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SettlementAgreement
Between
TheStateofMarylandandtheUnitedStatesDepartmentofJustice
SIXTHMONITORSREPORTFor
the
Cheltenham
Youth
Facility
and
Charles
H.
Hickey,
Jr.
School
ForthePeriodofJanuary1,2008throughJune30,2008
Submittedby
KellyDedel,Ph.D.
TimothyHoward
MichaelCohen,M.D.
PeterLeone,Ph.D.
EricTrupin,Ph.D.
BillWamsley
June30,2008
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MonitoringTeamMembersAreasofResponsibilityandTourDates
KellyDedel,
Ph.D.
LeadMonitor
ProtectionfromHarm,SuicidePrevention,andQualityAssurance
February1214,2008(CYF)
April89,2008(Hickey)
April2223,2008(CYF)
April24,2008(Hickey)
TimothyHoward
CoMonitor
ProtectionfromHarm,SuicidePrevention,andQualityAssurance
April
4,
2008
(Hickey)
May910,2008(CYF)
MichaelCohen,M.D.
MedicalServices
April2122,2008(Hickey)
April2324,2008(CYF)
June11,2008(HickeyandCYF)
PeterLeone,Ph.D.
EducationServices
April25and27,2008(CYF)
May5and
7,
2008
(Hickey)
June5,2008(Hickey)
EricTrupin,Ph.D.
MentalHealthServicesandSuicidePrevention
April23,2008(CYF)
April24,2008(Hickey)
BillWamsley
FireSafety
April2122,2008(CYF)
April23
24,
2008
(Hickey)
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TableofContents
Introduction.................................................................................................................................................. 5
MajorFindings.......................................................................................................................................... 8
OverallCompliance................................................................................................................................. 13
PolicyDevelopment
................................................................................................................................
18
ProtectionfromHarm................................................................................................................................ 20
ProtectionfromAbuse........................................................................................................................... 20
ReportingofStaffMisconduct,YouthonYouthViolenceandStaffUsesofForce............................... 23
HealthCareInquiriesRegardingInjury................................................................................................... 26
UseofForce............................................................................................................................................ 27
SeniorManagementReview.................................................................................................................. 29
StaffTraininginBehaviorManagement,DeEscalationandCrisisIntervention................................... 31
BehaviorManagementProgram............................................................................................................ 32
StructuredRehabilitativeProgramming................................................................................................. 34
Staffing.................................................................................................................................................... 36
SecuritySystems..................................................................................................................................... 38
RestraintPractices
..................................................................................................................................
39
Seclusion................................................................................................................................................. 40
DueProcess............................................................................................................................................ 42
AccesstoToilets..................................................................................................................................... 43
AdmissionIntakeandOrientation.......................................................................................................... 43
EmploymentPractices............................................................................................................................ 44
Classification........................................................................................................................................... 45
SuicidePrevention...................................................................................................................................... 47
ImplementationofPolicy....................................................................................................................... 47
SuicideRiskAssessments........................................................................................................................ 48
MentalHealthResponsetoSuicidalYouth............................................................................................ 49
Supervisionof
Youth
at
Risk
of
Self
Harm
..............................................................................................
50
HousingforYouthatRiskofSelfHarm.................................................................................................. 53
RestrictionsforSuicidalYouth................................................................................................................ 51
DocumentationofSuicidePrecautions.................................................................................................. 52
AccesstoEmergencyEquipment........................................................................................................... 53
SuicideandSuicideAttemptReview...................................................................................................... 54
MentalHealthCare.................................................................................................................................... 55
AdequateTreatment.............................................................................................................................. 55
EstablishmentofDirectorofMentalHealth.......................................................................................... 55
AdmissionsConsultationandReferral................................................................................................... 56
MentalHealthScreening........................................................................................................................ 56
Mental
Health
Assessment
.....................................................................................................................
57
TreatmentPlans..................................................................................................................................... 57
MentalHealthInvolvementinHousingDecisions.................................................................................. 58
InformedConsent................................................................................................................................... 58
MentalHealthMedications.................................................................................................................... 59
MentalHealthDevelopmentalDisabilityTrainingforDirectCareStaff................................................ 60
TransitionPlanning................................................................................................................................. 60
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MedicalCare............................................................................................................................................... 61
AppropriateCare.................................................................................................................................... 64
MedicalDirector..................................................................................................................................... 66
HealthAssessments................................................................................................................................ 66
MedicationAdministration..................................................................................................................... 67
MedicalandMentalHealthRecordsRetrieval....................................................................................... 67
MedicalandMentalHealthRecordSystem........................................................................................... 68
SpecialEducation....................................................................................................................................... 69
ProvisionofRequiredSpecialEducation................................................................................................ 70
SupervisionofEducation........................................................................................................................ 71
ScreeningandIdentification................................................................................................................... 71
Parent,Guardian,andSurrogateInvolvement...................................................................................... 71
IndividualizedEducationPrograms........................................................................................................ 72
VocationalEducation.............................................................................................................................. 75
Staffing.................................................................................................................................................... 76
Section504Plans.................................................................................................................................... 76
FireSafety................................................................................................................................................... 77
FireSafety
Precautions
at
Hickey
...........................................................................................................
77
FireSafetyPrecautionsatCYF................................................................................................................ 79
ComplianceandQualityAssurance........................................................................................................... 81
DocumentDevelopmentandRevision................................................................................................... 81
DocumentReview................................................................................................................................... 83
QualityAssurancePrograms................................................................................................................... 84
CorrectiveActionPlans........................................................................................................................... 85
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Introduction
OnJune29,2005,theStateofMarylandenteredintoaSettlementAgreementwiththeUnitedStates
DepartmentofJusticeconcerningtheconditionsofconfinementattheCheltenhamYouthFacility(CYF)
andtheCharlesH.Hickey,Jr.School(Hickey),twojuveniledetentioncentersoperatedbytheMaryland
Departmentof
Juvenile
Services
(DJS).
During
the
summer
of
2005,
the
Parties
jointly
agreed
upon
and
appointedaMonitoringTeamtoreview,assess,andreportindependentlyontheStates
implementationofandcompliancewiththeSettlementAgreement.
Originally,DonDeVorewasselectedasthejuvenilejusticeexpertandMonitoringTeamLeaderbythe
Parties.Mr.DeVoreresignedfromhisdutiesduringthefirstreportingperiod(June30,2005to
December31,2005).InMarch,2006,thePartiesjointlyappointedDr.KellyDedeltoreplaceMr.DeVore
astheMonitoringTeamLeaderandtoassessandreportontheProtectionfromHarm,Suicide
PreventionandQualityAssuranceprovisionsoftheAgreement.TimothyHowardwasappointedtoserve
astheCoMonitorintheareasofProtectionfromHarm,SuicidePreventionandQualityAssurance.The
othermembersoftheMonitoringTeamincludeDr.MichaelCohen(MedicalServices),Dr.PeterLeone
(EducationServices),Dr.EricTrupin(MentalHealthServicesandSuicidePrevention),andBillWamsley
(FireSafety).
InMay2007,theStateandtheDepartmentofJusticeamendedthisAgreementtoincludetheBaltimore
CityJuvenileJusticeCenter(BCJJC).OnlyasubsetoftheprovisionsapplytoBCJJCandaremonitoredby
theapplicablemembersofthesameteamselectedforHickeyandCheltenham.Findingsrelatedto
BCJJCarediscussedinaseparatereport.
TheAgreementplacestheburdenofdemonstratingcomplianceontheState,whichmusthavesufficient
documentationandotherevidenceavailabletodemonstratetheproperimplementationofallpolicies
andprocedures.Usingacombinationofdocumentandyouthrecordreviews,observations,and
interviewswithDJSadministrators,facilitystaff,andyouth,themembersoftheMonitoringTeam
assessedthe
facilities
current
policies
and
practices
relevant
to
the
56
provisions
of
the
Agreement.
Wheneverpossible,teammemberssupportedtheirconclusionswithmultiplesourcesofinformation.
Thisisthe6thMonitorsReport.Asbefore,theMonitoringTeamcontinuedtoreceiveoutstanding
cooperationfromDJSadministratorsandstaff,aswellasusefulassistancefromstaffoftheDepartment
ofJusticeandMarylandAttorneyGeneralsOffice.Inparticular,theDJSsCRIPACoordinatorwas
particularlyhelpfulandimmediatelyresponsivetoalloftheMonitoringTeamsrequests.DJS
administratorswereclearlycommittedtoensuringthatthefacilitiescontinuedtoprogresstoward
substantialcompliancewithinthetimeallottedbytheAgreement.
