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Head trauma, painful restraints: WA foster kids face abuse out of state

Jesus Lopez, 21, in his Mount Vernon home on Nov. 27, 2018. Lopez entered the Washington foster care system at age 3, and officially left the system on his 21st birthday. During his time in the system, Lopez was sent for a brief time to a facility in Iowa called Clarinda Academy. In October, Disability Rights Washington published a report about Clarinda and its "abusive" practices. (Photo by Dorothy Edwards/Crosscut)

Just three days after arriving at the Clarinda Academy in rural Iowa, Jesus Lopez lay unmoving in his bed, bruises across his forehead, arms, legs and back. Investigators would later report that staffers at the group home for foster kids and other troubled youths had repeatedly picked up the 17-year-old, dropped him onto his buttocks and pushed him forward until his face hit the floor.

Lopez says he blacked out. He remembers a nurse trying to wake him. One of the workers who had restrained Lopez told investigators he had checked on Lopez throughout the night, concerned because the boy didn’t move for hours.

Lopez agreed to attend Clarinda after bouncing between 29 foster homes and several group homes in Washington state, beginning at age 3. He had arrived excited to learn the welding trade. His Washington caseworker had encouraged the move. Things were finally looking up.

But when he got there, he says, the place felt like a prison. And when he tried to run away, staffers carried him back inside and took turns restraining him, first in a shoe closet and then behind a bedroom door. The result, an investigator for Iowa Child Protective Services found, was “severe bruising” to Lopez’s forehead.

Jesus Lopez’s experience at Clarinda in 2015 is just one of many stories of troubled foster youths mistreated there and at other out-of-state group homes housing Washington foster kids, government records show.

As far back as 2012, California authorities repeatedly found that foster youths they had sent to Clarinda were subject to inappropriate restraints, including incidents in which one youth’s collarbone was broken and another passed out and was hospitalized with possible head trauma, reports from the California Department of Social Services show.

Then last year, a government-appointed watchdog group, Disability Rights Washington, delved into the experiences of three Washington children who attended Clarinda two years after Lopez had left the facility. It revealed the use of what the group’s report called “abusive” and painful restraints on children for “questionable reasons at best.” Only at that point did the Department of Children, Youth and Families begin relocating the half-dozen Washington kids at Clarinda at the time. The last left at the end of January, the department says.

Yet dozens of other Washington foster kids remain at group homes in South Carolina, Wyoming and Michigan that also appear to have mistreated children, according to InvestigateWest’s review of official reports from oversight agencies in other states. These include other facilities owned by Clarinda’s parent company, the for-profit, Alabama-based Sequel Youth and Family Services. Mental health experts generally agree that physically restraining people in crisis can be traumatizing and dangerous, yet Sequel and other group care providers continue to rely on restraints to manage their charges.

Lopez said one reason he decided to share his story with InvestigateWest is that he wonders how Washington could let other kids suffer as he did at Clarinda.  “When I heard about that, it made me cry,” he said of the Disability Rights findings. “I don’t want other kids to go through what I went through,” he said.

About 100 Washington foster kids currently live outside the state at group homes across a dozen states as far away as Florida. Ross Hunter, secretary of the Department of Children, Youth and Families, declared in October his intention to bring all those youths back to Washington within two years. The department plans to do that mainly by increasing capacity at in-state group homes.

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Founded in 1992, Clarinda Academy was originally intended to be a facility for “delinquent” young men. Washington youth are sent there through the foster care system, not because they have committed a crime. (Photo by Tina Pinedo/Disability Rights Washington)

In the meantime, Washington continues to send foster youths to other out-of-state group homes, where authorities have documented short staffing, medication mix-ups, children running away and instances of workers improperly restraining and even assaulting youths:

  • At Palmetto Pee Dee, a South Carolina group treatment facility that currently houses more Washington youths than any other out-of-state facility, workers pushed and struck children and put them in “unsafe” physical holds, according to reports by the South Carolina Department of Health and Environmental Control. In one 2017 incident, captured on a surveillance camera, a staffer entered a child’s room, punched him and placed him in a headlock. The facility paid $19,700 in fines last year for 51 violations dating back to 2016. It’s unclear whether Washington youths were involved in any of the incidents described in state investigation reports.
  • At Normative Services, a Sequel facility in Wyoming, inspectors in 2016 concluded that “the organization uses physical restraints as punishment, for the convenience of the staff and as a program substitution,” according to reports by the California Department of Social Services. One worker improperly restrained a resident and broke the child’s arm, and another lost his temper and punched and kicked a youth.
  • Starr Albion Prep in Michigan has been the subject of nearly 60 investigations since 2014 by the Michigan Department of Health and Human Services. Reports from the Sequel-affiliated facility show that staffers in 2018 restrained youths unnecessarily and used unapproved techniques, in one case breaking a child’s thumb. The facility did not have enough workers to effectively deal with youths’ behaviors, state inspectors concluded.
  • Northwest Children’s Home, in Idaho, was threatened with losing its license in 2017 after a lack of appropriate supervision led to multiple incidents of children engaging in sexual acts with each other and an alleged rape, according to The Lewiston Tribune. The facility remained open but was banned from admitting more children for several months.

