Out of State, Out of Mind 

Does sending Montana’s troubled kids to out-of-state facilities put them in harm’s way?

It’s a problem endemic to Montana: Too few beds for all the youths who are emotionally disturbed, mentally ill, in protective custody or sentenced for criminal behavior. The result is that many of these kids have to be sent out of state to private facilities, which can be hundreds if not thousands of miles away from their families, friends and communities.

Meanwhile, their case workers, judges, and probation officers are miles away as well, which raises a fundamental dilemma: Who’s ultimately responsible for checking on their well-being?

The experiences at one facility in St. George, Utah highlight the nature of the problems that can arise. In January, two inspectors from the Montana Department of Public Health and Human Services (DPHHS) visited the Cinnamon Hills Youth Crisis Center, one of three residential facilities in the St. George area where Montana kids are routinely placed for behavioral and mental health problems, and one favored by Missoula District Court Judge John Larson.

During their two-day visit, the Montana inspectors— Kandice Morse and John Clymer with the Child and Family Services Division—interviewed administrators, staff and the nine youths (ages 12-17) placed in Cinnamon Hills by DPHHS. At the time, approximately 30 kids had been placed in Cinnamon Hills by Montana agencies, such as DPHHS, the Department of Corrections and Indian Health Services.

In a 13-page report obtained by the Missoula Independent, Morse and Clymer describe conditions that are “extreme and invasive,” where “painful and injurious methods of physical restraint appear to be the rule rather than the exception.”

According to the report, seven of the nine youths interviewed said that they had been physically restrained at some point during their stay and “youth being restrained ‘always cried’ because of the pain.” All nine kids told the inspectors that they had seen black eyes, bruises or other injuries on the faces, arms and legs of other kids. One child reported that surgical pins in his arms had been “popped out,” requiring a doctor’s visit.

The Montana inspectors themselves noticed bruises on several of those interviewed, which were photographed and referred to the Utah Division of Child and Family Services as evidence of possible physical abuse. Those injuries were investigated, but no charges were ever filed.

The report does note, however, that a Utah Office of Licensing officer, Rob Ross, told the Montana team that there had been “numerous reports of youths being injured during restraints at Cinnamon Hills over the summer.” Ross, who routinely inspects youth facilities in the St. George area, informed them that Cinnamon Hills was under a “Plan of Correction” dating back to August 21, 2000 for “unnecessary physical force to make clients conform with the rules.” The Plan of Correction also alleged that “the holding of girls upside down and twisting their arms until they scream is common.” Another section alleged, the report says, that an administrator failed to report a case of sexual abuse of a client.

Cinnamon Hills administrators never mentioned the Plan of Correction to the Montana team, nor did they report any of the injuries to the Utah Child and Family Services Division. In a telephone interview, Morse told the Independent that the state of California had earlier issued its own report about Cinnamon Hills and ultimately pulled all its children out of that facility.

Beyond the concerns over the physical welfare of the youths, Morse and Clymer also note a lack of privacy and question certain therapy methods used at Cinnamon Hills. For example, some kids who had suffered sexual abuse in their past were required to write essays about their experiences and read them in front of their peers during group therapy. Several reported that this was embarrassing and made them more distrustful of staff.

“While the Montana Team acknowledges that the Montana youths placed in Cinnamon Hills are very difficult youth, the extreme rigidity in the ‘structure’ provided by the facility appears to dehumanize these youth further,” the report reads. “The physical restraint methods typically used by Cinnamon Hills are painful and often injurious to the youths.”

The report concludes, “[T]he Montana Team recommends that the nine youths interviewed at Cinnamon Hills Youth Crisis Center be removed in a quiet and orderly fashion and that these youths be placed in facilities which will provide appropriate treatment and protection from harm.”

The report further recommends that “Child and Family Services Division not consider Cinnamon Hills as a placement option until the conditions of concern have been rectified for a period of time long enough to ensure that the changes are permanent.”

While these findings are disturbing, youth advocates say that such revelations are hardly uncommon.

“I don’t think Cinnamon Hills is a whole lot different than any other place we send kids,” says Nita Johl with the Montana Advocacy Program(MAP), a federally funded watchdog group that serves as an advocate for people in institutions. “My God! We could rent a hotel in Montana and turn it into a treatment center. Why are we sending kids all the way to Utah to live in those conditions?”

Like many youth advocacy groups nationwide, MAP opposes the practice of shipping kids out-of-state unless there’s a compelling reason.

“That’s the problem with out-of-state placement,” says MAP’s Alexandra Volkerts. “The people who care the most about the person are physically cut off from access to them. For most people, it means they just don’t see their kids, so they don’t know what’s going on. And those places pretty much do what they want because no one’s monitoring them.”

As for the prevalence of such complaints in Utah facilities, Ross agrees that Cinnamon Hills shouldn’t be singled out.

“It’s fairly common. They don’t hire professional staff for these positions, so these are typically really young people, just out of high school, maybe a little bit of college,” Ross says. “The turnover is pretty high, it’s tough to keep them trained, the jobs don’t pay very well. It’s been a problem across the board.”

Part of the problem, everyone admits, is limited funding, staff and resources. Out-of-state residential facilities are not visited as often as they should be, and Montana has no mandates for routine inspections. John Paradis, manager of the Department of Corrections (DOC) juvenile residential placement unit, says that out-of-state facilities are visited “as often as we can, unless travel budgets are cut.” Advocates estimate that can be anywhere from quarterly to once a year.

Moreover, it’s difficult to pinpoint exactly how many youth are placed outside Montana, since the numbers from one agency can overlap with another. According to Morse, Child and Family Services has 46 youths placed in out-of-state residential care; DOC has 31. Those numbers may or may not include kids sent from Mental Health Services, Indian Health Services or those sent by youth court judges and paid for privately. Johl estimates that between 75 and 120 Montana youths are in out-of-state facilities at any given time, some as far away as Texas.

“Usually, the kids that are sent out of state don’t have real intact families that are going to keep close contact with them,” explains Johl. “Social workers and probation officers usually get a phone call or check on them once a month, maybe once every six months, because we’re so overwhelmed with kids who need help. It’s almost like you find a bed or a safe place for the kid to go and then you forget about them until they’re ready for discharge, which is a pretty lonely place for a kid to be.”

For its part, Cinnamon Hills appears to be cleaning up its act. Ross says the Utah Office of Licensing plans to lift its Plan of Correction on Cinnamon Hills, and its administrators “have responded very favorably” to implementing committee review procedures any time a youth is physically restrained, and if necessary, implementing retraining classes or disciplining staff.

In addition, the federal Health Care Financing Agency issued new rules on May 22 for all psychiatric facilities that accept Medicaid funds, requiring that seclusion and restraint techniques be used only under the order and supervision of a physician, registered nurse or other licensed practitioner who has been trained in the use of emergency safety interventions. (Until recently, deaths resulting from physical restraint in such facilities did not have to be reported.)

For legal reasons, Morse cannot disclose whether any or all of the nine Montana youths mentioned in her report have since been removed from Cinnamon Hills. She does say, however, that no state-custody youths have been referred there since then, and copies of that report have been circulated to other Montana agencies.

That said, the DOC is still waiting for clarification on several of the statements made in the report, and Paradis says, “Until we see exactly where that situation lies, we officially cannot take any action one way or another.” He can say, however, that the DOC still has at least two kids living in Cinnamon Hills.

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