ExitconferenceswereheldaftertheconclusionofeachMonitorstours.Staffatalllevelsoffacility
operations
and
administration
took
a
keen
interest
in
the
Monitors
findings
and
their
recommendations
forimprovingfacilityoperations.Staffwerediligentintheireffortstoprovideunfetteredaccessto
documents,staffandyouthinorderfortheMonitorstoundertakecomprehensiveaudits.Responsesto
questionswerebothtimelyandthorough,andthequalityofthisreportwasmuchimprovedbythehigh
levelofcooperationreceivedfrombothParties.
TheStateisboundbytheSettlementAgreementforaperiodofthreeyearsbeginningJuly1,2005and
endingJune30,2008.TheMonitorisrequiredtosubmitastatusreporteverysixmonths.Thisreport
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coversthesixthreportingperiod,January1throughJune30,2008.Itisorganizedasfollows:usingthe
samenumberingsystemfromtheAgreement,eachprovisionisprovided,verbatim,followedby
separatecomplianceratingsforCYFandHickey,adiscussionoftheMonitorsfindings,
recommendationsforreachingcompliance,andtheevidentiarybasisfortheMonitorsconclusions.
ThreecomplianceratingsweredevelopedjointlybytheParties:
SubstantialCompliance: Substantialcompliancewithallcomponentsoftheratedprovision.Noncompliancewithmeretechnicalities,ortemporaryfailuretocomplyduringaperiodofotherwise
sustainedcompliancewillnotconstitutefailuretomaintainsustainedcompliance.Atthesametime,
temporarycomplianceduringaperiodofsustainednoncomplianceshallnotconstitutecompliance.
Thestandardsagainstwhichcompliancewillbeassessedarethosethatareconstitutionallyrequired
andrequiredbyFederalstatute.Adherencetobestpracticeisnotrequiredtoachievecompliance
withtheAgreement.
PartialCompliance:Compliancehasbeenachievedonmostofthekeycomponentsoftheprovision,
butsubstantialworkremains.
NonCompliance:
Non
compliance
with
most
or
all
of
the
components
of
the
provision.
WhiletheAgreementremainsineffectforthreeyearsfromwhenitwassigned(untilJune30,2008),an
opportunitytoterminatespecificsectionsoftheAgreementexistsiftheStatemaintainssubstantial
compliancewithindividualprovisionsfor18consecutivemonths.Therefore,wheretheStatehas
achievedsubstantialcompliance,thestartingdateofthe18monthperiodisnotednexttothe
compliancerating.Duringthepreviousfifthmonitoringperiod,threeprovisionswereterminatedfrom
theAgreementwithrespecttoCYFandHickey:
SectionIII.F.ii DirectorofEducation.TheStateshalldesignateadirectorofeducationwithinthe
facilities.Thedirectorshallmeetminimumstandardsasspecifiedbythestate.TheStateshall
providethe
director
with
sufficient
staff
and
resources
to
perform
the
tasks
required
by
this
agreement
SectionIII.F.iii SpecialEducationScreening.Qualifiedprofessionalsshallprovidepromptand
adequatescreeningoffacilityyouthforspecialeducationneeds,includingidentifyingyouthwho
arereceivingspecialeducationintheirhomeschooldistrictsandthoseeligibletoreceivespecial
educationserviceswhohavenotbeensoidentifiedinthepast.
SectionIII.F.iv ParentInvolvement.TheStateshallappropriatelynotifyandinvolveparents,
guardiansorsurrogateparentsinevaluations,eligibilitydeterminations,IndividualEducation
Programs(IEPs),placementandprovisionofspecialeducationservices.
Duringthecurrentmonitoringperiod,additionalprovisionswereterminatedfromtheAgreement.Atthestatelevel:
SectionIII.D.ii EstablishmentofDirectorofMentalHealth.TheStateshalldesignateadirector
ofmentalhealth.Thedirectorshallmeetminimumstandards,asspecifiedbytheState,to
overseethementalhealthcareandrehabilitativetreatmentofyouthatthefacilitiesby
performingtasksrequiredbythisAgreement
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ForBOTHfacilities:
SectionIII.B.xiv AccesstoToilets.TheStateshalldevelopandimplementwrittenprocedures
andpracticesatthefacilitiestoprovideallyouthwithtimelyaccesstotoiletsasneeded.
SectionIII.C.v HousingforYouthatRiskofSelfHarm.TheStateshalltakeallreasonable
measurestoassurethatallhousingforyouthatheightenedriskofselfharm,includingholding
rooms,seclusionroomsandhousingforyouthonsuicideprecautions,isfreeofidentifiable
hazardsthatwouldallowyouthtohangthemselvesorcommitotheractsofselfharm.
AtCheltenhamonly:
SectionIII.B.vii BehaviorManagementProgram.TheStateshalldevelopandimplementan
effectivebehaviormanagementprogramatthefacilitiesthroughouttheday,includingduring
schooltimeandshallcontinuetoimplementthebehaviormanagementplan.TheStateshall
developandimplementpolicies,proceduresandpracticesunderwhichmentalhealthstaff
provideregularconsultationregardingbehaviormanagementtodirectcareandotherstaff
involvedin
the
behavior
management
plans
for
youth
receiving
mental
health
services,
and
shall
developamechanismtoassesstheeffectivenessofinterventionsutilized.
SectionIII.B.x SecuritySystems. TheStateshalladequatelymaintainhousingunitsecurity
systems,includingindividualroomdoorlocks.
AtHickeyonly:
SectionIII.D.viii InformedConsent.ConsistentwithStatelaw,theStateshall,priortoobtaining
consentfortheadministrationofpsychotropicmedications,provideyouthand,asappropriate,
theirparentsorguardianswithinformationregardingthegoals,risks,benefitsandpotential
sideeffects
of
such
medications
offered
for
their
treatment,
as
well
as
an
explanation
of
what
theconsequencesofnottreatingwiththemedicationmightbe,andwhethera
recommendationismadeinadosageormannernotrecognizedbytheUnitedStatesFoodand
DrugAdministration.
SectionIII.D.ix MentalHealthMedications. TheStateshalltkeallreasonablemeasuresto
assurethatpsychotropicmedicationsareprescribed,distributed,andmonitoredproperlyand
safely.TheStateshallprovideregulartrainingtoallhealthandmentalhealthstaffoncurrent
issuesinpsychopharmacologicaltreatment,includinginformationnecessarytomonitorforside
effectsandefficacy.
While
these
provisions
are
no
longer
actively
monitored,
they
are
included
in
this
report
for
the
sake
of
continuityandclarity.
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MajorFindings
SincetheAgreementwassignedin2005,DJScurednearlyallofthedeficitsnotedintheDOJsFindings
Letter.1Inpart,thesechangesweremadepossiblebythesignificantfiscalresourcesthatwere
dedicatedto
improving
the
conditions
of
confinement
and
the
quality
of
care
at
Hickey
and
Cheltenham.
Theseresources,alongwiththeunwaveringcommitmentofagencyandfacilityadministrators,clerical
staff,professionalandlinestaff,andcommunityvolunteers,haveradicallyimprovedthecareand
treatmentofyouthandalsoenabledtoStatetosatisfynearlyalloftheextensiverequirementsofthis
Agreementinjustthreeyears.
Tobesure,therehavebeenmanyprogrammaticchangesthatsubstantiallyimprovedthequalityofcare
atCheltenhamandHickey.Thesearediscussedthroughoutthebodyofthisreport.Manyofthese
programmaticimprovementsweregreatlyfacilitatedbychangestothefacilitiesconfiguration.For
example:
The
size
of
the
facilities
and
the
level
of
crowding
have
been
drastically
reduced.
At
the
time
the
DOJconducteditsinitialtourin2003,Cheltenhamhad180bedsandhoused216youth(20%
overcapacity).SincetheAgreementwassigned,Cheltenhamreduceditscapacityto110beds
andtheaveragedailypopulationforthefirstfourmonthsof2008was100youth.WhentheDOJ
conducteditstour,Hickeyhad330bedsforbothdetainedandcommittedyouthandhoused
263youth.Currently,Hickeyoperatesonlya72beddetentionprogramandtheaveragedaily
populationforthefirstfourmonthsof2008was60youth.
