Montana sends troubled children to out-of-state programs who have been accused of abuse

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The high demand for treatment for children with behavioral and substance abuse problems has led Montana health officials to spend Medicaid funds to send children, including those who are foster children and wards of the State, in residential programs in other states with less strict supervision.

Some of those children were sent to out-of-state programs that have been accused of abuse and mistreatment, according to documents from state agencies and media.

Sending these children out of state for treatment for behavioral and substance use disorders comes at a high price, and often the children’s problems go unresolved or are even worse, said Michael Chavers, CEO of Yellowstone Boys. and Girls Ranch. “When they come back to us, they come back with worse outcomes and at a higher cost,” Chavers told Montana lawmakers last fall.

In 2019, Montana strengthened its oversight of private alternative treatment programs for youth, removing an industry-controlled oversight board and subjecting the programs to regulations and inspections from the Montana Department of Public Health and Human Services, reports Kaiser Health News. By the end of 2020, 11 of 19 programs operating in Montana had closed.

About 90 Montana children were attending Montana Medicaid-approved facilities in 10 other states this month, according to state officials. Facilities were in Arkansas, Florida, Georgia, Iowa, Kansas, Mississippi, Oklahoma, Tennessee, Utah, and Wyoming.

By comparison, Medicaid paid for 171 Montana children to be treated in state psychiatric residential facilities and 407 children to live in state therapeutic group homes in the state’s previous fiscal year. which ended on June 30, according to health department officials.

Almost all out-of-state programs that have been approved by the Montana Medicaid program and currently house Montana children have faced allegations of abuse or have a history of non-compliance with state regulations, according to state documents, inspection reports and investigations by media organizations.

Jon Ebelt, a spokesman for the Montana Department of Health, confirmed that there have been reports of abuse or neglect of Montana youth in out-of-state facilities over the past two years, although he did not specify which establishments or how many reports. In some cases, Montana has moved youth from out-of-state programs due to facility concerns, he added, without providing details.

The state where an allegation of abuse or neglect of a Montana child occurs is responsible for the investigation, Ebelt said.

Why out of state?

The majority of children attending out-of-state Medicaid-funded treatment facilities are referred by their parents or guardians, although some are referred by the Child and Family Services Division of the State Health Department. state or through the state juvenile justice system as wards of the state, Ebelt said.

Children are being sent to out-of-state programs due to a lack of available beds in state facilities due to the state’s low reimbursement rate and understaffing, state administrators said. Montana Psychiatric Residential Treatment Facility and Therapeutic Group Home Program. In-state providers are reimbursed an average of $405 per day per child, while out-of-state providers are reimbursed an average of $615 per day per child.

For the fiscal year that ended June 30, Montana spent a total of $12.6 million on stays in out-of-state psychiatric residential treatment facilities and $4.7 million on stays in out-of-state therapeutic group homes, Ebelt said.

“We always prefer to serve young people with severe emotional problems in or near their home community,” Ebelt said. “However, sometimes, due to a variety of factors, including the acuity of symptoms, the need for specialized care, or the availability of in-state beds, young people are referred to out-of-state providers.”

Among the Montana Medicaid-eligible programs currently housing Montana children is the Provo Canyon School in Utah, where Paris Hilton and hundreds of other students have alleged abuse, lawsuits allege. former students who shared accusations of program abuse, news agency investigations and state documents. These allegations have led Utah to increase oversight of residential youth programs.

When contacted for comment, Provo Canyon School sent a statement, last updated August 2021, which states that Provo does not “conclude or promote any form of abuse” and that the program “is committed to providing high quality care to young people with special needs, and often complex, emotional, behavioral and psychiatric needs.

Montana also sends children to another Utah facility, Falcon Ridge Ranch, whose employee was arrested and charged with multiple counts of sexual assault and distributing harmful materials to minors in March 2021. according to the St. George Spectrum & Daily News. The employee pleaded guilty to three counts of sexual assault in a plea agreement with prosecutors in January, said Cade Stubbs, the court clerk for Utah’s 5th District Court. Falcon Ridge Ranch was then owned by Sequel Youth and Family Services and is now owned by Rite of Passage.

