News from elsewhere, and from here

Texas, November:
http://www.myfoxhouston.com/dpp/news/local/101108-teen-boy-dies-while-restrained-at-treatment-center-in-manvel

Early in November, a Texas boy was the 4th child to die in a facility run by an organization called Daystar in Texas. In 2009, staff in a Daystar facility were found to have incited girls with developmental disabilities to fight, resulting in injuries to 4 girls. In that case, the staff involved were fired but never prosecuted. Because of hundreds of abuse/neglect incidents in Daystar facilities, a monitor had been appointed to oversee its operations. The monitor had left the position shortly before Michael Owen died in November. The county where Daystar was located refused to send children in its custody to Daystar, but other Texas counties did, and at the time of Michael's death, 24 California foster children remained in Daystar facilities. Michael died in his room in connection with staff restraint. Security cameras in the facility do not show the bedrooms' interiors. Facility officials claimed that video from the hallway area showed staff acting professionally. Of course, staff would likely reserve unprofessional conduct for off-camera locations. (Duh.)

Nebraska, September:
http://www.wowt.com/home/headlines/103704594.html

In September the Nebraska Department of Health and Human Services temporarily halted referrals of Nebraska children to psychiatric residential treatment at the renowned Boy's Town, due to improper psychiatric treatment. Corrective action requirements were imposed by Nebraska's Medicaid managed care contractor. The issues involved improper restraint and seclusion, alleged use of chemical restraints, and failure to report injuries. One girl, placed in seclusion, had choked herself with a hair tie, passed out, and was not discovered until 45 minutes had past. Federal law requires face to face monitoring of youth in seclusion in psychiatric facilities receiving Medicaid payments.  The monitoring cannot be by means of video but literally means face to face. Boy's Town denied any improper treatment but complied with the plan, and eventually Nebraska referrals resumed.

States often place children out of state for treatment. Both sending and receiving states have responsibilities for supervision, although the receiving state does not have responsibilities within the first 90 days. The question is, when a facility comes into question, who has what obligations regarding the children in the facility who are from other states--or counties? If there was a North Dakota child in treatment at Boy's Town last September, did Nebraska inform North Dakota about their own suspension of referrals? Were California authorities notified that their foster children might be in danger at Daystar?

Residential treatment facility deaths sometimes occur within the first weeks of placement--sometimes within the first hours. I don't know if anyone has studied whether there is a pattern of higher risk early in a residential placement--but it would make sense. Staff may over-react, kids may not have figured out how to protect themselves in a new facility.

In Fargo:

When my son was placed at a locked residential "treatment" (using that word reservedly) facility operated by Dakota Boys Ranch (now Dakota Boys and Girls Ranch), staff were not permitted to be inside residents' rooms with the door closed. Because DBR made a point of ensuring all contact between us was closely scrutinized--face to face, telephone, letters--he could only share fragments of what was happening to him there. Initially DBR violated state licensing requirements (and, possibly, Medicaid requirements--I tried to find out whether federal regulations applied to the facility but even Centers for Medicaid/Medicare Services in Denver could not give me clear information) by failing to document seclusion or restraint, or to even verbally report it--even to my son's caseworker, who was legally responsible for supervising his care. Only when I contacted state licensing authorities did the facility begin to document seclusion and restraint. After the clinical director (Carol Halone) was contacted by North Dakota DHS, she made it clear to me how angry she was, and insisted that all required documentation was done, just waiting for signatures. In fact, the facility never did complete reports for those first several weeks, even though a resident log (which they provided as a substitute) made brief references to multiple uses of seclusion and restraint during that time. The reports staff did eventually begin writing were very poorly done. It was obvious that the psychiatrist who had to sign them did not read them--since the wrong kind of information was often entered into spaces on the form, and since the right type of information was often contradictory, illogical, or simply vague. 

Bits and pieces emerged over the years after my son left DBR. Here's one:

Staff were not allowed to be in residents' rooms with the door closed. But one staff (a staff whose name often appeared on the seclusion and restraint reports) did just that a few times--went into my son's room, closed the door behind him, and said, "I'm in here and the door is closed--what are you going to do about it?"  Apparently the staff didn't do anything else those times--only intimidated, threated, caused fear--psychologically maltreated--a 13-year-old.