Staffsupervisionofyouthhasimproveddramaticallygivenenhancedstaffyouthratios.Inits
FindingsLetter,DOJnotedthatstafftoyouthratioshadbeenashighas120duringtheday
and160atnight.Obviously,thelackofsupervisioncreatedmanyopportunitiesforviolenceto
occur.ThroughoutlatterpartoftheperiodtheAgreementwasineffect,bothfacilitieswere
routinelystaffed
at
18
during
the
day
and
116
at
night.
Since2005,theStatespentapproximately$1.9milliontoimprovethephysicalplantatbothfacilities.
Amongtheimprovementswerenewmedicalclinicsatbothfacilitiesandtherenovationofabuildingat
Hickeywhichsituatedfacilityadministratorsinsidethefacilitysfenceandalsoallowedforexpanded
youthindoorrecreationareasandincentiveprograms.Inaddition,theStatecommittedover$2.5
millionperyearforacontractwithGlassHealth&Associatestoprovidementalhealthcaretoyouthat
bothfacilities.
Inordertoincreasestaffyouthratiostoacceptablelevels,theStatebothauthorizedovertimepay
(oftenbetween10and20FTEshiftsperdayateachfacility)andsoughtfundingfromtheLegislatureto
createnew
merit
and
contractual
positions.
Approximately
75
contractual
positions
have
been
convertedtomeritpositionswhichincurfringebenefitcostsbutalsomakethesepositionsmore
attractivetoprospectiveemployees.Further,13newdirectcarepositionswereaddedtothefacilities
rostersin2007.
1DOJFindingsLetter,issuedApril,2004,availableat:
http://www.usdoj.gov/crt/split/documents/cheltenham_md.pdf
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Overall,Cheltenhamsoperatingbudgetincreasedbynearly70%overthespanoftheAgreement,
despitethesignificantreductionsintheyouthpopulationcitedabove.Similarly,atHickey,whilethe
operatingbudgetdecreasedapproximately5%,thecapacityreductionatthatfacilitywassosignificant
(330bedsto72beds)thattheperyouthexpendituresincreased147%overthetermoftheAgreement.
Finally,theStatehascommittedtospendingapproximately$500,000peryeartofundaQuality
ImprovementunittoensurethatthereformsenactedunderthisAgreementremaininplace.
OneofthekeyissuescitedintheDOJsFindingsLetterwasthelevelofviolenceinthefacilities.Both
facilitiesparticipateinthePerformancebasedStandardsprogram(PbS),anationalprojectthatpermits
facilitiestocomparetheiroutcomesinkeyareasovertimeandalsopermitscomparisonstoafield
averageconstructedusingratesfromallparticipatingfacilities.2Severaloutcomemeasureshave
particularrelevancetotheAgreement,andthusresultsfromtheApril2008datacollectionperiodare
presentedhere.DuringthecourseoftheAgreement,theDJSalsodevelopedaninternaldatabase
throughitsOfficeofInvestigationsandAudits(OIA)whichcould,buthasnotyetbeenusedtoprovide
manyofthesamefunctionsasPbS.
StandardSafety11trackstheratesofyouthonyouthassaults,calculatedasaratewhichcontrolsfor
thesize
of
the
population
so
that
facilities
with
different
characteristics
can
be
compared
to
each
other.
AsshowninthegraphforHickeybelow,therateofviolencewasatitshighestpointinOctober2006.
Thepast18monthshavewitnessedsignificantdecreasesintherateofyouthonyouthassaults,
decreasingfrom1.892inOctober2006to1.012inApril2008(a47%decrease).Similardecreaseshave
alsobeenobservedwhentheratesarecomparedtothenationalfieldaverage(representedbythe
ribbonrunningthroughthebarchart),althoughtheratesofyouthviolenceatHickeyremain
significantlyhigherthanthefieldaverage.
2NotethatparticipationinPbSisvoluntaryandthusthefieldaverageisconstructedusingonlyasubsetof
detentionfacilitiesoperatingintheUnitedStates(fortheApril2008FieldAverage,n=39oftheapproximately760
detentioncentersnationwide).
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ThegraphforCYF,below,revealsamorevariabletrend,butasignificantlylowerrateofyouthviolence
ascomparedtoHickey.JustbeforetheAgreementwassigned,therateofyouthviolenceatCYFwasat
itshighest(October,2004).ByOctober2006andApril2007,therateofyouthonyouthassaultshad
decreasedconsiderably,(October2006rate=0.287;April2007rate=0.311).Therateofyouthviolence
roseagaininOctober2007,butthendecreasedslightlyduringthecurrentmonitoringperiod.Overtime,
CYFsrateofyouthviolencehasfluctuatedbothaboveandbelowthenationalfieldaverage.3In
summary,therehascertainlybeenadecreaseintheoverallrateofyouthviolenceatCYFsincetheAgreementwassigned,butthefacilitywasnotabletosustaintheverypositivechangesthatwere
witnessedin2007.Movingforward,continuoususeofthesedataandanalyticaleffortstounderstand
therootcausesofthesechangeswillallowthefacilitytoidentifythosefactorsthatcontributetoa
reductioninyouthviolence.Withoutthistypeofanalysis,positivechangesmayoccur,buttheywillnot
beabletobesustainedoverthelongterm.
YouthsafetyisreflectedinanotherPbSoutcomemeasure,Safety13(graphsnotshown).InOctober
2007,44%oftheyouthatHickeyreportedthattheyfearedfortheirsafety,whichwasanalltimehigh
forthefacility.ThemostrecentyouthsurveyfromApril2008revealedasharpdecrease,downtoonly
11%. AtCYFinApril2008,23%ofyouthreportedthattheyfearedfortheirsafety,whichis76%higher
thanthepriorreportingperiod(13%)ofOctober2007.Thereasonsforthesechanges,andtheir
relationshiptotherateofyouthviolenceshouldbeexploredmoreclosely.
ThePbSprojectalsotrackstherateofviolenceagainststaffinStandardSafety12.Asshowninthe
graphontheleftbelow,atHickey,theratesofviolenceagainststaffhavebeenconsistentlyhigherthan
thefield
average
for
the
past
four
reporting
periods.
While
these
rates
reflect
relatively
low
raw
numbers(i.e.,inApril2008,therewere2assaultsonstaff)andmaynothaveresultedinanyinjuryto
staff,thefactthatthisproblemhaspersistedovertimeisaconcern.CYF(graph,lowerright)hadnot
3Again,comparisonstothePbSnationalfieldaverageareopentointerpretationbecauseparticipationinthe
programisvoluntaryandthefieldaverageincludesonlyasubsetofdetentionfacilitiesoperatingintheUnited
States(n=39ofapproximately760detentionfacilities,nationwide).
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hadanyassaultsonstaffoverfourreportingperiods(throughoutallof2006and2007),buthad1in
April2008.
WorkingconditionsforstaffarereflectedinanotherPbSoutcomemeasure,Safety14(graphsnot
shown).AroundthetimetheAgreementwassigned,between40%and60%ofHickeystaffreported
thattheyfearedfortheirsafety.InApril2008,thisproportionhaddecreasedto25%.Reducingtherate
ofyouthviolenceatHickey,asdiscussedabove,wouldlikelyresultinstafffeelingsafer.AtCYF,atits
peak,30%ofstaffreportedconcernfortheirsafetyinApril2006.Thisproportionhasdecreasedover
time,landingat19%inApril2008,whichisa33%decreaseoverthepastfewyears.
Thus,overtheperiodoftheAgreement,whilebothfacilitieshavesuccessfullybuiltasolidinfrastructure
andestablishedmanyoftheprocessesandpracticesknowntoprotectyouthfromharmandimprove
thequalityofcare,significantworkremainstoreducetherateofviolenceinthefacilities.Usingthe
newlydeveloped
processes
and
sources
of
information,
both
facilities
must
focus
on
the
causes
of
youth
violenceanddevisetargetedstrategiesthatimpacttheconditionswhichcreatetheopportunitiesfor
youthviolencetooccur.
Anyremainingareasofconcernandfinalremarksineachsubstantiveareaaresummarizedbelow:
ProtectionfromHarm:
Bothfacilitiesareinsubstantialcompliancewith16ofthe17(94%)provisionsrelatedtoprotection
fromharm.TheyremaininpartialcompliancewiththesingleprovisionrelatedtoClassification.
