Portfolio at NYU

Posted 03.30.03
Astor Home for Children

By Jasmin Chua

Suzanne Button has one husband and 75 children. Her husband calls her "Suzie," "Suze," or when the mood arises, "Suzie-pie." Her children call her "Dr. Button." Remarkably, she doesn't get any of her children's names mixed up, except when she's unsure if Michael is going by "Michael," "Mike," or "M.J."

Before I can figure out which name she prefers, my ungloved hand is plunged fingers-first into the ice-cold interior of a pumpkin. Surrounded by children yanking up pumpkin innards by the handful, including 11-year-old Mike, the cacophony of laughter, chatter, and squeals is only interrupted by the occasional clatter of pumpkin seeds hitting the bottom of plastic bins. "Hey chicken butt," Mike calls out to someone behind me. "Get me another glove here, willya?" Mike zealously hacks and slices his pumpkin. "It looks just like you, Michael...I mean, Mike," says Dr. Button, a tall and slim woman with frizzy brown hair tied back into a low ponytail. "Three faces, huh? Very cool. Like each of your different moods," she suggests. He beams at her with obvious pride.

It is the day before Halloween and, like other children across the country, Mike and company are preparing for the spookiest night of the year. There is, however, one difference -- Dr. Button's kids make up some of the 5 to 10 percent of American children with serious mental health disorders. At the Astor Home for Children, a kids-only mental health facility in Rhinebeck, New York, where Dr. Button is Director of Residential Treatment, these children are among the luckier ones.

Between 60 to 70 percent of children with mental health disorders-attention-deficit disorder, autism, chronic and bipolar depression-do not receive the treatment that they need, according to the federal Center for Mental Health Services. The Surgeon-General's 2001 report estimates the number is closer to 80 percent.

Still, "lucky" isn't the word that comes readily to mind at Astor. These children, ranging in age from 5 to 13, have been removed from their families, either voluntarily or because of abuse and neglect. The average child's stay is 18 months, and despite efforts from staff members to downplay the institutional setting and recreate a sense of family, the fact remains that Astor isn't home. No one knows this better than the staff themselves. "These children are like empty holes," says Krista Miller, a social worker. "There's no way we could even fill that up."
Ninety miles from New York City, nestled among the hills of Duchess County in the town of Rhinebeck, New York, Astor is on the former King's Highway, a 1300 mile road from Boston to Charleston. Known less romantically today as U.S. Route 9, it was established in 1673 because of King Charles's desire to open up communication between the colonies.

More than 300 years later, on a weathered stone marker embedded in the squat wall running alongside a desolate stretch of highway, the words "98 Miles to NYORK" are barely visible. The wall also marks off Astor's grounds, which rise past a tree-lined driveway to reveal a stately three-story gabled-roof building-only part of a sprawling 90,000 square-foot facility. A crisp melange of maple, beech, and birch, flaunting their multi-hued adornments of red and gold, carries in the breeze.

Designed by master architect Harrie T. Lindeberg in the 1920s, the porch entrance of the original house still displays a white plaster relief of an overflowing cornucopia, flanked on both sides by the profiles of a boy and girl. Now with slightly more modern appendages, the residential home is a crazy-quilt of add-on structures and built-in wings, providing bedrooms for 75 children. Moving from one room to another, the squeaking of shoes on linoleum amplifies into a louder thumping on hardwood before muting suddenly into the tip-tap of heel against tile. The walls are white-washed one minute and solid red brick the next-an architectural wonderland for an out-of-town Alice.

Astor is both a Residential Treatment Center and a Resident Treatment Facility, run under the auspices of the New York State Office of Mental Health and the Department of Social Services respectively. There are 55 children in the RTC. The remaining 20, all boys, fall into the two RTF units. This easily translates into 21,000 meals and 200 loads of laundry a week.

High-risk children, defined as those who are more likely to hurt themselves and those around them, have their own bedroom. The room for an extremely emotionally-disturbed child might have somewhat barer walls than the others, but most are plastered with posters of NBA star athletes and pennants of their favorite baseball team. In order to make Astor feel more like a home, each child gets to pick the bedspread design they want -- whether it's the Powerpuff Girls or Batman and Robin. The same consideration is made when clothes-shopping so the kids aren't dressed in identical shirts and slacks.

