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Troubled Kids, Far From Home
Probing care, oversight at treatment centers
September 22, 2002
By Lauren Terrazzano
During her young life, Chloe Cohen
struggled with psychological problems that no one around her could
entirely grasp. To her family and those who knew her, she was an
exquisitely sensitive teenager, a generous spirit who gave dollar
bills to Manhattan panhandlers and channeled her creativity through
sketching portraits and writing verse.
But school officials believed the
16-year-old from Great Neck, who spent many of her years in special
education programs, was becoming increasingly prone to emotional
meltdowns and seemed to be in such pain that they worried about her.
As her problems deepened, the
school district in January sent her to the KidsPeace residential
treatment center in North Whitehall, Pa., which can cost as much as
$180,000 a year. They counted on Cohen getting the meticulous
attention she needed at the center that bills itself as one for
"children in crisis."
Six weeks later, she was dead.
Minutes after she went to her room
to take a shower on Feb. 21, KidsPeace workers said, she tied a
bathrobe belt around her neck and they found her body hanging from
the metal railing on her bunk bed. Her death was ruled a suicide by
the Lehigh County medical examiner.
Nearly 1,000 Long Island children
this year are expected to be institutionalized for emotional
problems, troubled pasts or juvenile delinquency. And more and more
of them are being sent to some out-of-area treatment centers where
serious questions exist about the care they receive. Because Nassau
and Suffolk lack adequate facilities to handle the youths, about a
third of the children are sent throughout New York or out of state
for treatment, far from their families, their homes and their
communities.
At the same time, the cost to
taxpayers is rising. The total bill for treating these 1,000
children is expected to top $80 million by the end of this year, 40
percent of which is borne by Nassau and Suffolk counties. Local
officials said they could not break down how much went to centers
off Long Island, but they noted that out-of-state placements can
cost $40,000 more annually than in-state ones. In some cases, the
annual price per child rivals the tuition for four years at Harvard
or Yale.
A Newsday review has found that
several of the institutions used by both counties have troubling
records themselves: boys and girls as young as 12 have been
assaulted, have committed suicide, or have been killed or molested
by the workers who are charged with their care. While the centers
strongly defend their programs, neither Nassau, Suffolk nor New York
State adequately monitor them.
"The only thing these places
effectively do is contain children who cannot be treated in their
homes," said Wanda Mohr, a Rutgers University professor of
psychiatric nursing. "They're often far from homes and communities,
and they're often toxic places for children to be."
In Chloe Cohen's case, no single
agency - not the Nassau County Department of Social Services, the
state's Office of Children and Family Services or the Great Neck
school district - knew of two prior deaths at KidsPeace. No one at
those agencies knew that Maine had stopped sending children to the
Pennsylvania center in the mid-90s because of what officials there
characterized as repeated instances of abuse by staff. One child
broke his arm after being restrained by a staff member who twisted
it behind his back, according to a report by Maine child welfare
officials, a contention that KidsPeace officials dispute.
In an upstate New York case, Amy,
15, of Smithtown, whose family agreed to speak to Newsday on the
condition her last name was withheld, said she was molested at the
St. Anne Institute in Albany by a counselor this past spring.
Suffolk Family Court Judge Ettore
Simeone had ordered her there in January after the family asked for
court supervision because her behavior, even by her mother's
account, was "incorrigible." She ran away from home and did drugs -
from snorting cocaine to smoking marijuana - actions her family said
began after she was raped a year earlier.
But instead of leaving her problems
behind, things got far worse at the nonprofit Albany treatment
facility, which charged Suffolk County about $200 a night for her
care. Within a few months of her arrival at the red brick campus she
said she was coerced three times by a male counselor to perform oral
sex in a staff bathroom. She was 14 at the time.
"I felt like I wasn't getting any
help. I needed to get away from him and what he did to me," Amy said
about fleeing in the middle of a cold March night,wandering Albany's
streets in the dark, then hopping a train the next morning to New
York City and eventually to her parents' house.