TheDepartment
must
implement
its
housing
classification
instrument
at
both
facilities.
Full
implementationwillrequiretrainingstaff;completingtheinstrumentforallyouthcurrentlyhoused
atthefacilities;completingtheinstrumentforyouthadmittedtothefacilities;andassigningyouth
toroomsthatarecommensuratewiththeirassessedsupervisionlevel.Implementationwillalso
requireDJStocollectdataover30to60daystoassesstheextenttowhichthesystemisoperating
asdesigned,andtomakemodificationsasneeded.Documentationthattheproperprocedureswere
followedforseveralmonthsthereafterwillberequiredtosubstantiatecompliancewiththis
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provision.AsagreedbytheParties,temporarycomplianceduringaperiodofsustainednon
complianceshallnotconstitute[substantial]compliance.
SuicidePrevention:
Bothfacilitiesremaininsubstantialcompliancewithall9oftheprovisions(100%)relatedtosuicide
prevention.
Therigorousfacilitybasedauditingmechanismsestablishedtopromotecompliancewiththis
Agreementwillbeanessentialfeatureofongoingqualityassurance.Althoughtimeconsumingfor
clericalandadministrativestaff,theregularauditsofthesedocumentswillensurethatprocedures
continuetobefollowedandthatstafftakeappropriateactiontoobtainhighqualitymentalhealth
careforyouthwhodemonstrateanelevatedriskofselfharm.
MentalHealthCare,MedicalCare,SpecialEducationandFireSafety:
Bothfacilitiesareinsubstantialcompliancewithall9oftheprovisions(100%)relatedtomental
healthcare.
Bothfacilitiesareinsubstantialcompliancewithall6provisions(100%)relatedtomedicalcare.
Bothfacilitiesareinsubstantialcompliancewithall8provisions(100%)relatedtospecialeducation.
Bothfacilitiesremaininsubstantialcompliancewiththeprovision(100%)relatedtofiresafety.
QualityAssurance:
TheStateisinsubstantialcompliancewithall4provisions(100%)relatedtoQualityAssurance.
TheDJSOfficeofQualityAssuranceandAccountabilityisfullyabletoassumethedutiesperformed
bytheMonitoringTeam.Acomprehensivesetofstandards,clearmethodology,qualitywritten
report,anddetailedcorrectiveactionplansshouldensurethattheconditionsofconfinement
envisionedbythisAgreementcontinuetobeprovidedatbothHickeyandCheltenham.
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OverallCompliance
TheStateisinsubstantialcompliancewith100%ofthe6agencylevelprovisions. Amongthefacility
levelprovisions,bothfacilitiesareinsubstantialcompliancewith98%oftheprovisions.Bothfacilities
remaininpartialcompliancewiththesingleprovisionrelatedtoClassification.
IntheFifthMonitorsReport,HickeyandCYFwereinsubstantialcompliancewith43and37provisions,
respectively.ThisSixthreportevidencesanetgainof6provisionsatHickeyand12provisionsatCYF.
Theseratings,separatedbysubstantiveareaoftheAgreementandbyfacility,areprovidedinTable1
below.
Table1.OverallCompliance,bySubstantiveArea
SubstantiveAreaTotal
Provisions
Substantial
Compliance
Partial
Compliance
Non
Compliance
Hickey CYF Hickey CYF Hickey CYF
ProtectionfromHarm 17 16 16 1 1 ~ ~
SuicidePrevention 9 9 9 ~ ~ ~ ~
MentalHealth* 10 10 10 ~ ~ ~ ~
Medical* 5 5 5 ~ ~ ~ ~
SpecialEducation 8 8 8 ~ ~ ~ ~
FireSafety** 1 1 1 ~ ~ ~ ~
TOTALFACILITYLEVEL 50 49 49 ~ ~ ~ ~
MentalHealth
1
1
~
~
Medical 1 1 ~ ~
QualityAssurance 4 4 ~ ~
TOTALAGENCYLEVEL 66
(100%)~ ~
*Oneormoreprovisionsareagencylevelissues.
Table2,below,comparesthecomplianceratingsfromtheMonitorsFifthandSixthReports.Thecurrent
compliance
ratings
were
compared
to
those
from
the
Monitors
Fifth
Report
to
determine
whether
the
ratingsevidencedslippage,werethesame,orshowedimprovement.Thoseprovisionsonwhich
substantialcompliancehadbeenpreviouslyachieved,andwasmaintained,weremarkedaccordingly.
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Table2.ComparisonofComplianceRatingsfrom4TH
and5TH
Monitors Reports
Provision
Hickey Status CYF
5th
report
6th
reportSlippage
No
ChangeProgress
Compliance
Maintained
5th
report
6th
reportSlippage
ProtectionFromHarm
ProtectFrom
Abuse
PC
C
X PC
C
Reporting C C X PC C
HealthCareInq. C C X C C
UseofForce C C X PC C
SrMgmtReview C C X PC C
TrnginBehMgmt C C X C C
BehMgmtPrgm PC C X C C
Programming C C X C C
Staffing C C X PC C
SecuritySystems
C
C
X C
C
RestraintPractices C C X PC C
Seclusion C C X PC C
DueProcess C C X PC C
AccesstoToilets C C X C C
Adm/Orientation C C X C C
EmpPractice C C X C C
Classification PC PC X PC PC
17 TOTAL ~ 1(6%) 2(12%) 14(82%) TOTAL ~
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Table2.ComparisonofComplianceRatingsfrom4TH
and5TH
Monitors Reports
Provision
Hickey Status CYF
5th
report
6th
reportSlippage
No
ChangeProgress
Compliance
Maintained
5th
report
6th
reportSlippage
SuicidePrevention
ImplementPolicy
C
C
X C
C
SuicideRiskAssesst C C X C C
MHResponse C C X C C
Supervision C C X C C
Housing C C X C C
Restrictions C C X C C
Documentation C C X C C
EmergencyEquipmnt C C X C C
Review C C X C C
9
TOTAL
~ ~ ~ 9(100%) TOTAL ~
MentalHealthCare
AdequateTreatment C C X C C
DirofMH C C X C C
Consult/Referral C C X C C
MHScreening C C X C C
MHAssessment PC C X PC C
TreatmentPlans C C X C C
Housing C C X C C
InformedConsent
C
C
X C
C
MHMedication C C X C C
DevelopDisability C C X C C
TransitionPlanning PC C X PC C
11 TOTAL ~ ~ 2(18%) 9 (82%) TOTAL ~
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Table2.ComparisonofComplianceRatingsfrom4TH
and5TH
Monitors Reports
Provision
Hickey Status CYF
5th
report
6th
reportSlippage
No
ChangeProgress
Compliance
Maintained
5th
report
6th
reportSlippage
MedicalCare
AppropriateCare
PC
C
X PC
C
MedicalDirector C C X C C
HealthAssessments PC C X PC C
MedicationAdmin C C X C C
RecordRetrieval C C X C C
RecordSystem C C X C C
6 TOTAL ~ ~ 2 (34%) 4(66%) TOTAL ~
SpecialEducation
ProvisionofSPED C C X C C
Supervision
C
C
X C
C
Screen/Identification C C X C C
Parent/Surrogate C C X C C
IEPs C C X C C
VocationalEducation C C X C C
Staffing C C X C C
Section504Plans C C X C C
8 TOTAL ~ ~ ~ 8 (100%) TOTAL ~
FireSafety
Precautions
C
C
X C
C
1 TOTAL ~ ~ ~ 1(100%) TOTAL ~
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Table2.ComparisonofComplianceRatingsfrom4TH
and5TH
Monitors Reports
Provision
Hickey Status CYF
5th
report
6th
reportSlippage
No
ChangeProgress
Compliance
Maintained
5th
report
6th
reportSlippage
ComplianceandQualityAssurance
DocumentDevelopt
C
C
X C
C
DocumentReview C C X C C
QAPrograms PC C X PC C
CorrActionPlans PC C X PC C
TOTAL ~ ~ 2(50%) 2(50%) TOTAL ~
TOTAL56Provisions HICKEY ~ 1(2%) 8 (14%) 47 (84%) CYF ~
AtHickey,
compliance
was
maintained
on
84%
of
the
provisions
(n=47).
