This story comes to you from The Imprint through a partnership with Sahan Journal.
In June, a congressional subcommittee released an investigation slamming residential facilities for youth calling them “warehouses of neglect” and warning that children in these settings face alarming living conditions, shoddy education and, too often, physical and sexual abuse.
High on the list of concerns identified in the report: Too many children sent to these far-flung institutions — which are meant to treat severe mental health needs — had no clinical reason to be there.
In Minnesota and across the country, specially trained professionals aim to prevent this. Beginning in 2021 and rolling out gradually nationwide, the federal Family First Prevention Services Act requires certified “qualified individuals” to weigh in every time social workers want to send a foster youth to residential treatment. Their job is to inform the civil courts whether these placements — intended to be a last resort, as children are more likely to thrive in a family home — are necessary and appropriate.
Lawanna Pitts is one of Minnesota’s qualified individuals, one of just 20 people employed by the state to help determine if children should remain in a family home or be moved to an institution. The work requires completion of a training program and passing a certification test focused on evaluating kids’ needs and strengths, and identifying if there are other, less intensive, ways to support them.
In Minnesota, there are roughly 5,300 youth in foster care, according to state data. As of 2022, the most recent data available, approximately 760 were living in a group home or treatment facility.
Currently a paralegal at a family law and immigration law firm, Pitts, 47, approaches this work with years of experience in public service through community-based work. She was a church volunteer and later spent four years working for the Minneapolis Youth Coordinating Board. In that role, she walked the city’s northern streets, engaging with young people to prevent altercations with police, learn about their needs and connect them with resources.
Pitts joined the ranks of qualified individuals when the role was created in 2021, based on a friend’s suggestion. She hadn’t planned to work with struggling young people, but now feels it’s her calling.
“I’m already in the community so much, working with families and knowing what supports are available,” Pitts said in a recent interview with The Imprint. “That’s kind of what you do when you’re in the role of the QI. You’re confirming the supports that are available to them, and make sure that they’re in the least-restrictive setting — with the best support system that they can have.”
Each month, Pitts receives requests to evaluate multiple children, though she can only take on one case at a time. She spends between 12 and 18 hours learning about the child’s struggles, strengths and community before concluding whether residential treatment is the best path. Judges presiding over the children’s foster care cases make the final decision, but Pitts said they nearly always heed her suggestion.
In a rare interview with a professional of her type, Pitts shared with The Imprint an insider’s perspective on how experts in positions like hers make these consequential decisions.
This interview has been lightly edited for length and clarity.
When judges or social workers request a residential care placement for a child in foster care, how do you go about assessing the child’s needs and whether that is the right placement?
I start by interviewing the case manager with the county child welfare agency, because most times they have the most background of why the referral actually took place. I like to get the background of why you believe that this is necessary.
After they tell me their side of the story — why they believe residential treatment is necessary — then I start interviewing the youth and everyone else on their family permanency team. This could include parents, family members, guardians, foster parents, as well as professional supporters like a guardian ad litem.
If other people come up, like Grandma says the youth spends a lot of time with his uncle, then I’ll ask for the uncle’s contact information. Everybody sees everything in a different lens. Based on your support of youth or child, you may see different behaviors, they might come to you for different reasons. So it’s kind of my way of getting the bigger picture.
How does the information you gather during these interviews translate into your recommendation about whether a child needs residential care?
There’s two documents that you fill out based on that information for your assessment. The first is called the Child and Adolescent Needs and Strength Assessment (CANS), which is a form that helps you score categories for them. The categories include family strengths and functioning, intellect and development, decision making, adjustment to trauma and danger to others, as well as mental health concerns like psychosis, anxiety, depression and self-harm.
At the end of that form it tells you, based on your scoring of their strengths and needs, if they should be put into the Qualified Residential Treatment Center or program.
Then there’s a secondary document, which is the actual QRTP Assessment and Recommendation form. That form is kind of going into detail from the previous form and explaining how you got to your decision. So it goes through who you interviewed, who was in support of residential treatment placement, who was not in support of it.
Do your recommendations ever deviate from what the CANS score says?
I’ve had it happen. In one case I had conflicting information, two people were saying one thing about a youth’s community interactions — like he’s always getting in trouble at basketball — and two were saying he was totally fine when they took him to basketball practice, or out swimming. There was literally one point on the rubric in favor of sending them. So that was not significant enough for me. I felt like this is too close to put them in there — because the most important part is it not being in a restrictive setting as much as we are able to prevent it.
Then there was another one where I scored it, and it did not put them in a QRTP based on the score. But he was not getting the support that he needed outside. He wasn’t getting evaluations that he needed. His parents were just not on board with any of that. Mom and Dad were like, ‘No, we’re not taking them to therapy, we don’t believe that that works.’ Everyone else, all seven other people, plus me talking to him, made me feel like he did need that kind of support. And just the parents were not wanting to do that.
Why is it important to you in making this decision to ensure that the youth is in the least restrictive environment?
I don’t want the restrictions to be more than what they require. If they can get the same support somewhere where they’re not required to be locked in, not required to be in the room at a certain time, that’s better for them — because in the QRTP setting, there’s a lot of restrictions. And so if I can prevent them from going into that setting, specifically, I’m going to do everything possible.
Investigations by the media, the federal government and watchdog groups have revealed widespread problems in residential care, including rampant abuse occurring at many facilities. Are those concerns that you weigh when you’re determining whether a kid needs to go to a residential facility?
Yes, I think about that. And I think about the reason why the QI role was even created. I think about the disproportionate reasons why youth of color were entered into the programs at a much higher rate than kids who are not of color.
Is it part of your job to assess what resources are available in the community that could meet the needs of the children?
I always ask what support has already been tried, what placements have already been in place, what type of support they’re already receiving — like if they get respite, if they’re getting skills training, they might be getting horse therapy, or whatever the case may be. I try to figure out everything they’ve already received and try to see if there is an opportunity for something else that would support them better, that maybe had not been thought of. I actually keep a spreadsheet and I have a couple of books that give me resources in the state of Minnesota.
Part of my recommendation is telling them what I think needs to be done, including different types of placement settings. So if there’s an option that doesn’t put them in a QRTP, I put my recommendation there.
What, to you, is the hardest part about this work?
I want to save everyone. I want to do right for everyone, every situation. But our scope of work is so limited. You’re just going in, you’re assessing it, and then you back away. I’m so used to holding the person’s hand and getting them to the finish line. So that’s the hard part, to have to be like, ‘OK, here goes, this is what I came up with. Good luck.’
Then I go to the next one. That’s probably the hardest part for me, because I’m so used to helping people to the end, the follow-through of it.