Charles Graham of Albany has been
charged with sexually abusing two unidentified girls, one from
Suffolk, at the institute. Since his arrest, a third girl, also from
Suffolk, has come forward to make additional charges. A second
worker was arrested in July on sex abuse charges involving a fourth
girl.
"We thought we were getting help
for her, but we found out the hard way though that no one was
minding the store," Amy's mother said.
The path that leads children to
such places winds mostly through Long Island's family courts - and
the numbers of children are increasing, from about 500 in 1998 to
about 1,000 expected by the end of this year. The largest group,
delinquent children on probation or those deemed as "persons in need
of supervision" for things such as running away from home, are sent
there by Family Court judges.
Usually, the court conducts a
hearing and accepts recommendations from the county probation
department on where to send a child. County social service
departments also send away their most troubled foster children who
cannot function in traditional foster homes. School districts make
placements through a committee process of teachers, psychologists,
parents and administrators when students' problems stretch beyond
what special education programs can do to help them. County social
service departments pay 40 percent of the bill for all the children
and are reimbursed by the state and federal government for the rest.
The local share for both counties this year will be about $32
million.
Both counties contract with more
than 100 such places in New York and as far away as Colorado and
Minnesota, with settings that vary from residential treatment
centers to more restrictive state-operated juvenile detention
facilities to, in some cases, group homes in the community. One
residential center, Tampa Bay Academy in Riverview, Fla., which
received about $200,000 from Suffolk since 2001 to treat county
kids, was criticized in a study by Florida child welfare officials
in 2001 for widespread use of psychotropic drugs on children.
The annual bill to treat a child in
an out-of-state facility can be upward of $180,000, money some say
should be spent to build facilities closer to home.
But part of the problem is that few
local placements exist. On Long Island, many youths are sent away
because Nassau and Suffolk have no place to put them. Of the 600
psychiatric beds in New York State licensed by the Office of Mental
Health and earmarked for the most mentally ill children, only 28 are
on Long Island, giving counties "little choice but to begin using
resources located outside New York," according to the same county
report by a Suffolk County task force on the problems it is facing.
The county is requesting a total of 84 beds.
The remaining options for other
children include about a dozen or so children's residences in Nassau
and Suffolk that treat emotional problems but often have no space.
"Our wish is to bring our kids
closer to home, for their sake, their families sake," said Dennis
Nowak, a Suffolk social services spokesman. But because of the lack
of beds locally, he defended the out-of-state programs used by the
county, saying Suffolk has longstanding relationships with many of
them and is confident about the quality of care kids receive.
But how well such institutions work
is being debated as the costs continue to rise. Advocates for the
placements say they serve society's most troubled youths: children
who set fires, are suicidal or are sexual prey and predators
themselves. "For children with very severe pathology, there is no
alternative to institutionalization," said Peter Clement, a Nassau
Social Services administrator.
Still, some question whether the
institutions are merely warehouses for children who would be better
served in their communities.
A U.S. Surgeon General's report in
1999 said that while such centers account for a quarter of what the
country spends on mental health care for children, "there is only
weak evidence of their effectiveness." In fact, a six-state study of
children in publicly funded residential treatment centers found that
75 percent had been re-admitted to a mental health facility, and 45
percent were in jails seven years later. In 1999, a New York State
study found that in its own facilities for juvenile delinquents, 81
percent of boys were re-arrested 36 months after being released.
Child welfare officials attribute
the increase in the numbers of children entering the system to a
growing population of children overall and better reporting of child
abuse, which can identify those in need of treatment. In addition, a
change in New York State law on July 1 has pushed even more children
into the system, making more 17- and 18-year-olds under court
supervision eligible for treatment.
And others say some judges are
reacting to the post-Columbine desire to get tough on juvenile
offenders. For example, the Suffolk task force said the 1999
Littleton, Colo., school shooting has made Family Court judges more
willing to send children into care.