Progress
was
evident
on
14%
of
the
prov
ratingsremainedthesamefor2%oftheprovisions(n=1). AtCYF,compliancewasmaintainedon73%ofthepro
evidenton25%oftheprovisions(n=14),andthecomplianceratingsremainedthesameon2%oftheprovisions
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PolicyDevelopment
ThefoundationofcompliancewithalloftheprovisionsofthisAgreementisasetofcomprehensive
policiesthatestablishstandardsforcareineveryaspectoffacilityoperations.Duringtheperiodthis
Agreementwas
in
effect,
atotal
of
22
policies
were
drafted
to
address
provisions.
These
include:
AdmissionandOrientation
BehaviorManagement
Classification
CriminalBackgroundChecks
GeneralDocumentationofLogBooks
IncidentReporting
KeyControl
PerimeterSecurity
PharmaceuticalServices
PhotographingofInjuries
PostOrders
Recreation
ReportingandInvestigatingChildAbuse
SafetyandSecurityInspections
Searches
Seclusion
SuicidePrevention
TreatmentServicesPlan
UseofCPMTechniques
VideotapingIncidents
YouthGrievances
YouthMovement
and
Count
Mostofthesepoliciesarerelatedtogeneralfacilityoperationsandpracticestoprotectyouthfrom
harm.TheothersubstantiveareasofthisAgreementarealsocoveredbywrittenguidelinesand
standards.DJShasonlyoneagencypolicyrelatedtoeducation(CoordinationwithCommunityAgencies
andEducationalInstitutions),butproceduresaregovernedbytheMarylandStateDepartmentof
Education(MSDE)specialeducationregulations.Bothschoolsusetheseguidelines.
Withregardtomedicalservices,theDJShasninepoliciescoveringthefollowingareas:
Sickcall;
Youthparticipationinexperimentalresearch;
Notification
of
illness,
injury,
surgery
or
death;
Communicablediseases;
Firstaidkits;
Handlingcontaminatedwaste;
AIDS;
Pharmaceuticalservices
Emergencymedicalservices;and
Bloodbornepathogens.
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Mentalhealthservicesareguidedbyfivepoliciescovering:suicideprevention,substanceabuse
treatment,psychologicalevaluations,drugandalcoholabuseassessment,andtreatmentplanning.The
treatmentplanningpolicyiscurrentlybeingrevised.Finally,facilityoperationsrelativetofiresafetyare
coveredbypoliciesthatdiscuss:useofflammable,toxicandcausticmaterials,emergencyevacuation
procedures,andsafetyandsecurityinspections.
ThesepoliciesprovideasolidfoundationforeffectivelyoperatingDJSfacilities.Theextenttowhichthey
havebeenproperlyimplementedisdiscussedinthesubsequentsectionofthisreport,whichdiscusses
eachofthe56provisionsindividually.
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ProtectionfromHarm
Provision
III.B.i
ProtectionfromAbuse:TheStateshalltakeallreasonablemeasurestoassure
thatyouthareprotectedfromviolenceandotherphysicalorsexualabuseby
staffandotheryouth.
Status
HickeySchoolSubstantialCompliance
(asofJune30,2008)
CheltenhamYouthFacilitySubstantialCompliance
(asofJune30,2008)
Discussion DuringthetermofthisAgreement,bothfacilitiesdevelopedasolidinfrastructure
thatincludesthekeyelementsknowntopromoteyouthandstaffsafety.These
include:
Procedurestoattractandretainqualifiedstafftoallowforappropriatestaff
youthratios;
Anincidentreportingprocessandsystemofreviewbyseniormanagers;
Acurriculumforsafecrisisinterventionthatemphasizesdeescalationand
usesphysicalandmechanicalrestraintsonlyasalastresort;
Asystemforinvestigatingandrespondingtoallegationsofstaffabuseand
misconduct;
Abehaviormanagementprogramthatsetsclearexpectationsforbehavior
andprovidesasystemofincentivesandconsequencesthataremeaningfulto
youth;
Stronglimitsontheuseofisolationasaresponsetomisconduct;and
Structuredprogrammingthatminimizesyouthsidletime.
Aswillbediscussedinthefollowingsections,DJShasimplementedpolicies,
proceduresandpracticesrelevanttoeachkeyarea.Someofthesepracticeswere
implementedsmoothly(e.g.,theOfficeofInvestigationsandAdvocacy
investigations),while
others
required
more
heroic
efforts
(e.g.,
many
staff
continuetoberequiredtoworkdoubleshiftsinordertomeetprescribedstaff
youthratios).Inallcases,thecommitmentoflinestaff,supervisors,and
administratorsresultedinsignificantenhancementstothewayyoutharetreated
andtheconditionsunderwhichtheyareconfined.
TheStatehasyettoachievesubstantialcomplianceononlyoneprovisionofthe
protectionfromharmsectionofthisAgreement:Classification.Asdiscussedin
detailinIII.B.xvii,theStatedevelopedandattemptedtovalidateaclassification
systemduringthesecondyearofthisAgreement.Thissystemsufferedfroma
varietyofproblems(confusingterminologyandinaccessibledata)andthusin
April2008,
the
DJS
decided
to
create
anew
system
that
was
better
aligned
with
Marylandssystem.WhiletheMonitorsupportsthisdecisionandbelievesitwill
resultinaclassificationsystemthatismorefullyintegratedintotheDJSsoverall
mission,thischangedidnotoccuruntillateinthefinalmonitoringperiodand
thusthenewsystemcouldnotbeimplementedinthetimeremainingbeforethe
terminationoftheAgreement.
Whilealloftheissueslistedabovearediscussedindetailundertherelevant
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provisions,oneissuefallsunderthismoregeneraldiscussion.Adequate
protectionfromharmrequiresadependablesystemformonitoringyouths
safetyandwelfareanytimetheyareconfinedtoalockedroom.TheDepartment
hasembracedthisstandardbyrequiringyouthtobecheckedat30minute
intervalsduringsleepinghours(althougha15minutestandardisusedbythe
CYF).
AtHickey,theGuardToursystemwasputintouseinthelatterpartof2007.The
previousMonitorsReportnotedsomeinconsistencyinthefrequencyof
overnightchecksandalackofvariationintheonsetofcheckscommensurate
withtheyouthsstaggeredbedtimes. Duringthecurrentmonitoringperiod,five
weekswerechosenrandomlyforreview.Acrosseachofthethreehousingunits,
checkswerefarmoreconsistent,withonly3percentofshiftsexhibiting
significantgapsinchecks(i.e.,gapsinwhichyouthwerenotcheckedfor60
minutesormore).Mostoftheshiftsreviewedindicatedthattheonsetofchecks
paralleledyouthsstaggeredbedtimes,andforthemostpart,checkscontinued
untiltheyouthwereawakenedformorninghygiene.
AtCYF,theGuardTourwasimplementedduringthecurrentmonitoringperiod.
Whilecompliancewithfacilityoperatingprocedureswasstrongduringtheinitial
periodofimplementation,itwasnotsustainedthroughoutthemonitoring
period.InearlyFebruary,2008,checksattheproperintervalswerebeing
executedbythemajorityofstaffassignedtoeachofthehousingunits.Staff
appearedtounderstandthemechanicsofthesystemandtouseitproperly.
However,anexaminationofGuardTourreportsforweeksrandomlychosenin
lateFebruary,MarchandAprilhigherratesoferrorwerenoted.Atotalof33
shiftswerereviewedfor3housingunits,foratotalof99shifts.Ofthese,46%
(n=46)shiftsshowedseveredeparturesfromtherequiredoperatingprocedure
(e.g.,two
or
more
periods
exceeding
60
minutes
where
no
checks
were
conductedatall;failingtocommencechecksatyouthsbedtime,insteadwaiting
untilafter3rdshifthadbegun;orendingcheckswellbeforetheyouthswake
time(4a.m.orearlier).Inotherwords,youthsafetywhenconfinedtotheir
roomswasnotproperlyverifiedonnearlyhalfofthenightsobserved.Although
notasignificantenoughproblemtoprecludeasubstantialcomplianceratingon
thisprovision,immediateattentiontothisproblemisrequired.
Thus,thefacilitieshaveachievedsubstantialcomplianceonallbutoneofthe
provisionscontainedinthissectionoftheAgreement.Someofthereformswill
endurewithoutsignificantmaintenance,oversightorrefreshertrainingstaff
have
simply
changed
the
way
they
do
business.