Prompted by Disability Rights’ report about Clarinda, the Department of Children, Youth and Families says it has stepped up its monitoring of youths placed out of state. It dispatched case workers to check up on all foster kids outside the state last fall. Washington case workers will continue to visit out-of-state youths quarterly, plus call them every month. In the past, the department relied almost exclusively on contracted case workers in those states to check up on Washington kids each month. The department is also developing systems to more thoroughly vet facilities before it contracts with them and to monitor compliance with those contracts, it told InvestigateWest.

“There’s no question that the oversight at out-of-state facilities was not as stringent as it should have been nor as thorough as it will be moving forward,” the department wrote in an email.

In a statement emailed to InvestigateWest, Sequel Executive Vice President Steve Gilbert wrote, "We work diligently to ensure that we are providing the best care possible for our students, including continually improving our policies and procedures. If we identify a problem in our organization, we self-report it and make the appropriate correction immediately.”

Clarinda, Normative Services and Starr Albion Prep, he wrote, “all have their full licensure status. As a behavioral health organization, we are subject to constant monitoring by state regulatory and licensing oversight bodies, as well as The Joint Commission. Our facilities each receive dozens of on-site assessments per year, including many unannounced visits.”

Dashed hopes

Washington sends children out of state only after it has exhausted all in-state options, said Doug Allison, who oversees services for adolescents, including those sent out of state, with the Department of Children, Youth and Families.

Keeping kids close to home is “just best practice,” he said. It’s not always possible, he added, because in-state options have dwindled to a “critical” level over the past decade, due in part to post-recession budget cuts.

By the time Lopez agreed to try out Clarinda in 2015, just months before he turned 18, he was losing hope. His last chance of finding a permanent family had evaporated a year earlier, when a couple that had been planning to adopt Lopez had a family emergency in another state and backed out of the adoption at the last minute.

“I fell apart,” he says of that period.

Stays in facilities for runaways, the hospital, juvenile detention and another group home followed. A social worker’s notes to the court said Clarinda Academy was “the only placement that was willing to take Jesus due to his behaviors over the last year.”

Lopez says a representative from Clarinda him told he could learn welding there. He would have a skill to support himself when he left foster care — an important goal for foster youths, who face high rates of unemployment when they leave the system.

“It sounded awesome,” Lopez says now. “I wanted to give it a try.”

But as soon as he got to Clarinda, he could tell it wasn’t for him.

The imposing brick buildings felt like a prison and look out on an actual medium-security prison across the road. Youths attend school on campus. They are rarely permitted to leave.

The program aims to reform “delinquent” kids, as Clarinda’s website calls them, and the facility’s policies assume that a court has ordered their placement there for violating the law, according to Disability Rights. Rules are enforced through a series of escalating “interventions” that can end with staffers physically restraining youths if they fail to comply.

Lopez says staffers told him he would have to stay until he “finished the program.” He felt like a criminal, he says, instead of a foster kid who had gone there voluntarily.

“When you voluntarily admit yourself to a facility, you’re allowed to leave,” Lopez said. “If you’re not allowed to leave, it’s prison.”

Jesus Lopez, 21, leaves an administrative procedure hearing at the Mount Vernon courthouse where he was released from the Washington foster care system.
Jesus Lopez leaves an administrative procedure hearing at the Mount Vernon courthouse, where he was released from the Washington foster care system on his 21st birthday on Nov. 27, 2018. (Photo by Dorothy Edwards/Crosscut)

 

More than a month after staffers roughly restrained Lopez, Iowa Child Protective Services opened an investigation into the incident. One worker admitted to investigators that he and others were performing “improper restraints.” He said that Lopez “wasn’t aggressive or fighting and was limp as a noodle” after they carried him back into the building. The workers said they’d been working double shifts and were “tired and frustrated.”

“It’s shocking what they did,” said Alexandria Hohman, a state-appointed lawyer who represented Lopez as he prepared to leave Washington’s foster care system last year. “I wouldn’t tackle a dog the way Jesus was tackled.”

