EDITORIAL

Child Care? Youth Care? Managed Care? Who Cares?

As child and youth care work has sought to establish its profes- sional dest iny in recent decades, one of the significant issues has been whether the programs in which it works are within the education domain or tha t of heal th and social services. Thus, day care has been offered under both school and social agency auspices (as well as others) and has been funded through both of these systems. Residen- tial programs have been adminis tered primarily as social and menta l heal th services, bu t they have been conceptualized as residential edu- cation in some sett ings as well, part icularly bu t not exclusively abroad (Beker & Magnuson, 1995). So what? Why should we worry about such jurisdict ional issues when there is so much tha t needs to be done?

One reason is tha t labels and what they connote matter; they affect not only wha t we do, bu t even wha t we look for and wha t we see. Residential programs abroad tha t have an education perspective look very different from most of ours (Beker & Magnuson, 1995). This re- lates to such dimensions as competency vs. deficit models, develop- mental vs. t reatment/correct ions approaches, health- vs. i l lness-based conceptualizations, and the like. In each of these cases, the child and youth care field is on record as generally committed to the former of the two listed perspectives. The failure of the field to progress more rapidly in its own professional development is not unre la ted to this, because most group care policies and programs emphasize the alter- native position. Into this si tuation now enters managed care.

Inc reas ing ly - -a t a faster pace than many of us would have thought poss ib le - - the philosophy and real i ty of managed care appear to be dominating our heal th care system and related human services, par- t icularly where subsidized services to the poor are involved. As a re- sult, the "conditions" for which services are to be made available are increasingly t ightly defined, as are the types and amounts of services

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tha t may be provided in response. Relatively expensive services are particularly t ightly monitored. As a result, residential services will increasingly be seen-- indeed, they are a l ready--as usable only when clients are defined as having specific "deficits" or "illnesses," ra ther than for developmental purposes or to address problems resulting from family malfunction or negative community conditions. And rudi- mentary approaches to behavior modification will increasingly be seen-- indeed, they are a l ready--as the intervention of choice, be- cause they are quantifiable and can be used to directly address spe- cific behavioral deficits tha t are all too often only the visible tip of the metaphoric iceberg tha t is the real problem.

Thus, under managed care our work will be th rus t back into exactly the negative, fire-fighting mode that we have been resisting for now so many years- -unless , that is, we can at last succeed in redefining the work as providing an educational service, an alternative educa- tion modality tha t can successfully address the developmental needs of young people who cannot be educated as effectively in non-residen- tial schools. Efforts are currently under way to t ransform our often just ly maligned Native American boarding schools in this direction, and other programs around the country have turned explicitly to resi- dential education models (Goldsmith & Hahn, 1995; Miller & Caneda, 1994), al though their numbers are still small.

Many have stressed the importance to the child and youth care field of its becoming seriously involved with policy issues and the pol- icy-maid,rig process. Here is one- - the reconceptualization of American residential group care as a residential education funct ion--where our best interests and those of our clientele seem clearly to coincide. What better direction is there toward which we could tu rn our energy?

J . B .

R e f e r e n c e s

Beker, J., & Magnuson, D. (Eds.). (1995). Residential education as an option for at-risk youth [Special issue]. Residential Treatment for Children and Youth, •3(3).

Goldsmith, H., & Hahn, A~ (1995). The role of national youth policy in the development of residential education in the United States. Residential Treatment for Children and Youth, •3(3).

Miller, D., & Caneda, C. (1994). Children's Academies for achievement: Residential aca- demies of excellence. Princeton, NJ 08540: Authors.