In the living area of the Joseph unit, childcare workers and psychologists are discussing new admissions and living arrangements. Finding space is a constant struggle at Astor, especially since the older sections of the building are deteriorating. "We do a really good job of making a silk purse out of a sow's ear," Dr. Button says. "But what we really need is money for new buildings. Because of physical limitations, a simple matter of a new intake can present a knotty problem. "If we move Zack into a double, then we can put someone else with him and Brian into the single," a childcare worker says. "But who are we going to put with Zack?"

"No way Cody, no way Shane," the psychologist pipes in. "That really leaves Kenny."

"Doesn't Shane have a history of sexual stuff?" another childcare worker asks.

"Yeah, so that would be a problem," someone else replies. "He hasn't been doing it for a while but it's better to be safe."

The six staff members continue to bounce ideas off one another with rhythmic ease.

"Okay, so we'll move Cody into the triple and keep Kenny in the double."

"This new guy Jake doesn't look so bad."

"Well at least his file doesn't."

"We'll see when he gets here."

Someone brings up the fact that one of the boys, Timothy, has been fighting with the others. Astor uses a consequence system to keep order, and in this case, Timothy won't be getting his "super-snack." The children's regular meals, including dessert, are never withheld as a form of punishment, but the super-snack, a little something extra, is a bonus the kids get for keeping their noses clean.

There are other incentives for positive behavior, depending on which of the units a child is in. Some units have a "level" system. There might be four levels in total, each carrying a number of points. Points are given for such tasks such as getting ready for breakfast on time or completing chores. Instead of prizes, a child jumps up a level, perhaps winning a later bedtime or extra pocket money. "I wonder what shape Kenny will be when Charles moves upstairs?" one of them muses. Kenny and Charles are brothers, Dr. Button explains to me, but Charles is being moved to a unit with older boys. "He's a big fish in a small pond right now," the psychologist says. "But then when he goes upstairs he's going to be the smallest fish." They will still get to see each other since there are sibling therapy sessions. But being in different units means less time together.

Because of Astor's small size, moving up can sometimes mean moving out. Once a child turns 14 he has to leave. "Hey Corey," Dr. Button calls out as we walk by a pale-looking 13-year-old with floppy brown hair and large, languid eyes. "Hi Dr. Button," he responds meekly. Corey is someone who is "aging-out" of Astor. Still not ready to rejoin the community, he is being moved to the Parson's Child and Family Center RTF in Albany. Corey's main worry, Dr. Button explains, is that he won't be able to see his grandfather as often after the move to Parsons. "They age-out and we just have to let them go," she says. "It'll be a new place with new faces and a new set of guidelines and rules to get used to. There isn't a continuum of care for these kids."

Since many of the children are at Astor due to parental abuse or neglect, the foster care system often presents additional complications. Social worker Krista Miller recounts the story of one girl, a four-year-old named Missy, whose brother had been taken from his foster family and placed into respite care that week. "She's going to lose all the mail she's been getting from that foster family," Miller says. "She gets mail like three times a week. We have no idea where her brother is right now and she doesn't have anybody else. We're going to try and find him." Like other children in the foster care system, there are kids at Astor who are up for adoption. "It's just a matter of people enquiring about them," Miller says. "People aren't exactly jumping up screaming to adopt these kids."

Despite additional clinical and therapeutic needs, the children at Astor toil under a more familiar yoke-school.
Elementary Spanish is in session when Dr. Button leads me into one of the classrooms. "Hola," a round bespectacled boy, who looks around 12, calls out. Green tennis balls are jammed into the desk and chair legs, not only to prevent scuffing of the floor, but also because some of the more sensitive children cannot stand the screeching sound the chairs make when dragged. Standard schoolroom accoutrements are displayed on the four walls. Above the blackboard, a poster drawn in a bold childish hand states the class rules. "1) Treat others the way you want to be treated," it decrees. "2) See Rule #1."
"Some people might think that this is a bad place," says Corrine, a pretty 8-year-old with her hair wrapped in a red kerchief.

"Yeah," agrees Eric, the boy who had greeted me in Spanish earlier. "We have a pool." He wriggles his nose to adjust his spectacles sans-hands.

