Monday, February 21, 2022

What do you do when you’ve institutionalized children as young as age 7 in a place that was the subject of a “cascade of complaints” alleging abuse? If you’re New Hampshire, you give ‘em a $9.8 million contract, of course!

This excerpt from a report by the New Hampshire "Office of Child Advocate" describes, and illustrates,
the "quiet room" at the Nashua Children's Home.

On the surface, this story from New Hampshire may seem like just another example of children institutionalized in a place that has been the subject of multiple allegations of abuse.  In fact, it’s much more. 

● It’s a story about the willingness of regulators to bend over backwards to dismiss complaints against such places. 

● It’s a story of how a state “child advocate,” even as she wrote a report that offered tepid criticism of serious alleged abuses at the place, suggested changes that are almost meaningless. 

● It’s a story about how the same “child advocate” unintentionally pushed the state to rely on such institutions. 

● It’s a story about how institutional providers dismiss the overwhelming evidence that, even when there is no abuse, institutionalization harms children

● It’s a story about how the limits on such places supposedly imposed by the Family First Prevention Services Act are as toothless as some of us predicted. 

● It’s a story about an institution that says it’s going to change its practices to conform to a new contract but denies that there is anything wrong with the way it did things under the old contract.  As a report from the “Office of Child Advocate” (OCA) puts it: 

[T]he [institution] expressed skepticism of the provision of evidence-based care now included in contract expectations. They questioned the value of evidence-based practices and noted conversations … in which they suggest [their] “practice-based evidence” informed their own development of a practice model 

Yet the Office of Child Advocate seems to believe the new contract will be enough. 

● Most of all, it’s a story about foster-care panic – about what happens when a state family policing agency, in this case, the Division for Children, Youth and Families, responds to a high-profile tragedy with a sharp sudden increase in removals of children from their homes.  New Hampshire now tears away children at a rate double the national average - in part because of the “Child Advocate” herself.  DCYF created an artificial “shortage” of foster homes.  So DCYF  institutionalizes children as young as seven, responds to allegations of abuse with bureaucratic gobbledygook and agrees to pay the institution $71,050 per year per child! 

All of this (except the part about the foster-care panic) is made clear in the report noted above from New Hampshire’s “child advocate,” Moira O’Neill, and a subsequent news story from WMUR-TV

So let’s take a close look at the case of the Nashua Children’s Home 

The first thing to know about the Nashua Children’s Home is it’s not a home.  It has 37 residents and is licensed for 55. That makes it an institution.  Children as young as seven have been stuck there.  So let’s be clear: The state of New Hampshire is willing to institutionalize seven-year-olds. 

The second thing to know about the Nashua Children’s Home is that even had there never been an allegation of abuse, the place would be bad for children of any age.  That’s because institutions are inherently the most harmful form of care – and they are unnecessary.  As is discussed below, there is nothing an institution can do that can’t be done better with Wraparound programs.  Institutions are especially bad for young children, which is what makes New Hampshire’s willingness to institutionalize seven-year-olds particularly horrifying.  

The third thing to know is that between March, 2019 and October, 2020 this one institution, the Nashua Children’s Home, was the subject of what O’Neill describes as “a cascade of complaints” to her office, 17 in all. Below I discuss two of them.  (I only hope that readers who probably have read many accounts of institutional brutality that are even worse than anything alleged concerning the Nashua Children’s Home have not become jaded to the trauma allegedly inflicted by this institution’s staff.) 

● Dennis was subjected to 27 “restraints” and removal to what the institution calls its “quiet room” – which looks more like a cell.  Under state law, restraints are only supposed to be used when there is a “substantial and imminent risk of serious bodily harm” to the child or to others.   But Dennis was restrained and/or hauled off to the quiet room for things like hiding in a closet or under his bed.  Dennis was eight years old. 

● Anthony was older, he was all of 16.  When he tried to leave the “quiet room” he wound up restrained, prone, on the floor, by three adult male staff – for an hour and 20 minutes.  A complaint to the division of DCYF that investigates alleged abuse in foster homes and institutions said that these actions “inhibited [anthony’s] breathing.” 

