Struggling with kids' safety out of state

Last spring, Philadelphia sent a veteran inspector to check out a Connecticut facility that cared for some of the city's most severely mentally handicapped children.

The inspector, Haiying Xi, wrote a report with a candid disclosure: The Department of Human Services, he said, had given him no clear standards to assess whether kids were safe in out-of-state centers.

Still, he gave Lake Grove at Durham a passing grade. On the very same day, May 9, Connecticut announced it would begin pulling its own children out, saying the state's child advocate had found problems in medical care "so grossly serious as to create risk of possible injury or death."

Connecticut said it had informed other states of its intention to move its kids out by Sept. 15, though the facility remains open. Philadelphia moved its three clients in November.

Despite a changeover in management and a spate of improvements at DHS, the Lake Grove files illustrate how the agency still struggles to ensure the safety of vulnerable children placed in out-of-state treatment facilities.

Some of Philadelphia's most psychologically troubled children, sent outside the state for treatment and care, have been killed, sexually assaulted, sent to emergency rooms with broken bones, and entrusted to staff who are former convicts, according to records, lawsuits and interviews.

Since 2000, five children from Philadelphia have died in out-of-state homes or institutions - one of them after an overhaul that began 18 months ago, when The Inquirer revealed the agency's poor record in protecting vulnerable children.

Since then, DHS has undertaken the most sweeping changes in its history. Officials have rechecked kids under their care, cleared out poorly performing contract agencies, and raced to arm caseworkers with better methods to assess when children face danger at home.

And last week, members of an oversight board said DHS had made much progress in how it tackled safety. But some board members, and the state's welfare director, said the city had a way to go to keep kids safe in far-flung institutions.

"This is an issue we're going to take a look at," said Carol Spigner, who leads a DHS oversight panel.

Even today, Philadelphia has kids in a Colorado facility where DHS inspectors found that youngsters were kept in isolation rooms and strapped into a "restraint chair" - the same model that the U.S. government uses to force-feed suspected terrorists in the prison at Guantanamo Bay, Cuba.

The Inquirer began a review of out-of-state facilities used by DHS after 17-year-old Omega Leach, sent to a Tennessee institution, died last summer in a struggle with a staff member.

Documents and interviews show the agency routinely misses critical signs of danger in out-of-state juvenile centers or, worse, notes the problems but fails to do anything about them.

Among the findings:

The city's system for ensuring the safety of kids is fragmented and chaotic, with the responsibility for guaranteeing safety divided among three sets of social workers who rarely communicate.

Philadelphia doesn't check the regulatory files in states that oversee treatment centers it uses. At least twice, records show, other state regulators found institutions unsafe and removed their children - while Philadelphia continued to house kids there.

Even when its own reviews raise serious concerns, DHS is often slow to act. In at least three cases, the city removed children only after someone died, and even then took months to do so.

Acting DHS Commissioner Arthur C. Evans, who took over in late 2006, said the department had taken some important steps, one of them a new committee to comb through reports for signs of overlooked problems.

The department also now requires centers tell it when children die, even if they are not from Philadelphia, and plans to inspect troubled facilities more frequently. This month, an independent agency hired by DHS began to interview kids in institutions.

"If you look at any place in the country, we are doing as much to make sure kids are safe," Evans said.

But he conceded that DHS could do more - including reading the reports filed by other states' regulators that license the facilities.

About 200 children, nearly 15 percent of the 1,554 Philadelphia youths removed from their homes this year, live in residential facilities outside of Pennsylvania.

All of them need mental-health therapy, many because they have been abused or neglected. Some are kids pulled out of unsafe homes by DHS; others are juvenile offenders sent by the courts.

The city places children in out-of-state centers, sometimes hundreds or more than a thousand of miles away, because many facilities in Pennsylvania turn away deeply troubled or violent youths, Evans said.

For this, the city pays millions of dollars each year, as much as $112,000 per year per child, according to DHS figures.

Since Leach's death last summer, Evans said, DHS has been looking to bring kids home. "We're absolutely not OK" with the number of children in out-of-state institutions, he said.

But, he said, good alternatives are hard to find.

"You don't want to cause more trauma by pulling children from a facility and sending them to a place that's not a good fit," Evans said.

The same problems have shown up inside Pennsylvania; by far, most of DHS's clients are housed here. More than 20 city children have died in those institutions in the last decade, according to the state Department of Public Welfare.

But experts say the problems of oversight are exacerbated when regulators have to try to evaluate care from hundreds or more than a thousand of miles away.

Jeanne Milstein, the child advocate for Connecticut, has a theory why cities settle for substandard care.

"States and cities go into facilities with their hands over their eyes," she said, "because they're so desperate to place kids."

Richard Gelles, dean of the University of Pennsylvania School of Social Policy and Practice, said he understood there were too few beds and too many children.

But states can't use that as an excuse for keeping kids in a facility months after another child has been killed, he said.

"If you were a parent who had five kids and the babysitter killed one, would you say, 'That's the only babysitter I have?' "

Trouble far from home

Files show some facilities used by DHS were troubled almost from the day they opened. But DHS relied on them to care for scores of children, overlooking problems until tragedy forced its hand.

One such facility, the High Pointe juvenile treatment center in Oklahoma City, was willing to take on the hardest cases. DHS had plenty.

