Introduction Washington’s foster care system has been sending many young people in need of residential care and treatment to the Clarinda Academy, an institution in Iowa. This is a report by Disability Rights Washington (DRW) to expose the conditions and treatment experienced by Washington foster youth at this institution. About Disability Rights Washington DRW is a private non-profit advocacy organization with a mission “to advance the dignity, equality, and self-determination of people with disabilities” and “to pursue justice on matters related to human and legal rights.” DRW has been specially designated to serve as the federally mandated Protection and Advocacy (P&A) system for Washington citizens with disabilities and mental health conditions. Following the harrowing 1972 expose of conditions at Willowbrook State School in New York, Congress enacted a series of legislation known as the “P&A Acts,” which require states to designate P&A systems to serve as “watchdogs” to ensure the human rights of people with developmental, physical, and mental health disabilities. Congress provided federal funding and mandated that each P&A have authority to provide information and referrals, outreach and monitoring, as well as advocacy and education for policy makers regarding the rights of its constituents. Under these statutes, P&A’s also have broad access authority to conduct investigations of abuse and neglect upon receiving complaints or probable cause to believe abuse or neglect has or may be occurring. DRW is releasing this report in furtherance of its mission and federal mandate to “protect and advocate” for Washingtonians with mental health disabilities. Washington’s Out-of-state Foster Care Placements DRW’s investigation of Clarinda Academy began several months after DRW discovered that the Children’s Administration of the Washington State Department of Social and Health Services (DSHS) was placing many young people in out-of-state institutions. Specifically, DRW received a call from a community member who was concerned that a
As explained in its brochure, “Norms are defined as expected group behaviors, or what most people in a group do. [Clarinda Academy] has hundreds, if not thousands of norms that staff and students learn. Norms are not written down, but instead, behavioral expectations are passed on from person to person and then maintained through group peer pressure.” Students and administrators gave some examples of norms, which they reinforce with statements of “around here, we…” For instance, “around here, we tuck in our shirts” or “around here, we walk in a single-file line.” Another norm discussed by a male student was “around here, we do not talk to female students.” The female students reported the same norm: “around here, we do not talk to male students.” In fact, teens of both genders reported that they are forbidden to communicate with students of the opposite gender. During its visit, DRW observed that there were no co-ed lines or groups anywhere on campus. Norms are enforced using what Sequel calls the “7 Levels of Intervention.” These seven levels escalate sequentially based on whether the offending individual demonstrates compliance with any norm or expectation. Clarinda Academy strongly encourages everyone on campus, including other students, to “intervene” even the “little” behaviors that violate one of the “hundreds if not thousands of norms” by initiating the seven levels of intervention. The seven levels of intervention begins with Level 1, which is called a “Friendly/helpful nonverbal” intervention. This includes a gesture of disapproval, most often a head shake to indicate “no.” If the student does not change his or her behavior, the levels escalate to a “concerned non-verbal” (a second and more firm gesture of disapproval) to a “friendly/helpful verbal” to a “concerned verbal” where the intervening individual verbally explains what norm is being violated by stating, “around here, we…” Students referred to this fourth level as “being put in a verbal.” If a student does not change behavior after “being put in a verbal” they reported that they are “placed in a group support,” otherwise known as Level 5. A “group support” requires everyone in the area, including all students, to stand up behind the individual who initiated the
Clarinda Academy’s Restraint Practices Policy and Behavior Management Plans To further investigate allegations of inappropriate restraints, DRW reviewed and requested Clarinda Academy’s policies and plans to assess the standards for employing restraints. Neither the polices nor the plans contained specific nor individualized guidance to help prevent incidents from escalating into restraint episodes. Under Clarinda Academy’s “Physical Restraint/Crisis Intervention” policy, physical restraints are a “last resort option when students are creating situations which pose an imminent/immediate harm to themselves or others.” The Clarinda Academy policy requires one of following criteria: Imminent or immediate danger to themselves Imminent or immediate danger to others Any behavior including serious disruption, destruction of property or truancy that could pose an imminent or immediate danger to self or others. The policy does not define “imminent or immediate danger.” Unlike the other “Behavior Change Methodologies” policies that detail numerous examples of “norms” and “accountabilities,” the policy on physical restraint offers no examples of behavior that may indicate “imminent or immediate danger.” Additionally, there is no definition of “serious disruption” or examples of such disruptions that create “imminent or immediate danger.” Nonetheless, DRW considered the possibility that more detailed descriptions of what constitutes “imminent or immediate danger” would be included in individual plans. Clarinda Academy’s policy states that treatment plans “should address any contraindications or inappropriate interventions for the student,” and Washington’s contracts with Clarinda Academy require that each student have an “Individualized Behavior Management Plan.” This plan should include details such as “safety issues” and “factors that may contribute to escalated behavior for the youth,” as well as “response strategies for preventing or defusing escalated behavior” and a “back-up plan for behavior.” Washington’s contract further obligates Clarinda
discussed a history of substance abuse without documentation of any historical signs of aggression that would support staff’s interpretation that turning a shoulder indicated an intent to assault staff. Yet, when uncertain about a student’s intentions, staff acted as if the student’s motions were in preparation for an assault and erred on the side of escalating to the highest level of physical restraints. Yet another investigation participant experienced a restraint episode when staff observed the young person scratching the person’s own leg, which is not typically an action that could reasonably be viewed as creating a “danger.” Nothing in the initial and quarterly assessments for that student discussed a particular danger associated with scratching. Instead, the assessments for this student repeated listed “current presenting issues” as being aggressive towards others, not self. The assessments documented self-reports that the student had disclosed a history of engaging in self-harm, and at least one of the assessments stated that this student had been placed on close observations for expressing thoughts of self-harm while at the facility. But, the treatment plans had no descriptions of the student’s signs of self-harm or the types of self-harm that individual would be likely to attempt. Nor was there any information on the ESI form or other records about strategies other than the “7 levels” of intervention for or de-escalating when staff were concerned about possible self-harm. In a later interview, this person identified a handful of staff who were very skilled in helping to de-escalate without “using their hands,” but stated that other staff would go so far as to taunt with sarcastic questions such as, “why don’t you just go and cut yourself?” Finally, some ESI forms completely failed to document any actions that would indicate “an imminent or immediate danger” as required by Clarinda policy as well as Iowa and Washington regulations. Records documented episodes that escalated into a restraint after the student pushed through staff in an attempt to walk away from an “intervention,” with no logical explanation of any ongoing threat or risk of harm. __________________________________________________________________