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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
www.bridges4kids.org.
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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