However,
in
other
areas,
continuedvigilancewillbenecessarytoensurethattheinitialimplementation
takesholdandbecomesapermanentpartofhowtheStateapproachesthe
youthinitscare. WithregardtoClassification,inparticular,continuedeffortis
neededtoensurethatthesystemisimplementedasitwasdesigned.
Evenwiththesechanges,incidentsofviolencecontinuetooccuratthefacilities.
However,withthesatisfactionofthisAgreementcomenewtoolstounderstand
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andaccuratelytargetthecausesofviolencewiththeintentionofreducing
violenceovertime.AbsenttheinfrastructurecreatedviathisAgreement,
strategicviolencereductioneffortswouldnotbepossible.
Recommendations Bothfacilitiesareinsubstantialcompliancewiththisprovision,asofJune30,
2008.
ItisstronglysuggestedthatCYFtakeimmediatestepstoensurethatthe
GuardTourpolicyisproperlyimplemented.
EvidentiaryBasis Alldocuments,interviews,andobservationslistedinthesubsequent
provisionsoftheProtectionfromHarmsectionofthisAgreement.
GuardTourreportsfromHickeyfortheweeksofJanuary13,January27,
February24,March23andApril6,2008.
GuardTourreportsfromCYFfortheweeksofFebruary2,February24,March
16,March30andApril13,2008.
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Provision
III.B.ii
ReportingofStaffMisconduct,YouthonYouthViolenceandStaffUsesofForce:
TheStateshalldevelopandimplementappropriatepolicies,proceduresand
practicestoenhancethereportingtoappropriateindividualsofincidentsofstaff
misconduct,youth
on
youth
violence
and
staff
uses
of
forces,
and
to
provide
that
suchreportingmaybedonethroughconfidentialmeans,withoutfearofretaliation
formakingthereport.TheStateshalldocumentandreportappropriatelyandwith
sufficientdetailallsuchincidents.
Status
HickeySchool
SubstantialCompliance
(asofOctober25,2007)
CheltenhamYouthFacility
SubstantialCompliance
(asofJune30,2008)
Discussion Thefollowingpoliciesarerelevanttothisprovision:
UseofCrisisPreventionManagementTechniques
IncidentReporting
ReportingandInvestigatingChildAbuseandNeglect
YouthGrievances
IncidentReporting: Policy.Theresponsibilitytoreportincidentsofstaff
misconduct,youthonyouthviolence,usesofforceandothertypesofincidentsup
thechainofcommandisdiscussedintheDepartmentsIncidentReportingpolicy.
BothfacilitiesalsohaveaFacilityOperatingProcedure(FOP)thatprovidesspecific
proceduresforcompletingtheincidentreportitself.Inaddition,thetraining
departmentdraftedaStepByStepGuideforCompletingtheDJSIncidentReporting
Form.Thismanualisanexcellenttrainingtool.
Training. Afourhourreportwritingtrainingprogramismandatoryforalldirect
carestaff.
With
only
one
exception,
all
staff
at
both
facilities
participated
in
this
coursein2007.
Practice.Toassesscompliancewiththisprovision,asampleofincidentreports
(IRs)werereviewedateachfacility.Thissamplewasnotchosenrandomly,but
ratherwaspurposefullyselectedtofocusonthoseinvolvingseriousincidents
(groupdisturbances,usesofforcewithinjury,youthonyouthassaultsrequiring
offgroundsmedicaltreatment)andarandomsampleoflessseriousyouthon
youthassaultsandmoreroutineusesofforce.
Overall,theprocessforreportingincidentsofstaffmisconduct,youthonyouth
violence,andtheuseofforcehasbeenfullyimplemented.TheDepartments
incidentreportingform(introducedinSeptember2006)broughtnewstructure
andguidancetotheprocessandresultedinhighqualitynarrativedescriptionsof
theincidents.TheIRpacketsatbothfacilitieswerewellorganized,easilyretrieved,
andusefultothetaskofassessingthecausesofviolencesothatitcanbe
prevented.ThefactthattheIRformsareautomatedpermitstheDepartments
OfficeofInvestigationsandAudits(OIA)toproduceusefulstatisticalreportsonthe
type,frequency,locationandtimeofallincidentswhich,inthefuture,maylend
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themselvestocreativestrategiestoreducethelevelofviolenceinthefacilities.
Atotalof24incidentreportsgeneratedbetweenJanuary1andmidApril2008
werereviewedatHickeyandatotalof33werereviewedatCYF.Whileasmall
numberofreportshaddeficiencies,themajorityofreportsconformedtogenerally
acceptedpractices
in
the
following
areas:
Descriptionsoffactorsthatprecipitatedtheevent(e.g.,wastheassault
completelyunprovokedorhadtheyouthhadanearlierverbalaltercation?
Whatdidtheyouthdojustbeforethefight?);
Accuratelistingofthestaffandyouthpresentandwherestaffwereposted
whentheincidentbegan;
Detailedaccountsofthefightorassault(e.g.,onepunchortheexchangeof
blowsandkicks);
Descriptionsofthewayinwhichstaffintervenedandtheyouthsresponsesto
thoseinterventions(e.g.,thespecificphysicalrestrainttechniqueusedand
howitwasexecuted);
Statementsfromyouthwhowereinvolvedandwhowitnessedtheincident(or
awritten
statement
from
youth
indicating
their
refusal
to
provide
a
statement);and
Statementsfromstaffinvolvedorwhowitnessedtheincident.
Thesedetailsareessentialforasubstantivereviewbymanagementandalsofor
determiningwhetheraspecificincidentshouldbeinvestigatedbytheOfficeof
InvestigationsandAudits(OIA).PriortothedatethisAgreementtookeffect,
incidentreportswerenotwrittenforeveryincidentthatoccurred.Thosethatwere
generatedusuallylackedsufficientdetailtodeterminewhathappenedandhow
staffresponded.Now,however,thereportsprovidesufficientinformationto
assessstaffshandlingofspecificsituationsandalsotoidentifypatternsandissues
thatare
ripe
for
strategic
violence
prevention
efforts.
StaffKnowledge:Structuredinterviewswereconductedwithdirectcarestaffat
eachfacility(n=10atCYFandn=11atHickey).Allstaffreportedthattheyhad
receivedtraininginverbaldeescalationandCrisisPreventionManagement(CPM)
inthepastyear.Allstaffaccuratelyunderstoodtheirresponsibilitytoreport
incidentsinvolvingyouthonyouthviolenceandtheuseofforce,tonotifytheShift
Commanderoftheincident,andtoobtainmedicalattentionfortheyouth
involved.
GrievanceProcedure: Theincidentreportingprocessissupplementedbyaformal
grievance
procedure
as
a
means
for
youth
to
report
perceived
misconduct
or
abuse
bystaff.
AllgrievancesfromJanuarythroughApril,2008werereviewedandtheYouth
Advocatesateachfacilitywereinterviewed.Mostofthegrievancesdiscussednon
safetyrelatedissues(e.g.,clothing,activities,pointdeductions,etc.).Whenstaff
misconductwasalleged,thecomplaintwasforwardedtoinvestigatorsfromthe
OfficeofInvestigationsandAudits(OIA)asappropriate.Youthinterviewedatboth
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facilities(n=11atHickeyandn=12atCYF)reportedthatstaffexplainedthe
grievanceprocesstothemandthattheyknewhowtousethesystem.Youthwho
hadfiledgrievancesreportedthattheissueswereresolvedtotheirsatisfaction.
Seriousandpersistentissuesarebroughttotheattentionofthefacility
Superintendents.Theprocessisclearlyoperatingasitwasdesignedandprovides
youthat
both
facilities
with
free
access
to
aconfidential
grievance
process.
ReportingChildAbuseandNeglecttoChildProtectiveServices:Staffatboth
facilitiesaremandatedchildabusereportersbyStatestatute.Assuch,theyare
requiredtoreportallegationsofabusetotheDepartmentofSocialServices(DSS).
DJSpolicy[ReportingandInvestigatingChildAbuseandNeglect,Policy#010103,
effective2/2000]states,Anyemployeewhohasreasontobelievethatachildhas
beenabusedorneglectedshallimmediatelynotifythelocalDepartmentofSocial
Services(DSS)forsuspectedneglectortheappropriatelawenforcementagency
forsuspectedabuse.Ratherthanrequiringeachindividualtoreporttheincident
toDSSandlawenforcement,DepartmentpolicydesignatestheFacility
Administratorastheresponsibleparty[seeDJSNotificationofIncidentspolicy].
