Witness Raises Alarms Over The Treatment Of Children At Youth Residential Treatment Facilities

6 months ago

At a Senate Finance Committee hearing earlier this month, Sen. Mike Crapo (R-ID) spoke about youth residential treatment facilities.

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Transcript

00:00Thank you, Senator Wyden, and Ms. Stanford, I'd like to start with you as well.

00:06In your testimony, you indicated that we should not just assume that the model is working

00:14the way it should, that this is the model that we should be using.

00:18And you indicated that a significant amount of the kind of treatment that is referred

00:22to this model could be handled in a home setting with some number of hours a week of counseling

00:29or support outside the home.

00:31Could you expand on that notion a little bit?

00:34Yes.

00:35So I'm not a mental health professional, but absolutely from what we've seen, I think there's

00:39been this assumption that there's constant services and therapy that's being provided

00:44or time for self-reflection inside these facilities, and that's not what we see at all.

00:48It's chaos most of the time, and they're not being engaged.

00:52They're getting very little therapy.

00:54So there's, I mean, there are lots of models out there with different types of therapy

00:58involving the families, involving just the children, but different methods and supports

01:03that could be put in place.

01:04I think what kids need is individualized care, and when you put them in these facilities,

01:09it necessarily becomes about the efficiency of the facility and not the individual care

01:13that can be provided to each kid.

01:15They're all being provided the same thing that is what the model inside that facility

01:20is.

01:21And so just relying, just assuming that these places are providing intensive services and

01:26relying on that without looking further into what it is they're providing or what additional

01:30issues they're creating with the children is a real disservice to the children.

01:35Well, thank you.

01:37And we and each of you have already talked about the notion of the need for much more

01:41aggressive oversight of these facilities, but Ms. Manley, would you agree that, if I

01:46could kind of give a shorthand to what Ms. Stanford was saying, is we're over-utilizing

01:51this model because we should be focusing on getting more kids getting their treatment

01:56at home with the assistance from outside as needed.

01:58Is that something you would agree with?

02:03Absolutely.

02:06Providing good care up front means that many young people can be provided their care in

02:13their own homes.

02:14There are some young people who benefit from short, trauma-responsive, family-engaged residential

02:21interventions that are very close to home.

02:23And you emphasized the word short.

02:26Yes.

02:27And again, I can't remember which of you, several of you, referenced the fact that when

02:33we do, when abuse does happen, that there's concern about how to get it reported.

02:41Ms. Lahren, you indicated that the states and local communities are more in charge of

02:44the oversight than the federal government.

02:47But I think that several of you referenced the fact that whoever's in charge of oversight,

02:54the system, the way it works right now, is one in which the fear of retaliation may cause

02:59a block to being able to conduct that appropriate oversight.

03:04Is that correct?

03:05Ms. Lahren, would you like to comment about that?

03:07Yeah.

03:09That's definitely true.

03:11We talked about barriers to getting good information about how often this occurs.

03:16A big one is fear of retaliation, both by staff who may observe abuse and not want to

03:23report it, and by residents who don't have safe ways to report abuse.

03:28So I've only got about a minute and a half left.

03:31Could each of you take about 30 seconds and tell me how should we improve the oversight

03:36in those cases where children do need to be referred to this type of treatment?

03:41Ms. Lahren, let's start with you and then move down.

03:45While oversight is primarily a state responsibility, we really believe that HHS could do more to,

03:52for example, identify best practices for oversight and share those, facilitate the information

03:58sharing among states.

03:59This is something we've recommended that HHS has not acted on.

04:02Thank you.

04:03Ms. Manley?

04:05At the state level, state understanding of each of the residential interventions, but

04:09more importantly, putting intensive care coordination included for every young person who touches

04:16within residential.

04:17So there's an actual team of individuals who know that young person and spend time with

04:22that young person who can actually report back what is that's happening.

04:26And Ms. Stanford, I want to get to you, but I think Ms. Manley, in your testimony, you

04:29indicated that you thought that family members should be more involved at the facilities.

04:34Is that true?

04:35Yes.

04:36They should have access to young people 24 hours a day, seven days a week.

04:39I think that would help get to the reporting, frankly.

04:43Ms. Stanford?

04:44I think there could be a lot more of a focus on quality of care.

04:47Right now, the minimal federal regulations that relate to these facilities are very specific

04:52and don't overall cover that whether this place is providing a therapeutic environment

04:57or the quality of care or even the level of services that are being provided.

05:01So that information needs to be looked at and shared among states in a manner so people

05:06can see overall what these providers are providing across the nation.

05:11Thank you.

05:12Thank you, Senator Crapo.

Witness Raises Alarms Over The Treatment Of Children At Youth Residential Treatment Facilities

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