While juvenile crime statistically
has decreased over the past five years, data show that the number of
youths being detained for less serious crimes is increasing locally
and nationally. A Suffolk study showed that during 2001, 69 percent
of delinquent children under Family Court supervision were sent by
judges to residential centers because they violated probation for
relatively minor offenses such as skipping school or missing a
curfew.
Even first-time offenders are sent
far away. That was the case for 13-year-old Daryl Dumas, convicted
of third-degree assault, a misdemeanor, after a particularly brutal
fight in May, in which he beat and kicked another boy at his middle
school in Selden.
After being reprimanded by the
court for the "malicious and vile" manner of the assault, Dumas was
ordered last month by Suffolk Family Court Judge David Freundlich to
be treated for "anger management" in a yearlong program at the Allen
Residential Center in South Kortright, in Delaware County.
"My son has never even been away
from me for a weekend ... " said his mother, Vanessa Tyre, of Port
Jefferson, a single mother who will have to drive eight hours
roundtrip to see him. "I just wish they could have placed him
somewhere closer."
Particularly troubling to advocates
for children is that many centers are subject to a lax system of
government regulation. Or no regulation at all.
Nassau and Suffolk social service
officials acknowledge regular inspection visits to out-of-state
centers are rare. "We do not send employees out of state to visit
institutions. But representatives from time to time are brought to
Nassau County for service plan reviews," said Social Services
commissioner Bob Sherman.
The departments also rely on
national accreditating bodies and the New York State Office of
Children and Family Services to regulate them.
But even though the Nassau
Department of Social Services has paid New Jersey's Bancroft
Neurohealth $1.08 million over the past three years to treat
children, the county was unaware Bancroft was cited last month by
New Jersey officials for abusing a 14-year-old autistic teen, a
month before his death of a blood infection.
To protect him from himself, the
school said, it required Matthew Goodman of Buckingham, Pa., to wear
a helmet that resembled a hockey mask with black screening across
his face and restraints that went from his wrists to his elbows, so
he couldn't bend his arms. The investigation showed that workers
sometimes left him unattended and rarely removed the restraints,
even though the protocol is to take them off every 30 minutes, for
circulation. The state is requiring the school to correct problems
and is recommending fines.
His parents believe the restraints,
over 16 months, compromised his already fragile immune system and
led to his death from blood poisoning and pneumonia. Nassau
currently has five children at the facility, according to Sherman,
who said all the placements were made by school districts.
New York State doesn't monitor
out-of-state facilities either, even though thousands of New York
children are sent to them annually. "Out of state institutions are
covered by state regulators there," said Kent Kisselbrack, a
spokesman for the Office of Children and Family Services, who said
New York has no jurisdiction beyond its boundaries.
The agency does track cases of
institutional abuse in the state, he said, a number that has risen
from 69 in 1998 to 185 in 2001.
But no one from the St. Anne
Institute or the state Office of Children and Family Services
notified Suffolk when Graham was charged with repeatedly raping and
sodomizing a teenager before Amy came forward. Tipped off by a diary
entry made by another 15-year-old girl, institute workers told
police, who say as many as five girls may have been victims.
"This man was incarcerated for
several months before we found out about these incidents, and
children were still being referred to this agency," said Jayne
McPartlin, chief attorney with the Suffolk County Law Guardians
Bureau, which represents the interests of children in court
proceedings.
Since the arrests, administrators
have stepped up security and begun conducting criminal background
checks on all new employees.
Still, the families of the two
Suffolk girls are contemplating legal action against the county.
"The system is plagued with so many problems at every turn," said
Peter Bongiorno, a Garden City attorney for the children. "There are
often no meaningful investigations conducted on any level, so the
stage is set for these types of things to happen."
Long before Cohen's death in
February at KidsPeace, a sprawling campus for 390 children that
boasts an Olympic-sized swimming pool and wildlife trails, the
facility had been investigated in the deaths of two boys.