But DCYF concluded there was no abuse because Anthony suffered no actual injury (after all, it’s not like he actually stopped breathing) and the restraint was being used for “behavior management purposes.”  They did refer the matter to a separate unit that handles licensing of institutions.  

The licensing unit initially thought there was a problem.  But then the institution explained how the whole thing was just a result of their deep concern for Anthony’s safety.  You see it was very cold outside that night, and if Anthony had left not only the quiet room but also the entire institution, he’d be really, really cold. 

Although the OCA reports no evidence of anyone at the institution making any such claim at the time, the licensing unit accepted the institution’s explanation. 

I’m sure all readers would agree that all of these various authorities would have reached exactly the same conclusion had birth parents “restrained” their own children that way. 

Are they “creaming”? 

You would think that the institution wouldn’t be having so much trouble since it also appears to engage in a common industry practice known as “creaming” – as in skimming the cream.  They get to pick and choose who they’ll accept – and they get to kick them out when things get tough. 

Consider the case of 16-year-old Jake, also the subject of an allegation of excessive use of restraint.  Jake apparently was a juvenile justice placement.  (We should pause here to note that the OCA report expresses no concern – indeed, does not even mention, that 16-year-olds placed through the juvenile justice system are in the same institution as seven and eight-year-olds placed through the “child welfare system.”) Jake was restrained in a prone position for a mere 15 minutes – because he’d been sitting in the doorway of his room and yelling after his DVD player was confiscated.  That happened because his mother had given him R-rated videos.  Yes, really. 

The day after the incident, the director of the institution made clear he’d had it up to here with Jake.  He sent a slew of emails to Jake’s juvenile probation and parole officer, one of which said: 

"...I want this kid OUT on Monday...send him back to SYSC...convince a judge to make it happen. You know our reluctance in taking him. Especially during this time, can't have this kid endangering my staff like this.” 

Oh, and in case you’re wondering what SYSC is – it’s the Sununu Youth Services Center, which as one news account last year put it, has seen 

recent abuse allegations made by more than 300 men and women who say they were physically or sexually abused as children by 150 staffers at the state’s facility from 1960 to 2018. Eleven former workers have been arrested since April …   

Family First won’t fix this 

Back when the Family First Prevention Services Act first was introduced in Congress in 2016 we wrote that no one should believe the hype about how it would curb institutionalization.  On the contrary, we said, it institutionalizes institutions.  As we said at the time: 

If the bill becomes law, the federal government would stop reimbursing states for part of the cost of group home and institutional placement after two weeks. But it creates a giant loophole: funding would continue for something called a “Qualified Residential Treatment Program.” 

What does it take to become a QRTP?  Very little: 

● Write lots and lots of plans filled with appropriate buzzwords. (Drop the word “trauma-informed” into every third paragraph and you should be fine.)

● Hire nurses during working hours and have them on call the rest of the time.

● Get a rubber-stamp seal-of-approval from an accrediting agency.

Now flash forward to 2022, and the case of the Nashua Children’s Home. 

The Office of Child Advocate recommendations all boil down to: blah blah blah trauma-informed, blah, blah, blah, trauma-informed.  So basically, everything should be fine if the institution follows through on a new contract with the state that is filled with all the buzzwords needed for the state to keep collecting federal aid for institutionalizing children at the Nashua Children’s Home.  The contract is for $9.8 million over three years for 46 beds – or $71,050 per child per year. 

I suppose we’ll never know if children would be better off if the state just gave the $71,050 to the children’s families so they could buy whatever help they or their children need – but I think we can guess. 

As for accreditation, accrediting agencies are generally dominated by providers and make their money by accrediting fellow providers.  That’s not exactly an incentive to get tough.  The institution gets to choose its accreditor from a list of several. 

And sure enough, in its response to the Child Advocate, the Nashua Children’s Home reprinted nearly two single-spaced pages of gushing praise from the accreditor they chose. 