Acrosstheincidentsandformalgrievancesreviewedandyouthandstaff
interviewedduringthismonitoringperiod,theMonitoringTeamdidnotidentify
anyallegationsofmisconductorabusethathadnotbeenpromptlyreportedto
CPSandlawenforcementbydirectcareoradministrativestaff.
Recommendations Hickeyhasbeeninsubstantialcompliancewiththisprovisionforapproximately8
months,beginningOctober25,2007.
CYFisinsubstantialcompliancewiththisprovisionasofJune30,2008.
EvidentiaryBasis Policyreview
CY2007
Training
records
for
all
direct
care
staff,
compiled
by
DJS
at
the
requestoftheMonitor
CYF
Youth interviews,n=12
Staffinterviews,n=10
Incidentreports,n=33,selectedpurposefullyfromthoseoccurringbetween
January1andApril10,2008
Grievances submittedtotheYouthAdvocatebetweenJanuary1andApril10,
2008
Hickey
Youthinterviews,n=11
Staffinterviews,n=11
Incidentreports,n=24,selectedpurposefullyfromthoseoccurringbetween
January1andApril15,2008
GrievancessubmittedtotheYouthAdvocatebetweenJanuary1andApril15,
2008
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Provision
III.B.iii
HealthCareInquiriesRegardingInjury:Anurseorotherhealthcareprovidershall
question,outsidethehearingofotherstafforyouth,ifappropriate,eachyouth
whoreportstotheinfirmarywithaninjury,regardingthecauseoftheinjury.If,in
thecourseoftheyouthsinfirmaryvisit,ahealthcareprovidersuspectsabuse,
thathealth
care
provider
shall
immediately:
a. Takeallappropriatestepstopreserveevidenceoftheinjury(e.g.,
photographtheinjuryandanyotherphysicalevidence);
b. Ifareporthasnotalreadybeenmade,reportthesuspectedabusetothe
appropriateauthorities;
c. Documentadequatelythematterintheyouthsmedicalrecord;andifone
hasnotalreadybeeninitiated,completeanincidentreport.
Status
HickeySchool
SubstantialCompliance
(asofApril25,2007)
CheltenhamYouthFacility
SubstantialCompliance
(asofSeptember14,2006)
Discussion Thefollowingpoliciesarerelevanttothisprovision:
Photographingof
Injuries
NotificationofIncidents
DJSHealthStandard#10
TheDepartmentsNursingReportofInjuriesForm(theBodySheet)istobe
completedforallyouthinvolvedinanincident,whetherornottheyouthis
injured.Acrossthe57IRsreviewedduringthismonitoringperiod,aBodySheet
waslocatedforeachoftheyouthinvolvedintheincidents.Whileaverysmall
minorityoftheformshaderrors(e.g.,timeordatewasnotindicated,Injury
SeverityRatingwasnotcompleted),therateoferrorswasacceptable.Further,
photographinginjuriesforevidentiarypurposesisroutineandphotoswerelocated
forevery
youth
involved
in
the
57
incidents
reviewed.
Inthesmallnumberofinstanceswhenyouthallegedabuseormistreatmentduring
thecourseofthenursesinterview,appropriatestepswerenearlyalwaystakento
ensurethattheallegationswerereportedtothefacilityadministratorortoOIA.In
twocases(oneateachfacility),nursesdidnotreporttheallegationimmediately,
butthenursingsupervisorcaughttheerrorwithin24hours.Althoughnevera
pervasiveproblem,theMonitorhasnotedsimilarconcernsinpriorreport.Nurses
compliancewithmandatoryreportinglawsmustbereinforcedfrequently.
Recommendations CYFhasbeeninsubstantialcompliancewiththisprovisionforapproximately21
months,beginningSeptember14,2006whileHickeyhasbeeninsubstantial
compliancefor
approximately
14
months,
beginning
April
25,
2007.
EvidentiaryBasis CYF
Incidentreports,n=33,selectedpurposefullyfromthoseoccurringbetween
January1andApril10,2008
Hickey
Incidentreports,n=24,selectedpurposefullyfromthoseoccurringbetween
January1andApril15,2008
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Provision
III.B.iv
UseofForce:TheStateshalldevelopandimplementcomprehensivepolicies,
proceduresandpracticesgoverningtheusesofforcetoassurethattheleast
amountofforcenecessaryisusedonyouthforthesafetyofstaff,youthresidents
andvisitors.
StatusHickey
School
Substantial Compliance
(asofDecember31,2007)
CheltenhamYouth
Facility
SubstantialCompliance
(asofJune30,2008)
Discussion Thefollowingpoliciesarerelevanttothisprovision:
UseofCrisisPreventionManagement(CPM)Techniques
VideotapingofIncidents
Policy: TheDepartmentsUseofCrisisPreventionManagement(CPM)Techniques
policywasissuedonMarch27,2007andclearlyarticulatestheroleofphysical
restraintinthecontinuumofinterventionsusedtoensurethesafetyofstaffand
youth.
Training: Atotalof21staff(10atCYF;11atHickey)wereinterviewedabouttheir
trainingandcomfortlevelusingtheCPMtechniques.Allstaffreportedthatthey
receivedannualtraininginCPM.Staffresponsessupportedanunderstandingthat
acontinuumofprogressivelymorerestrictiveresponsesshouldbeused,limiting
theforcetotheleastamountrequiredtoensuresafety.Whenaskedto
demonstrateparticularrestrainttechniques,staffwereabletodoso.
ForthepreviousMonitorsreport,stafftrainingrecordswereanalyzedto
determinetheproportionofstaffwhoreceivedannualtrainingintheuseofCPM
duringCY2007.4AtbothHickeyandCYF,allstaffreceivedCPMtrainingin2007.At
thetime
this
report
was
drafted,
only
one
third
of
CY2008
had
elapsed
and
thus
theserecordswerenotanalyzed.
AttheinceptionofthisAgreement,manystaffhadnotreceivedtraininginthe
properuseofforceforseveralyears.Currently,allstaffreceivethistrainingatleast
annually,andstaffwhoexhibitalackofskillinthisareaarefrequentlyreferredfor
additionaltraining.Further,theCPMtrainingmodulewasenhancedduringthe
previousmonitoringperiodtoemphasizedeescalationandcommunication
strategies.
Practice:TheDepartmentsIncidentReportFormrequiresstafftoidentifythe
specificCPMtechniquesusedandautomaticallygeneratesaUseofForceReport
anytimetheincidentiscodedassuch.Staffarealsoaskedtodescribetheuseof
forceintheaccompanyingnarrative.
4OnlystaffwhowerehiredpriortoJanuary1,2007wereincludedintheanalysis,giventhatstaffhiredafterthat
datewererequiredtosatisfyEntryLevelTraining(ELT)requirementsduringCY2007andwerenotyetsubjectto
annualtrainingrequirements.
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Amongthe57incidentreportsreviewedacrossthetwofacilities,mostofthe
narrativesfullydescribedtheuseofforce,howitwasexecuted,lessrestrictive
measuresthatweretriedbeforehand,andtheyouthsresponsestoeachmeasure.
Supplementaryinformationisavailableinthestaffwitnessstatementsinwhich
eachpersoninvolvedintherestraintaccountsforhisorherbehavior.These
accountsdemonstrate
staff
do
not
automatically
advance
to
the
most
restrictive
holdavailable(e.g.,takekidstothefloorimmediately);instead,theywork
progressivelythroughaseriesoflessrestrictivetechniques,gaugingtheyouths
responsebeforeadvancingtomorerestrictivetechniques.
StaffhavemadeexcellenteffortstoadoptCPMlanguageandtoprovidevery
detaileddescriptionsoftheiractions.However,thoseauditingtheincidentreports
mustrecognizethattherewillbeoccasionswhenthetimingoftheincident,
positioningoftheyouth,orotherfactorsmakeitimpossibletouseaspecificCPM
technique.Inthesesituations,staffshouldsimplydescribe,ratherthanlabel,their
actionstodemonstratethattheyapproachedtheyouthwithcareandmoderated
theirresponsestoonlywhatwasnecessarytobringthesituationsafelyunder
control.
