A state-licensed residential treatment facility for troubled children near Butte is facing some troubles of its own. Kids Behavioral Health (KBH), an 85-bed “child and adolescent residential treatment facility for emotionally and behaviorally disturbed kids” was recently slapped by the state Department of Public Health and Human Services with an order to cease admitting new clients and to increase staffing after the Montana Advocacy Program (MAP)—a federally funded non-profit advocacy organization—uncovered serious problems with the way the facility oversees the children in its care.
The initial order came from DPHHS Sept. 2 and placed a moratorium on new admissions, required KBH to increase staffing to adequately meet the needs of residents, and required KBH to report any aggressive behavior by residents to the DPHHS Quality Assurance Licensure Bureau. The order also requires KBH to address violations alleged in a MAP report by Oct. 3. That deadline has come and gone, and according to Helena-based MAP Executive Director Bernadette Franks-Ongoy, KBH hasn’t followed through.
“[KBH has] not, in our opinion, corrected in practice what they are saying they are doing on paper,” says Franks-Ongoy.
The DPHHS order stems from an April incident in which a teenage girl, identified as “Kathy R.” in the MAP report, was systematically assaulted by fellow clients at KBH. The assaults ended only after Kathy R. ended up in the emergency room with a broken nose. After investigating the incident, MAP determined that KBH policies and staffing practices played a role in the incident and filed the complaint with DPHHS and the state Mental Disabilities Board of Visitors. In August, DPPHS conducted a licensure survey at KBH and discovered 113 incidents of aggressive resident behavior from June 30 through July 31. Of those, 68 incidents involved resident-on-resident aggression, and 45 incidents involved resident-on-staff aggression.
The DPHHS order states that “the Kids Staff are unable to protect the residents from assaults by peers due to inadequate staffing thereby putting both residents and staff in danger.”
Officials at DPHHS left the order in place following the Oct. 3 deadline, though department officials say KBH is moving toward compliance.
“Since our report has come out we have continued to monitor KBH. There have been an additional three reports of staff abusing clients,” says Franks-Ongoy. “We’ve made it our business to know what’s going on there.”
Franks-Ongoy told the Independent Oct. 7 that Pam Broughton, KBH’s CEO, resigned her post that day, and Gene Haire, executive director of the Board of Visitors, confirmed that on Tuesday; calls to KBH to confirm the resignation were not returned by press time.
According to Franks-Ongoy, one of MAP’s functions is to advocate for people with disabilities—including mental disabilities—who reside in institutions, and to investigate allegations of abuse and neglect. That oversight doesn’t extend to children enrolled in private alternative adolescent residential or outdoor programs. That’s because those facilities are not licensed by DPHHS.
“I have concerns that there isn’t the sort of oversight that there needs to be,” says Franks-Ongoy of the private adolescent and outdoor programs. “I think of the levels of oversight licensed facilities have, and there is still so much that falls through the cracks. It’s outrageous to think that we would allow these types of programs to go on without minimum standards.”
Sen. Trudy Schmidt of Great Falls introduced a bill in the last legislative session that would have put licensure of private adolescent facilities in the hands of DPHHS, but that bill was shot down in favor of House Bill 628, which created a board under the state Department of Labor to study the possible benefits of licensure.
“I still think licensure needs to happen in the Department of Health and Human Services,” says Schmidt.
Trout Creek Rep. Paul Clark, an owner and operator of an alternative outdoor program, was HB628’s primary sponsor and now chairs the new Board of Private Alternative Adolescent Residential or Outdoor Programs. He says the board is charged by the Legislature to study the benefits of licensing private programs. The next step, if the board deems licensure necessary, will be to ask the Legislature to draft a bill.
Clark says it’s likely that the same kinds of checks and balances that currently exist for licensed mental health facilities would be incorporated into any future bill covering private alternative programs.
“I think it’s important for programs to have checks and balances,” says Clark.
Critics of the new board, which is comprised of three members of the private residential or outdoor program industries and two members of the general public, say it’s unlikely that any substantial regulation will result.
“I think that the industry people are doing what industry people always do, and that is they are trying to protect their industry,” says Franks-Ongoy.
Clark counters that nearly everyone close to the process believes a move toward licensure is likely, and programs are already required to report abuses to the state.
“We are mandated by state law to report any incidents of abuse and neglect, including prior history,” says Clark. “All the state laws, in terms of how kids are treated, apply to our programs.”
But Franks-Ongoy says without a system in place to make sure children are being cared for, like the state licensure and reporting requirements for mental health facilities that uncovered the Kathy R. incident, the safety of children is dependent on individuals.
“I think we’re fooling ourselves if we think that these are behavior models that do not need oversight in terms of minimum standards for monitoring that system,” she says.
Clark says the people on the alternative programs board and its subcommittees are earnest in their efforts to study possible licensure.
“I know that on my watch, we are going to be moving in a responsible direction,” says Clark.