Report describes 'abusive restraint practices' for Washington foster youth sent out of state

Oct 17, 2018

The state of Washington sent high-needs foster youth to a residential facility in Iowa where they were isolated, held in a restrictive setting and at times subject to “abusive restraint practices," according to a scathing report released Wednesday by the advocacy group Disability Rights Washington.

The report, titled “Let Us Come Home,” concludes that Washington foster youth placed at Clarinda Academy in Clarinda, Iowa "have suffered additional emotional and psychological harm." The report also argues for the state of Washington to end the practice of sending hard-to-place foster youth, many with acute mental health and behavioral needs, to out-of-state facilities.

“Washington’s use of out-of-state facilities is creating an unacceptably heightened risk of abuse and neglect and further harm to youth who have already suffered from multiple, prolonged, or chronic traumatic events,” the report said.

A representative of Sequel Youth and Family Services, the company that owns Clarinda Academy, did not respond to multiple requests for comment before the public radio Northwest News Network’s publication deadline. On its website, Sequel says its mission is “to prepare our clients to lead responsible and fulfilling lives by providing mentoring, education, and living support within a safe, structured, dynamic environment.” 

Currently, Washington has approximately 80 foster youth in out-of-state facilities, according to the Department of Children, Youth, and Families (DCYF), a new agency which oversees the state's foster care system. Disability Rights Washington identified 18 facilities in a dozen states from Idaho to Kansas to South Carolina that have housed Washington youth in recent years.

Prior to July 1, out-of-state placement decisions were made by the Washington Department of Social and Health Service’s Children’s Administration. On July 1, DCYF took over the state’s foster care system. In a recent letter to the state’s budget director, DCYF said the state sends foster youth out of state due to a lack of in-state beds.

“This costs more and results in increased risk for children because we are dependent on other states for health and safety checks for the children and they are far from their communities and families,” the letter said.

Ross Hunter, DCYF secretary, said he was “alarmed” by the allegations contained in the Disability Rights Washington report. After viewing a draft version of the report, the agency said it halted new placements at Clarinda Academy for 90 days and is working to find permanent placements for the youth who are currently at the facility.

Hunter said he also dispatched his executive staff to visit all of the out-of-state facilities where Washington youth are currently living. Those inspections, he said, are nearing completion. Longer term, Hunter said his goal is to end the practice of placing youth at facilities in other states.

Susan Kas, an attorney with Disability Rights Washington, said she provided Sequel a draft copy of the report in August. Kas said an attorney for Sequel told her by phone that the company disputed some of the findings, but to date had not provided a detailed response to the report.

Use of "inappropriate physical restraint"

Over two days in February, DRW and its partner, Disability Rights Iowa, interviewed about a dozen foster youth from Washington who were living at two Sequel-opearated residential facilities in Iowa: Woodward Academy and Clarinda Academy.

According to the report, youth at both facilities reported being homesick for Washington and described the living conditions as “restrictive and segregated.” But the approximately half dozen youth from Washington at Clarinda Academy went further. They said they were subject to verbal and even physical abuse, including the inappropriate use of physical restraint.

Those reports of mistreatment prompted Disability Rights Washington to launch a formal investigation into conditions at Clarinda Academy. Three of the youth from Washington at the facility agreed to cooperate with that inquiry. That included signing waivers so that investigators could review their case files.

"While we can't say that the experience of the three is representative of all the youth at Clarinda, we did find that the policies and training practices there provided for weak protections against abusive restraints," Kas said. She added that youth who did not formally participate in the investigation made similar allegations about the use of restraints.

One of the youth who did participate in the investigation told the public radio Northwest News Network that her time at Clarinda Academy was a combination of “good and bad.” She described fun times playing tug-of-war and listening to music and said she bonded with some of the staff.

But in a phone interview from a facility in South Carolina where she’s now housed, the youth also said she was restrained by staff on multiple occasions.