On his second day at KidsPeace,
Jason Tallman, 12, of Barnegat, N.J., had become agitated and
threatened to run away. According to records, two counselors grabbed
the 85-pound boy when he began kicking and screaming, and put him
face down on the floor on a pillow, even as he complained he
couldn't breathe. They held his arms, legs and lower back until he
was still. One of the workers was arrested, but he later was
acquitted of involuntary manslaughter. The other was never charged.
In December, 1998, Mark Draheim,
14, of Pelican Island, N.J., was asphyxiated by counselors who were
trying to control him after he reportedly tried to stab a counselor
with a pen. His lungs crushed and his brain deprived of oxygen, he
slipped into a coma and died 26 hours later, records show.
The Lehigh County District
attorney, James Martin, chose not to file charges against the three
KidsPeace employees involved, because he said they followed
procedure and Draheim's death was an accident. State welfare
officials cited KidsPeace for an "unneccesarily high use of
restraints," and inadequate reporting of such incidents in the case.
KidsPeace staunchly defends its
programs, saying it has successfully worked with 100,000 children
since its inception 120 years ago. Mark Stubis, a spokesman, likened
what the organization does to that of the emergency responders to
the Sept. 11 terrorist attacks: "Our job, day in and day out, is to
run into the burning buildings of these children's lives. We do
that. We are the ones working in the trenches, trying to save these
children, and we don't shy away from those risks. That's our work
and our mission."
Stubis said that since Draheim's
death, KidsPeace has spent a half million dollars to retrain staff
on the use of restraints. He also noted that the Joint Commission on
Accreditation, which is the leading accrediting body for hospitals,
has consistently given high marks to KidsPeace.
The state of Maine no longer places
children at KidsPeace in Pennsylvania because child welfare
officials received reports about abuse and neglect, including
excessive, sometimes violent restraints of the 12 children who were
placed there, said Newell Augur, a spokesman for the Maine
Department of Human Services. But the state has done business with
the KidsPeace branch in Maine, he said, where it can be locally
monitored. Stubis disputes Maine's findings with the Pennsylvania
center, saying officials never talked to KidsPeace workers about the
allegations.
There currently are 76 Nassau and
Suffolk children there. Though Nassau and Suffolk counties have paid
$13.3 million to KidsPeace over the past three years to treat
children, social service officials and officials from the Great Neck
School district were unaware of any deaths at the center prior to
Cohen's. Great Neck school officials said they have since stopped
placing children there.
Even Cohen's relatives said they
had no real knowledge of KidsPeace, other than that it was portrayed
as a tranquil setting where she would get the help she needed. "It
was presented as this wonderful place with all kinds of benefits
with pools and skiing, a resort almost, but where she'd be getting
the help she needs," said a relative of Cohen's who contacted
Newsday after her death. "I just wonder if it could have been
prevented."
Her parents struggled to help her
and they were active participants on the Great Neck committee on
special education that decided to send her there. Cohen's mother was
optimistic that the program could benefit her daughter. "It was very
impressive," said Maleka Cohen, who visited the center before her
daughter was sent there. Her parents still believe she never would
have ended her own life.
Pennsylvania's Department of Public
Welfare investigated Cohen's death but did not cite KidsPeace,
saying the dormitory where Cohen lived was adequately staffed on the
night of her death. Social service sources familiar with the case,
however, questioned why Cohen was living in a group residence and
not in the campus psychiatric hospital, which would have monitored
her around the clock. She was prone to outbursts and had been under
close supervison in other programs that tried to help her, said
those familiar with her history.
Seven months have passed since
Cohen's death, and Maleka Cohen still wonders about what happened
that night. More importantly she wonders if Cohen and others like
her are best served in such places. "We had so much hope that this
place can help," she said recently. "My poor girl, she never came
back home. She went there and she never came home."
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