This behavior by the institution is crucial for another reason.  The Child Advocate is counting on the institution to obey all the terms, and all the blah-blah-blah trauma-informed in the new contract from the state.  But the institution has made abundantly clear it doesn’t really believe in all that blah-blah-blah.  Again, as the Office of Child Advocate report notes: 

[T]he [institution] expressed skepticism of the provision of evidence-based care now included in contract expectations. They questioned the value of evidence-based practices and noted conversations … in which they suggest [their] “practice-based evidence” informed their own development of a practice model. 

The institution’s rebuttal to OCA makes clear they think there is absolutely nothing wrong with the way they did things before the new contract – and they know better than a bunch of ivory-tower regulators anyway!  Indeed, the institution’s director, David Villiotti, told WMUR: 

“We think our staff should get a lot more kudos and recognition and congratulations than they do, rather than be criticized by somebody sitting up on Pleasant Street in an office or sitting at home.” 

Perhaps all this explains why, even though staff at the institution began getting “trauma-informed care training” in September, 2020, the OCA report concluded the training has had “no demonstrated effect yet.”

As for the quiet room, Villiotti said: 

“Our response is most of the people critical of it have never been in the position of having to deal with an out-of-control child.” 

But the gentleman in the video below has. His name is Karl Dennis.  He’s a pioneer in replacing not just “quiet rooms” but entire institutions with Wraparound programs that bring whatever help a child needs into the child’s own home or foster home.  Listen as Dennis describes how Wraparound deals with youth who are far more out-of-control than an eight-year-old hiding under a bed. 

Once again, the price of panic 

The other problem with the new contract is that, as a practical matter, it’s unenforceable.  DCYF wasn’t exactly aggressive about problems under the old contract.  Why should anyone think that would change? 

In fact, it can’t change.  That’s thanks to DCYF -- and the “Child Advocate” herself. 

Because right now in New Hampshire, it’s a sellers’ market for residential treatment “providers.” 

The video version of WMUR’s story ends with the statement that the state has 662 family foster homes but says it “needs” 1,000 such homes.  The implication is that this is why DCYF has no choice but to institutionalize young children. 

But the “shortage” is only because New Hampshire tears apart families at one of the highest rates in America, double the national average even when rates of family poverty are factored in. 

It wasn’t always so.  Entries into care in New Hampshire began to skyrocket in 2015.  And though, of course, DCYF and other foster care apologists will blame opioids, plenty of states with serious opioid abuse problems don’t tear apart families at such an obscene rate.  More important, as has been documented over and over, the problem isn’t opioids as much as it is child welfare’s knee-jerk take-the-child-and-run response to opioids. 

No, what happened in New Hampshire was a classic foster-care panic – a rush to tear apart more families in the wake of high-profile child abuse tragedies, such as one that occurred in New Hampshire at the end of 2014.  Such tragedies often lead to bad “solutions” including creating “child advocate” offices which almost always throw gasoline on the fire.  Maine is a recent case in point, there have been many others

That includes New Hampshire, where the panicky response to tragedy included creation of O’Neill’s office.  O’Neill’s very first report annual report, in 2018, in the midst of skyrocketing removals, embraced the Big Lie of American child welfare – that children are endangered because lawmakers and courts supposedly are making the “best interests of the child” subordinate to “parents rights.” The data, of course, tell a different story. 

So O’Neill herself helped create an artificial “shortage” of foster parents which, in turn, means the state will keep on relying on institutionalizing children as young as age seven.  (It doesn’t help that, according to O’Neill’s report, on at least two occasions, the Nashua Children’s Home allegedly behaved in ways that helped undermine the transition of children into family foster homes – charges the institution denies.) 

All this is why all O’Neill’s blah-blah-blah about “trauma-informed” this and “trauma-informed,” that has such a hollow ring.  The problem isn’t that it’s wrong to be “trauma-informed” the problem is that people like O’Neill effectively stip the concept of all meaning.  Because, like so many others who invoke the phrase, O’Neill seems to be startlingly ill-informed about one of the worst traumas one can inflict on a child: Taking that child needlessly from her or his parents.