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In his first two years as Massachusetts Commissioner of Youth Services, Jerome Miller initiated a number of reform measures in an effort to provide more humane treatment for the young persons in his department's care, but he became increasingly frustrated by the difficulty of developing therapeutic treatment alternatives in an institutionalized setting. The (A) case provides background and also highlights how Miller dealt with internal administrative problems, as well as with external forces, such as the press and the state legislature. Part B describes Miller's unilateral strategy to replace most of the department's training schools with community-based treatment programs managed by private organizations under contract. The case details the impact of deinstitutionalization on the department's operations and on its political base. The sequel summarizes the reaction to Miller's resignation and later developments in the department.