But Philadelphia kids placed there routinely ran away. Some were caught robbing people in the city, others turning tricks at truck stops, according to Oklahoma regulators and DHS reports.

Helena Costello was a wild 15-year-old when a Philadelphia judge took her from her Frankford home and sent her to High Pointe in 2001. In an interview, she said it had been just as easy to get in trouble there; drugs were easy to get, she said, and she had sex with male and female staff members.

One night in 2001, Costello said, she tried to stop a 6-foot-1, 250-pound counselor from pouncing on a female resident. During the melee, he hit her upper arm so hard it broke, according to a lawsuit that was later settled.

"He just punched it, and crack, I went down," she said in an interview at her home in Blackwood, Camden County. Afterward, Costello said, staff refused to let her call home, telling her parents that she had fallen.

A DHS inspection report in 2002 found the center was struggling to "safely and effectively manage the behavior" of the kids from Philadelphia.

By 2003, police complaints about the center's teens were stacking up, and a hospital reported a spate of High Pointe kids showing up injured at its emergency room.

But DHS continued to rely heavily on High Pointe. In 2003, Philadelphia kids occupied more than half the institution's 130 beds.

It took the death of Jerry Trivett for regulators to pay attention.

The 15-year-old from Johnstown, Pa., was born with a slew of conditions that had damaged his lungs, twisted his body, and gave him rages that were hard to control.

Just 4 feet tall, Trivett had been through more than 20 foster homes before landing in a Cambria County shelter in 2003. Social workers called 57 centers before they found one willing to take him: High Pointe.

Less than three months later, another resident slammed the boy to the ground.

Trivett was having trouble breathing and asked to go to the hospital. The staff told him, "Not today - maybe tomorrow," according to an Oklahoma investigative report.

Later, his lips turned blue. But staff didn't call an ambulance until he went into convulsions.

By the time he arrived at the hospital, Trivett had stopped breathing.

Five nurses were disciplined for failing to provide adequate care. One, it turned out, had spent five years in prison for drug dealing.

While Philadelphia did move some children right away, the last one did not leave until High Pointe was forced to close nine months later.

Evans wouldn't comment on DHS's actions before he took over. Former Commissioner Alba Martinez said that during her tenure, the agency also had regularly visited centers and moved children if one was found unsafe.

She did not recall the specifics surrounding High Pointe but, like Evans, said it was difficult to find spots for the most damaged children.

"I was not happy with the lack of alternatives so we could remove kids from facilities that were not good for them," she said.

Splintered oversight

Philadelphia has a fractured system of oversight, with responsibility for evaluating juvenile centers split among a patchwork of social-service offices.

The city's mental-health agency mostly makes sure facilities offer therapy and are licensed and accredited.

DHS has two teams of inspectors. One group examines whether the institution provides good living conditions and appropriate treatment - but DHS says those workers, too, are not primarily responsible for safety.

The agency's social workers are the only ones explicitly charged with keeping kids safe. But they visit only twice a year, or less.

Xi, the inspector who wrote the Lake Grove report, did not return phone calls seeking comment. His supervisors defended his work, saying Xi had been trying to point out only that inspectors can't be held responsible if they haven't been properly trained.

Connecticut pulled its clients from Lake Grove by September, but state regulators did not revoke the facility's license. Today, the center remains open.

John Claude Bahrenburg, chief executive officer of the school's parent company, Windwood Meadow, said the facility provided good care.

Top Family Court Judge Kevin Dougherty said he could no longer rely on DHS to do a good job of evaluating out-of-state facilities.

Instead, he has sent his probation officers to check on centers, and just last week hired his own inspector.

Until Leach's death, Dougherty said, DHS for months had failed to send him inspection reports. DHS said the judge had been as getting the reports.

'Isolation rooms'

Even when inspectors do flag issues at the facilities, documents show, DHS often fails to follow up.

During reviews from 2004 through 2006 of the Colorado Boys Ranch, a therapeutic program in La Junta, Colo., DHS workers repeatedly noted allegations that staff kept emotionally disturbed children in isolation rooms.

"There was a lot of documentation of physical restraint," the 2004 report said.

The same reports said the facility routinely controlled the most volatile children by strapping them into a restraint chair with belts that fasten across the chest, legs and arms.

Philadelphia's inspectors did not take a more critical look at the use of the chair or the isolation rooms until 2006, when they said a city youth with emotional problems had been locked in a room for three months.

They found residents were confined to those rooms at all times, though staff would "allow them out for air" if their behavior improved, the reviewer wrote in 2006.

Despite inspectors' concerns, DHS rated the institution "average," records show.

Boys Ranch director Chuck Thompson denied those findings. The Boys Ranch does not keep children in isolation, he said in a recent interview, but has two seclusion rooms where distraught children can go to quiet down. He said children stayed in the rooms for only a few hours.

The chair is still on the premises but no longer in use, Thompson said. "It's a chair used to safely transport a child," he said.

"There are some kids who want and like to stay in that room," he said. "This is a caring entity that operates at highly professional standards."

He also said that no one from DHS had asked the staff about the allegations.

Evans acknowledged the lack of follow-up, calling it "unacceptable."

He said DHS had lacked a consistent system for addressing problems flagged in inspections.

"Recommendations were made," he said, "but nothing really happens to the recommendations."