always telling us they were doing it,” he says, but “it hadn’t occurred.”

Fallon, the psychologist who worked at Maryville, concurs: “The priests were getting huge amounts of money from the state for a different staffing model. They were saving money by thinking that’s not the problem.”

Dykstra, the independent monitor for DCFS, says he and other monitors met resistance when they asked about retraining main campus staff as recently as last year. In a September 2003 report to DCFS, the monitors wrote of “little progress . . . in improving the daily operations and treatment practices within the [group] homes. It does not appear that Maryville has adopted a sense of urgency in response to its difficulties.”

“That’s his opinion,” Smyth says.

A frustrated Guidi says the monitors didn’t note the changes that had occurred since he became program and clinical manager two months earlier. “It wasn’t until I was around that we started going 100 miles per hour,” he says.

The FBI is investigating Maryville’s use of federal Medicaid funds that came through DCFS, Slomka says. He says some of the money was intended to retrain the staff in the clinical model.

“I’m not saying that there’s fraud here,” Slomka says. “I’m saying, ‘Be more specific about for what the money was spent.’ ”
“Whatever Medicaid [spending] was done, it was done very, very properly,” Smyth says.

In September, DCFS announced that it will move all of its wards off the campus. Maryville administrators hope to retool the academy as an educational institution.

Guidi insists the retraining had been going forward prior to DCFS’ decision. Ryan believes DCFS is emptying the main campus because Maryville became too much of a political hot potato after its troubles splashed onto the front pages.

About two-thirds of the youth have been sent elsewhere, with the rest scheduled to leave within the next few months. The monitors have reported that Guidi, Cimmarusti and their staff have stepped up the process of implementing a more clinically oriented model and making other reforms.

“They’ve assessed and weeded out those kids who they really can’t treat,” says Jim Osta, who has stepped in for Dykstra as a DCFS monitor.

Ryan believes Maryville should get another chance at operating its main campus as a residential treatment facility. “This is a solid program that could again meet the needs of children coming here,” he says.


Mary Vitulli
Development Department
Maryville Academy
1150 N. River Road
Des Plaines, IL 60016
(847) 294-1890

Bryan Samuels, Director
Illinois Department of Children and
Family Services
100 West Randolph St.
Chicago IL 60601
(312) 814-4150

For a DCFS summary of the Maryville situation,
go to

Staff Attitudes Change

Maryville Academy staff were surveyed before and after significant changes, including staff training, designed to help the Nolan Center work with more psychologically and emotionally troubled youth. Among the responses to questions about residential treatment centers, according to the University of Illinois-Chicago:

Before changes and training:
• The centers are unsafe for clients: 69 percent
• The centers are unsafe for staff: 83 percent
• The centers are not therapeutic or are destructive to clients: 61 percent

After changes and training:
• The centers are safe for clients: 65 percent
• The centers are safe for staff: 61 percent
• The centers are therapeutically effective: 65 percent