Residential treatment centers are the most intensive form of long-term treatment Florida provides for troubled children. They’re also the most expensive, costing up to $110,000 a year per child.

Florida has 17 of these centers, all privately run, which have contracts with the state to house, educate and treat disturbed children.

The settings vary, depending on the severity of the child’s problems. SandyPines in Tequesta, for instance, resembles a hospital. Sitting on 19 wooded acres next to a state park, it is home to 60 of the state’s most disturbed children, including a 6-year-old boy who thinks he’s a girl.

Other residential treatment centers are designed to be more homelike, with children living in small groups supervised by house parents.

The state spends $9 million a year treating children, about 500 statewide, in these residential treatment centers.

Another 2,400 children whose problems are less severe live in specialized group and foster homes at a cost to taxpayers of $28 million a year.

The residential treatment centers and homes emerged in the last three decades as part of a national movement to get children out of mental institutions and jails, where they were often warehoused without treatment and forgotten.

But some child advocates are wondering how much better off children are in these different settings. No research has been done to measure their effectiveness, and state officials concede they have done a poor job of monitoring what they are getting for the money.

“There’s absolutely no research to show residential treatment to be superior to anything,” said Gary Melton, a Clemson University professor and co-author of No Place to Go: The Civil Commitment of Minors.

Many of the employees hired to care for these difficult children have no more than a high school diploma and a few days of training.

In the past three years, Florida’s child welfare authorities found evidence of abuse or neglect in 55 cases at eight treatment centers, records show, and the mistreatment could be more widespread. In a recent review of one of the centers, Brown Schools in Sunrise, state officials found abuse investigators did not thoroughly investigate reports. They failed to interview children who might be witnesses, the review found, or to ask essential questions.

And the state doesn’t track children once they’re discharged to see whether the treatment improved their behavior.

“These are not healthy places,” said Wanda Mohr, a University of Indiana professor and national expert on psychiatric facilities for children. Mohr has published research on children in psychiatric centers and testified before congressional committees on the topic.

Mohr and others say treatment centers have become dumping grounds for children in state custody and kids nobody knows what to do with.

The centers’ programs are designed to teach troubled children how to control their behavior through intensive therapy, structure and supervision. The goal is to have them return home or to a foster family, usually within a few months, state officials say.

In Florida, some children have been sent to locked treatment centers simply because the state has no place else to put them, state officials say. Once confined, some children have spent years in treatment centers because of the state’s perennial lack of foster homes.

The average length of stay for children in treatment centers statewide is nine months. But in some parts of the state, it is much higher: 16 months in Gainesville, for instance, and two years in Tampa.

One 15-year-old foster child from Miami spent more than three years at Lock Towns, a treatment center in Pembroke Pines.

“I have not learned anything,” she wrote in a letter to a judge this spring. “I do not feel comfortable in this place at all.”

The state finally moved the girl in July — to another treatment center.

The centers, some operated by for-profit corporations, have developed with little state oversight or regulation. Officials acknowledge they have not closely monitored whether children are getting appropriate treatment or whether they even need to be there.

“This department did not have adequate contract monitors,” said Kathleen Kearney, head of the Department of Children & Families since January.

At least a quarter of the children in treatment centers could be helped in less-restrictive, less-expensive foster homes or group homes, state officials say.

Treatment centers cost taxpayers as much as $300 a day per child, or $109,500 a year, compared to $4,140 to $12,000 a year for a child in a foster home.

Children’s lawyers say that in Florida, foster children who have behavior problems but no mental illnesses are often sent to treatment centers out of convenience.

“I see them placed like a piece of furniture,” said Carolyn Salisbury of the University of Miami’s Children & Youth Law Clinic. “For the state, it’s the easier thing to do. Out of sight, out of mind.”

But with only 4,000 foster homes statewide for 10,500 children in state custody, and with as many as three-quarters of those kids exhibiting behavior problems, there aren’t many alternatives to the centers, officials say.

“All too often, something is needed now. It’s been easier for children to just be placed in these deeper-end” centers, said Pat Kramer, who oversees mental health programs for DCF in Broward County.