“I didn’t like the restraints at all, they hurt,” said the youth. The Northwest News Network is not identifying the teen because of her age and the fact she is in the foster system.

She described a particular incident when she said she was trying to harm herself and the staff restrained her. She said one staff member pulled her arms up behind her back causing a great deal of pain.

“And I couldn’t take it no more so I fought it, and then eventually I was put on to the ground,” the youth said. “I was so sore for at least three days.”

Ultimately, investigators concluded that Clarinda Academy “subjects young people needing mental health treatment to highly restrictive and segregated residential and educational services … that severely limit individual liberty, expression and relationships.”

The report also found that Washington social workers were alerted to allegations of “inappropriate physical restraint practices” at Clarinda Academy, but failed to investigate or visit the youth. Instead the state relied on contracted social workers in Iowa to conduct in-person visits.

An expert hired by Disability Rights Washington, Gauri Goel, concluded that Clarinda Academy failed to assess or treat the “complex trauma needs” of the Washington youth sent to the facility and recommended that the youth be brought back to Washington for treatment and care.

This isn’t the first time Clarinda Academy’s has come under scrutiny. On three occasions in 2013 and 2014, the Iowa Department of Education “found serious, widespread problems” at the facility, including underserving students with special education needs, according to a 2014 story by The Des Moines Register

Seven levels of intervention

On its website, Clarinda Academy is described as a residential foster care facility that was started in 1992 to serve “at-risk and adjudicated delinquent males” between the ages of 12 and 18. Since then, the academy has expanded and now serves up to 265 boys and girls from several states.

Sequel Youth and Family Services, Clarinda Academy’s owner, is an Alabama-based company whose majority stakeholder is Altamont Capital Partners, a Palo Alto, California-based private equity firm. 

Sequel operates programs in 20 states and serves youth from more than 40 states and territories, according to its website. The report by Disabilities Right Washington found that 75 percent of Washington’s contracts for out-of-state youth care are with facilities owned by Sequel. Records show the state of Washington has paid Sequel $816,072 since July 2017. 

Clarinda Academy is located adjacent to a state prison and operates “like a correctional institution,” the Disability Rights Washington report concluded. The report said residents are required to adhere to “norms” including tucking in their shirts, walking single file, not communicating with students of the opposite gender and asking permission to use the bathroom.

“Despite the fact that Washington sends youth to Clarinda Academy for residential care, not because they have been sentenced for a crime, Clarinda Academy policies assume that its students are ‘court ordered into placement,’” the report said.

To enforce the “norms,” Clarinda Academy employs “7 Levels of Intervention” beginning with “helpful nonverbal” — such as a disapproving head shake — and ending with physical restraint. The step before physical restraint is labeled “staff intervention” which the report said “often includes being yelled at, cursed at, spit upon, and threatened.”

Administrators at Clarinda Academy told investigators that physical restraint is only used as a last resort when there’s an immediate risk of harm. But the students reported something different. They said the use of restraints was a daily occurrence at Clarinda Academy and that staff would “drop you if you move” during an intervention.

“They explained this means that staff ‘put their hands on you and force you to the ground,’” the report said. In one case, the report said, a Washington foster youth’s glasses were broken while being restrained.

Records obtained by investigators also showed that one Washington student at Clarinda Academy was restrained for 45 minutes, another student was restrained on average once a week over a three month period, and at least two youth were restrained for failing to follow verbal orders.

Case records also indicate a Washington student passed out due to being restrained.

“I did talk to staff about this to see if this happened,” a social worker in Iowa wrote to a social worker in Washington. “Staff has no records of this happening. They did report that [name redacted] did feel dizzy after a restraint but did not have documentation that [name redacted] passed out.”

According to the report, the students told investigators that some staff were “exceptional” and worked to de-escalate situations. But the investigation also found that many staff members “had received multiple warnings or corrections for failing to adhere to various Clarinda Academy policies.”