Minnesota, Oregon and Maryland stopped sending children to Sequel programs after the May 2020 death of a 16-year-old student at a Michigan facility. Cornelius Frederick died after staff members held him at the now-closed Lakeside Academy in Sequel, according to an investigative report from Michigan child welfare officials. California and Washington also severed ties with Sequel after an article published by APM Reports in September 2020 detailed abuse and non-compliance with state regulations at Sequel facilities across the country.

An investigation by The Imprint and the San Francisco Chronicle found that of the hundreds of violations or alleged shortcomings at Sequel facilities investigated by child welfare officials in California and other states, more of 75% resulted in confirmation by state authorities that violations had occurred.

Sequel officials did not respond to multiple requests for comment.

Regulatory confusion

A January report from the federal Government Accountability Office found that monitoring out-of-state youth treatment facilities is difficult due to the state’s “difficulties in collecting and reporting facility-level information “. He also found that different definitions of abuse, fear of retaliation, and residents’ inability to communicate with others outside of the program posed challenges in reporting abuse and collecting data.

The report found that federal agencies have been inconsistent in addressing state and federal program noncompliance and recommended better state oversight and tougher enforcement to hold facilities accountable.

Oregon State Senator Sara Gelser Blouin, a Democrat from Corvallis, encountered these regulatory issues firsthand when investigating reports that Oregon children had been abused at the Sequel’s. Northern Illinois Academy in 2019.

Gelser Blouin said she contacted the Oregon abuse investigator and the state health department, but found no agency officials able to investigate the matter. Gelser Blouin then contacted Illinois officials who she believed might have the authority to investigate the Northern Illinois Academy, with the same result.

“No one thought they had the power to investigate,” Gelser Blouin said. “They kept saying, ‘Well, they’re accredited by the Joint Commission. So I called the Joint Commission, and the Joint Commission told me that this was not a “Betty Crocker seal of approval” for child safety.

The Joint Commission is a private organization that accredits healthcare organizations and programs in the United States and is funded primarily by the fees it charges institutions for accreditation. In some states, Joint Commission accreditation can relieve treatment facilities from the oversight of most other organizations.

At Gelser Blouin’s request, the federal Centers for Medicare & Medicaid Services launched an unannounced investigation of the Northern Illinois Academy. CMS investigators said all children at Northern Illinois Academy were at immediate risk of serious injury or death.

A month earlier, in November 2019, the Joint Commission had reaccredited all Sequel facilities, including the Northern Illinois Academy, in a system-wide accreditation pilot.

The Northern Illinois Academy closed last year after a state-funded report by a disability rights organization documented allegations of abuse and neglect, leading the state to withdraw all children of which he was responsible.

Oregon and California lead with bans

Oregon and California are the only states to have passed legislation to prevent young people from being placed in facilities that are not supervised by a young person’s home state.

California banned the practice of sending foster children accused of crimes to out-of-state programs in July 2021. That same month, Oregon, driven in large part by the work of Gelser Blouin, became the first and the only state to require everything out of state. state facility housing Oregon children to comply with Oregon regulations and be licensed by the Oregon Department of Social Services.

Gelser Blouin is now working with other youth rights advocates, including Paris Hilton, to champion a federal bill called Accountability for Congregate Care Act. It would establish standard regulations and common definitions of abuse and treatment across all states and identify the rights of children in institutional settings.

The bill would also create a federal database to track youth placements, critical incident reports and complaints, among other information. Currently, complaints against the programs are channeled through various state agencies and accrediting bodies.

In Montana, for example, Ebelt said complaints about out-of-state programs housing Montana youth can be filed in different ways “due to the various individuals and entities that interact with or monitor out-of-state programs. ‘State”.

The bill would also define different types of programs, which Caroline Lorson, a lawyer working on federal legislation, says is at the heart of the need for change.

“They all have different requirements, they all have different standards, and they all have different agencies interacting with them, and that’s why they’ve been difficult to regulate,” Lorson said.

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