The same constraints sometimes force treatment centers to keep children long after they are ready to leave.

“We have a boy who was ready to go last summer [1998], and he’s still here,” said Elizabeth Perugini, director of clinical services at SandyPines.

Sometimes, it’s not a matter of a shortage of foster homes, but of finding a family willing to take difficult children.

“When you have a child who masturbates in school, sets fires at home and smears feces, there’s no shelter or foster home that will take him,” said Deborah Spellman, a children’s mental health administrator for DCF in Tampa.

Even so, Spellman is among those who question the effectiveness of treatment centers. “I don’t see it working, but it keeps the child off the street and safe,” she said.

Proponents say treatment centers are better than the jails and locked mental institutions of the past, where children often were housed with mentally ill adults and hardened criminals.

“We used to lock them up and throw away the key,” said Jack Levine, president of the Center for Florida’s Children, a nonprofit agency that advocates for children. “The only way we heard about them is if they hurt themselves or someone.”

Beginning in the ’70s, as states moved children out of institutions and jails, officials turned to private social-service agencies, thinking they could do it better. The focus shifted from keeping children out of society to treating the causes of their deviant behavior and helping them function in society.

The demand for treatment centers grew with an explosion in the foster care population, beginning in the early ’80s. Today, half a million children are in foster care systems throughout the country.

“There are so many kids, they created a market for residential treatment centers,” said Al Guida, vice president of government affairs at the National Mental Health Association based in Alexandria, Va. “There are states that run residential treatment center mills, in which they are profiting off the mental disorders of youngsters.”

Oversight of the centers has not kept pace with their growth, Guida and others say. State officials who are responsible for monitoring must oversee thousands of other contracts. They admit they have not kept close tabs on children in treatment centers.

The state also doesn’t track children once they leave the centers.

Center administrators tell of children who have become A students and returned home to their families. But other kids have gone on to be arrested, drop out of school or become teen-age parents, the Sun-Sentinel found in interviews with children and their families.

Anecdotal evidence aside, no one knows whether these centers are effective or not.

Melton and Mohr believe housing children in treatment centers for long periods of time actually harms them. Kids do better, they say, in their communities in homes with parents, even if the homes and parents are not their own.

“No matter how good the program is, [it] isolates the kids from the community,” Melton said. “It’s clear the transition to adulthood is a lot harder when you’ve been outside a family setting.”

Nationwide, the use of treatment centers for children increased by 60 percent from 1975 to 1986, according to a 1991 article in the Journal of the American Academy of Child and Adolescent Psychiatry.

In a 1990 study, researchers identified 40,570 children in psychiatric facilities throughout the United States at a cost of more than $1 billion a year.

No studies have been done since to count the number of children in treatment centers or to tally the cost. State officials cannot say with any certainty how many children are in treatment centers compared to the past, or how long they are staying, because they have not kept track of that information, said Sue Ross, acting chief of children’s mental health for DCF.

“Our information system isn’t there yet,” Ross said.

State officials agree with advocates that children do better in their communities with families. They are trying to reduce the number of children in treatment centers and get kids out faster.

“I don’t want kids growing up in residential treatment centers,” Ross said.

And the state is working to develop more alternatives to treatment centers. It has doubled the number of children placed in specialized, therapeutic foster homes, for instance, from 256 in 1994 to 537 last year, records show.

“There’s a push to not have kids go into residential treatment and disappear until they’re 18,” Ross said.

Karen Gievers, a Tallahassee lawyer who forced statewide reforms on behalf of foster children through a 1990 lawsuit, said she plans to sue the state again by the end of the year on behalf of those in residential treatment centers.

“Kids should not be spending long periods of time in these places, if they really need to be there at all,” she said.

Gievers said no child belongs in a treatment center, “not the way they’re operating today.”

Melton, the Clemson professor and author, agrees.

“There may be some reasons why … we need residential treatment centers, but I can’t think of them,” Melton said.

“The fundamental question is what do you do with kids when you have no place to go. The answer is you send them to some place that’s no place to go.”