Troubled Kids, Far
From Home
Probing care, oversight at treatment centers
By Lauren Terrazzano, Newsday, September 22, 2002
For more
articles on disabilities and special ed visit
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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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