Four workers involved in the incident told investigators they had been suspended for three days, placed on probation for 90 days and required to take additional training. One had been reprimanded three previous times for using improper restraints, according to the Child Protective Services report.

Sequel said privacy laws prevent it from commenting on Lopez’s case. In an emailed statement, Sequel Executive Vice President Gilbert wrote that the Iowa Department of Human Services’ November 2018 report on Clarinda “concluded that our use of restraints as an emergency safety intervention were all appropriate and were consistently utilized for the safety of the students and people around them.”

The approach Sequel takes to reforming what it calls “delinquent behaviors” at Clarinda is the same approach it seeks to use at all 30 of its facilities, according to the Disability Rights report.

Washington had placed about 50 foster children at nine Sequel group homes, including Clarinda, as of November 2018. The state paid Clarinda $733,000 in the fiscal year ending June 2018.

The Department of Children, Youth and Families was unable to answer InvestigateWest’s questions about what actions caseworkers took after Lopez was injured three years ago.

A Washington state child welfare supervisor did visit Lopez at Clarinda, but it’s unclear if she knew at the time of her visit about the way he had been mistreated. A different social worker’s later report to the judge overseeing Lopez’s case mentioned that he “has required several physical interventions,” but it does not describe his injuries or the Iowa Child Protective Services investigation.

Without that information, the judge couldn’t take steps to protect Lopez, his former lawyer, Hohman, pointed out.

“The lack of transparency is alarming to me,” she said. “If nobody says anything, nobody can act.”

Are other group homes any better?

Even though Washington has stopped sending kids to Clarinda, other group homes the department still uses also have been cited for multiple serious violations.

At Palmetto Pee Dee in South Carolina, which serves youths with autism and psychiatric disorders, children have been injured by each other and by staffers on multiple occasions, reports by the state’s Department of Health and Environmental Control show. The 59-bed facility housed 16 Washington youths at the end of last year, according to the facility.

In one 2016 incident, a youth said a staffer “kept calling him stupid” and “got into my face,” according to the state’s report. When the youth pushed the staffer, she “punched me in the face, grab [sic] my hair and hit my head on the rail.” The youth was taken to the hospital with bruises and scratches on his face.

When you voluntarily admit yourself to a facility, you’re allowed to leave. If you’re not allowed to leave, it’s prison.
— Jesus Lopez

According to another 2016 complaint, a girl lost one-quarter of her body weight in an unspecified period, going from 132 pounds when she entered the facility to less than 97 pounds by the time the state investigated.

The Department of Health and Environmental Control took the unusual step of fining Palmetto Pee Dee nearly $20,000 for dozens of violations related to those and other shortcomings over a four-month period ending January 2017. It cited understaffing, failure to document physical examinations, and numerous failings related to meals, cleanliness and facility upkeep, among others.

Of 11 licensed residential treatment centers for children in South Carolina, Palmetto Pee Dee is the only one fined in the past three years, according to the Department of Environmental Health and Control. State officials met with facility managers in February 2018 to review their compliance with agreed-upon measures, and the department said in an email to InvestigateWest that it considers the matter closed.

Yet Palmetto Pee Dee has faced multiple investigations since the ones that led to the fines: 

  • In two October 2018 incidents, a staffer placed a youth in an “unsafe physical hold” and struck him in the face. Another worker pushed a youth against a wall and put him in a headlock.
  • One youth was bitten by his peers at least a half-dozen times in 2017, and investigators concluded the facility failed to take appropriate actions to protect the child.
  • A staffer attempting to escort a youth away from a confrontation with a peer in 2017 “heard a popping sound come from the resident’s arm.” The youth was sent to hospital and diagnosed with a broken elbow.
  • Multiple youths were able to run away due to insufficient staffing in 2017. Last May, nine kids dashed out doors and climbed fences in a mass escape.

In each case, Palmetto Pee Dee agreed to take corrective actions to remedy the violations state officials found.

CEO Daniel Eichelberger said in an email that the facility has successfully treated and returned numerous children to Washington.

“Washington State representatives, case managers, social workers, and administrators are very involved in their children’s treatment while in our care,” Eichelberger wrote. He noted that the facility’s relationship with Washington “remains strong,” and that the facility is “in compliance with all regulatory agencies.”

Washington has placed youths at two other South Carolina facilities also owned by Palmetto Pee Dee’s parent company, Universal Health Services. The state has investigated few complaints at those two facilities over the past year.