"The kids here aren't bad," Corrine reiterates. "We just have some problems." While I kept in mind that this was one of the higher-functioning classes, it was easy to forget that these weren't regular kids. They complain about the fire drill they had that morning and then gush excitedly about what they are going to wear for tomorrow night's trick-or-treating. The best thing about being a kid at Astor is getting to the highest level in your unit, the field trips, or Nintendo, depending on whom you ask.

Donna, a bright-eyed 13-year-old with a dazzling smile, frowns for the first time since I arrived. "I miss my parents," she says. Corrine nods solemnly. "I think she speaks for all us kids," she says. She looks down at her hands and fidgets. "Sometimes when we're really bad, we have to got to Four Winds," she says. "I don't like it there."
She is referring to Four Winds Saratoga, one of the inpatient psychiatric hospitals that step in to handle children who are acutely suicidal, homicidal, or dangerously aggressive. Dr Button explains: "They may keep our children for anywhere from a few days to a few months in order to stabilize them so we can maintain them safely in our setting. Children don't go to the hospital for 'misbehaving'."

Other life-lines include New York-Presbyterian at Cornell, Rockland Children's Psychiatric Center, and Stony Lodge Hospital. Where the children go to be treated depends on the parents' input.

Later, when Donna and Corrine play hostesses and give me a tour of their school, we walk by one of the crisis intervention rooms. The frustrated wailing of a child throwing a tantrum can be heard even through the closed door. Donna lowers her voice. "Someone's having a problem," she says.

Dr. Button had shown me the interior of one of these crisis intervention rooms earlier. The four walls of the room-bare, except for a thick exercise mat-were painted with a bright underwater scene. The doors don't have locks. "The staff is trained on several types of holding techniques that they are allowed to manage the kids," Dr. Button says. "But these doors don't lock-they are never locked and they are never held shut-we never force kids to be in the room against their will."

Depending on the child, a childcare worker may be inside the room with them, or if the child wants to be left alone, waiting outside. Then there are those who know how to give themselves a time-out. "Sometimes the kids learn to use this room in a way that's more voluntary," Dr. Button says. "They'll say that they need to go to the crisis room and they'll come down, bounce around, beat the mat, and then they'll be ready to go back to their unit."

The arms of the Astor Home for Children stretches far beyond the confines of Rhinebeck. In addition to family-based treatment homes and therapeutic foster family homes in Duchess and Orange Counties, community-based behavioral health programs and early childhood programs are peppered across Duchess County and the Bronx.

Annual program statistics give a head-count of over 5,000 children and families in Astor programs. The agency as a whole has 650 staff members operating at 35 different locations. Fifty of them operate within this building itself.
Beginning life as Holiday Farms in the early 1900s, and supported by the landed aristocracy living along the Hudson, Astor was originally a convalescent home for children suffering from communicable diseases such as tuberculosis. When Colonel John Jacob Astor IV and his wife went down with the Titanic in the spring of 1912, Holiday Farms was renamed the John Jacob Astor Memorial Home for Children.

With the advent of better drugs and improved sanitation, the home soon outgrew its original purpose. "It was realized that there was no real psychiatric treatment for kids," says Elise Barry, Director of Development and Public Relations and Astor's resident historian. "They were being treated with the adults. One mental health model applied to everyone."

In 1953, the Astor Home for Children found a new lease on life as one of three pilot projects designed to develop a residential treatment program model for emotionally disturbed children who might have otherwise required psychiatric hospitalization. The Archdiocese of New York becomes its main sponsor. A faded photograph immortalizes Astor's first director, Sister Serena Branson, welcoming their first child in January of that year. By April, the sisters were providing care for 17 children. Next January marks Astor's 50th anniversary.

The Christopher unit is a living relic of Astor's past. Housed in the only building that's set apart on its own, the cottage was originally meant to sequester away children who suffered from a relapse of tuberculosis. Today, it symbolizes something entirely different. The "Christophers" are boys 12 to 13 in age. They wash their own laundry, have separate cooking facilities, and are unencumbered by many of the rules children from the other units have to follow. One step away from rejoining the community-at-large, initiation into the Christopher fraternity is definitely something to crow about.

"Hey Jordan," Dr. Button cries out as she spots a tiny form carting a basketful of laundry. "Hi Dr. Button!" Jordan shouts back. "You're with the Christophers now?" she asks. He nods and waves. Dr. Button gives him a solid thumbs-up and the brightest smile imaginable.