Investigators also found, based on a review of personnel records, that of the 26 Clarinda Academy staff who had engaged in restraining the Washington youth, more than a third “had convictions for criminal driving offenses or illegal use of alcohol and controlled substances.”

Despite reports of the liberal use of restraints at Clarinda Academy, investigators found that Children’s Administration social workers in Washington did not document the complaints of the youth there or investigate “whether Clarinda Academy improperly uses restraints in violation of Washington’s own standards.”

The investigation also determined that Clarinda Academy was not complying with a requirement in its contract with Washington that it develop and maintain an “Individualized Behavior Management Plan” for each of the youth and instead used boilerplate “crisis plan” language for each of the residents.

A difference in state law

The Disability Rights Washington report noted that studies have shown restraining youth with mental health issues is both "harmful and dangerous." Both Washington and Iowa law limit the use of restraints, but Washington law is more restrictive, the report said. For instance, in Washington staff must proactively work to de-escalate situations whereas Iowa law does not include that requirement, the report found.

The type of restraint techniques used also differs between Washington and Iowa, the report said. In Washington, control through the use of pressure points is prohibited. Iowa law, however, does not restrict the use of pain or pressure points.

“The young people at Clarinda Academy consistently described experiencing seated restraints involving pressure on their knees, shoulders, necks, backs, arms, and legs,” the report said.

The report raises the specter that the treatment of Washington foster youth at Clarinda Academy violated the Americans with Disabilities Act and the federal Individuals with Disabilities Education Act by failing to serve the youth in the “least restrictive” and most integrated setting possible.

Youth at Clarinda Academy are prohibited from attending local public schools and are rarely allowed off campus, unless it’s to participate in a team sport, according to the report. Their contact with family and friends back home is also highly restricted, investigators found, with students sharing a single phone in each dormitory and “phone call time” limited to between 10 and 20 minutes a week.

“Because the phones are located in common area of the dormitory hall, individuals stated that having meaningful phone conversations with friends and family is often difficult if not impossible due to noise and lack of privacy,” the report said. Some youth also reported that they didn’t get their allotted phone time because of the limited amount of free time in the evenings to place calls and the competition for the single phone.

In addition to restrictions on their movement, Clarinda Academy policy allows staff to conduct random searches of students and their belongings for contraband, the report said.

Ultimately, the report concluded that Washington youth sent to Clarinda Academy were subjected to “involuntary commitment … without consent or due process” and were held against their will in violation of Washington law.

When the youth were sent to Iowa there was no plan to bring them back to Washington and, as a result, some of the youth stayed at Clarinda Academy for 10 months to a year the investigation found.

“Washington State’s child welfare system has been isolating young people against their will in an exceedingly restrictive institution over 1700 miles away from their friends and family,” the report concluded.

The report went on to call for all out-of-state youth to be brought back to Washington, even those not at Clarinda Academy.

“To stop the harm youth are suffering, Washington must bring them home,” the report urged.

Funding needed to bring youth back to Washington

The Department of Children, Youth and Families is already requesting funding in the state’s next two year budget to bring all out-of-state youth back to Washington over the next 18 to 24 months.

“They need to be home,” said DCYF secretary Ross Hunter. “There’s little reason in general to have kids out of state.”

In the meantime, he has ordered case workers to make quarterly, in-person visits to each of the out-of-state youth and speak with them at least once a month by phone.

Hunter noted that of the appoximately 9,100 foster youth in Washington, 4 percent are in group or congregate care, as opposed to family foster homes. That includes 300 youth at in-state facilities and the 80 or so who are out of state. By contrast, the national average for placement in congregate care is 16 percent, according to DCYF. 

The former Clarinda Academy resident who is now in South Carolina said a return home to Washington can’t come soon enough.

“Sending me out of state makes me more … stressed and depressed,” she said. “I want to go back to Washington so, so bad.”