The Department of Children, Youth and Families was aware of the infractions at Palmetto Pee Dee, said Steven Grilli, the department’s director of child welfare programs. It sent a team there to visit Washington children and review their files, he said. “They have to our knowledge been compliant with all of their plans of correction, and they have full licensure,” he said.

There are times when “things don’t go the way they are supposed to” in these facilities, Grilli acknowledged. “But by and large ... the work that they are doing and the progress that Washington kids are making has been really good.”

Washington’s plan: More in-state group homes

Officials overseeing Washington’s child-welfare system have vowed to bring all Washington foster kids back to the state within two years. The question is, where will they go?

Private agencies in Washington that contract with the state to run group homes and other programs for foster kids with mental health and behavior challenges have drastically cut the number of children they serve in the past decade, in part because state payment rates didn’t keep up with rising costs.

The Department of Children, Youth and Families says it needs space for 200 to 300 more youths in group homes inside Washington. That would roughly double the state’s current capacity. Washington would still have a relatively low proportion of foster kids in group settings — about 6 percent, according to the department, compared with a nationwide average of about 13 percent in 2017.

Keeping kids in Washington makes it easier for them to stay connected to family and other supports they have here, Allison said, which improves their chances to return to family once they get out. The department also has greater authority to monitor facilities inside the state and to investigate when problems arise, he explained.

The state Legislature appropriated $2 million to expand and renovate group homes, which will create room for up to 39 more foster youths by this fall. This year the department has asked the Legislature for $25 million to boost payment rates to group homes, which it hopes will encourage agencies to expand or reopen facilities.

The state spends about $12,000 per child per month on out-of-state group homes, and a similar amount on in-state homes equipped to handle the most troubled youths.

But is increasing Washington group homes the answer?

Many of the youths in group homes could live successfully with specially trained and supported “therapeutic” foster parents, while receiving mental health treatment in their communities, research suggests. That approach is not only cheaper than group homes, but kids typically do better in family settings, child welfare experts say.

Recruiting therapeutic foster parents, however, is a daunting challenge, according to the private agencies that run such programs. Department officials say they are working to increase the number of both therapeutic and regular foster parents, and also to give them more support so they can respond to kids’ needs. But expanding group homes inside Washington, while improving their quality, remains the state’s main strategy for addressing the current shortage of options for the most troubled foster youths who are now being sent out of state.

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Jesus Lopez leaves an administrative procedure hearing at the Mount Vernon courthouse. (Photo by Dorothy Edwards/Crosscut)

Looking to the future

On a blustery morning last November, Jesus Lopez dashed up the steps of the Skagit County Courthouse as fast as his slide sandals would let him. It was his 21st birthday, the day he would cut legal, if not emotional, ties with the foster care system.

Lopez’s case was the first on the day’s docket. He slid off the wooden bench and joined his lawyer in front of the judge. “It’s been an adventure,” he told the judge.

Lopez’s adventure continued after he left Clarinda at 18, he told InvestigateWest. After a failed attempt to live with his mother on the other side of the country, Lopez signed up for extended foster care, which allows youths to get services until age 21. When the next foster home didn’t work out, Lopez found himself homeless for a while, then in trouble with the law. He spent nine months in jail after pleading guilty to charges related to stealing a car with some other kids. His story isn’t unusual — former foster youths have higher-than-average rates of homelessness and incarceration as adults.

Lopez says his social worker and staffers from a group home where he’d spent several years rallied behind him.

“The state is my family,” Lopez said. “I didn’t have my mom and dad growing up in the system, I had my social worker.... I had a case manager. They are my family.”

Lopez will soon have the chance to create the sort of family he never had. His girlfriend is expecting their first child this spring. He recently began volunteering again with a program that uses animals to help children with emotional troubles, which was a refuge during his years in foster care. Someday he plans to work with foster kids — his “brothers and sisters,” as he calls them.

Despite his experiences, Lopez has hope that the system can improve. It should start, he said, by making sure that the kids it sends far away are safe.

“What if this was a congressperson’s child?” he asked. “What if this was your child placed there?” 

Joy Payton-Stevens contributed to this report.

Do you know of other problems with out-of-state placement of foster youth? Please contact reporter Allegra Abramo at aabramo@invw.org and editor Robert McClure at rmcclure@invw.org. InvestigateWest is a Seattle-based nonprofit newsroom producing journalism for the common good.

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Head trauma, painful restraints: WA foster kids face abuse out of state

About the Authors & Contributors

Allegra Abramo

Allegra is a freelance writer whose stories and photos have appeared in ProPublica, NBCNews.com, InvestigateWest, and other local and national outlets. She grew up on the East Coast but loves the mountains and trees of the Pacific Northwest too much to ever go back.