Videotaping: TheDepartmentsVideotapingpolicywasissuedinSeptember,
2007.Despitetheexistenceofthepolicyandtheavailabilityofcameras,battery
packs,andblanktapes,videotapingisstillnotaroutinepractice.Moststaff
indicatedtheywerenotcomfortableusingthecameraduringincidentsastheyfelt
theirinvolvementincontrollingtheyouthsbehaviorwasahigherpriority.If
staffinglevelsareincreased,thevideotapingpolicymightbefollowedmore
dependably.Whenitiscaptured,videotapedfootagehasbeenextremelyhelpful
asatrainingaidforstaff.
Staffand
Youth
Perceptions:
All
of
the
staff
interviewed
reported
that
physical
restraintwasusedasalastresortandthattheleastrestrictivetechniqueswereto
beusedtocontrolyouthinvolvedinanaltercation.Noyouthreportedobserving
staffhit,slap,kick,orotherwiseinjureayouth.
Recommendations Hickeyhasbeeninsubstantialcompliancewiththisprovisionforapproximately6
months,beginningDecember31,2007.CYFisinsubstantialcompliancewiththis
provisionasofJune30,2008.
EvidentiaryBasis Policyreview
CYF
Youth interviews,n=12
Staffinterviews, n=10
Incidentreports,n=33,selectedpurposefullyfromthoseoccurringbetween
January1andApril10,2008
Hickey
Youthinterviews,n=11
Staffinterviews,n=11
Incidentreports,n=24,selectedpurposefullyfromthoseoccurringbetween
January1andApril15,2008
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Provision
III.B.v
SeniorManagementReview:TheStateshalldevelopandimplementasystemfor
reviewbyseniormanagementofusesofforce,allegedchildabuseandyouthon
youthviolence.
Status
HickeySchool
SubstantialCompliance
(asofOctober25,2007)
CheltenhamYouthFacility
SubstantialCompliance
(asofJune30,2008)
Discussion Thefollowingpoliciesarerelevanttothisprovision:
OfficeofProfessionalResponsibilityandAccountability,StandardOperating
Procedures
VideotapingofIncidents
IncidentReports: TheDepartmentsIncidentReport(IR)requiresaSupervisorto
revieweachIR.Thisreviewservestwopurposes:1)toensuretheIRpacketsare
complete;and2)toprovideathoughtfulcritiqueofhowstaffhandledtheincident,
howsimilarincidentscouldbepreventedinthefuture,andtoidentifyanytraining
needs.
Amongthe57IRsreviewedacrossbothfacilities,themajorityoftheIRsupervisory
reviewsevidencedanadequatecritiqueofthewayinwhichstaffhandledeach
situation.AfewSupervisorslimitedtheircommentstoalistofthedocumentsthat
weremissingfromtheincidentreportpackage.ItistheSupervisorsresponsibility
toensurethepackageiscomplete.Simplyidentifyingmissingdocumentsdoesnot
enhancetheusefulnessoftheincidentreportand,absenteffortstocollectthe
missinginformation,Supervisorswillnothavetheinformationtheywouldneedto
completeasatisfactorycritique.Movingforward,Supervisorsshouldbeheldfirmly
responsibleforcreatingcompleteincidentreportpackagesandofferinginitial
commentson
staffs
handling
of
the
incident.
InternalFileAudits:Atbothfacilities,thefacilitySuperintendentorhisdesignee
conductsanauditofeachincidentoncethepackageissubmittedbythe
Supervisors.Whiletheauditprocessatbothfacilitiesisusuallytimelyandrequires
staffresponse,thisprocesscaneasilybedisruptedbyanauditorsabsenceora
lackofvigilancearoundstaffresponsiveness.Atbothfacilities,thesecritiquesoffer
thekeystostrategicviolencepreventionefforts.Byprobingforthecausesof
violenceortheenvironmentalconditionsthatcreatedtheopportunityforviolence
tooccur,thefileauditsareacriticalstepinstrategicviolencepreventioninitiatives
toenhancethesafetyofthefacilities.
OIAInvestigations: All20oftheOIAinvestigationscompletedJanuary1through
April30,2008werereviewed(9fromHickey;11fromCYF).Noneoftheincidents
wereacceptedforreviewbyChildProtectiveServices,butsomewerejointly
investigatedbytheMarylandStatePolice.Ofthe20investigations,20%(n=4)were
sustainedforvarioustypesofmisconduct(e.g.,failuretoproperlysupervise,
falsifyingdocumentation,excessiveuseofforce).Allstaffweredisciplinedina
timelymanner.
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TheOIAinvestigationsmeetcontemporarystandardsintermsoftheir
methodologyandquality,andarealsocompletedinaverytimelymanner. The
practiceofhavingonsiteinvestigators,theprocessesbywhichincidentsare
investigated,thequalityofthewrittenproductsandreasonablenessofthe
findings,and
the
consistency
with
which
staff
are
disciplined
are
all
core
componentsoftheprotectionfromharmenvisionedbythisprovision.OIA
investigatorsroutinelydebriefwithfacilityadministratorstoidentifypracticesand
proceduresthatcouldbestrengthenedintheefforttoprotectyouthfromharm.
Recommendations Hickeyhasbeeninsubstantialcompliancewiththisprovisionforapproximately8
months,beginninginOctober25,2007.CYFisinsubstantialcompliancewiththis
provisionasofJune30,2008.
EvidentiaryBasis Policyreview
OIAinvestigationscompletedbetweenJanuary1andApril30,2008,n=20
CYF
Staffinterviews,n=10
Incidentreports,
n=24,
selected
purposefully
from
those
occurring
between
January1andApril15,2008
Internalfileauditscompletedontheincidentsreviewed
Interviewswithfacilityadministrators
InterviewswithonsiteOIAinvestigators
Hickey
Staffinterviews,n=11
Incidentreports,n=24,selectedpurposefullyfromthoseoccurringbetween
January1andApril15,2008
Internalfileauditscompletedontheincidentsreviewed
Interviewswithfacilityadministrators
Interviewswith
on
site
OIA
investigators
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Provision
III.B.vi
StaffTraininginBehaviorManagement,DeEscalationandCrisisIntervention: The
Stateshalldevelopandimplementacurriculumforappropriatecompetencybased
stafftraininginbehaviormanagement,deescalationtechniques,appropriate
communicationwithyouth,andcrisisintervention.Suchtrainingshallbe
completedbefore
staff
may
work
independently
with
youth.
Status
HickeySchool
SubstantialCompliance
(asofDecember31,2007)
CheltenhamYouthFacility
SubstantialCompliance
(asofDecember31,2007)
Discussion Thefollowingregulationsandpoliciesarerelevanttothisprovision:
MarylandCorrectionalTrainingCommission(COMAR12.10.01)
BehaviorManagement
Professionalstandards(e.g.,ACAstandard3JDF1D09)suggestthattrainingfor
directcarestaffshouldinvolve,ataminimum,120hoursofbasictrainingduring
thefirstyearofemploymentandanadditional40hoursofinservicetrainingeach
yearthereafter.
Topics
should
include
use
of
force
(discussed
more
specifically
in
III.B.iv,above)alongwithinterpersonalrelations,communicationskillsand
counselingtechniques.Currently,theMarylandCorrectionalTrainingCommission
requiresa120hourtrainingduringthefirstyearofservice,butonlyan18hour
annualinservicetraining.ThisprerequisiteissupplementedbyDJSpolicywhich
requires40hoursofannualinservicetraining. TheDJShasaddedtoitsrequired
courses.Theynowinclude:suicideprevention,childabusereporting,incident
reportwriting,verbaldeescalation,CPM,bloodbornepathogens,gangawareness
andadolescentmentalhealthanddevelopment.
TrainingrecordswerereviewedforstaffhiredpriortoMay1,2007toassessthe
extentto
which
training
requirements
for
new
hires
are
being
met.
5
Staff
hired
priortoMay1,2007shouldbefullycertified.AtHickey,all97staff(100%)hired
beforethisdatewereproperlycertified.AtCYF,however,ofthe96staffhired
beforeMay1,2007,11(11%)werenotfullycertified.Mostoftheserequiredfield
trainingtocompletetheircertifications.Whilethe89%successrateissufficientto
achievesubstantialcompliance,itisessentialthatELTandfieldtraining
requirementsbecompletedwithinthetimeallottedbytheDJS.
Annualtrainingrecordsfor2007werereviewedforallstaffatbothfacilitiesforthe
previousMonitorsReporttoassesstheextenttowhichdirectcarestaffmetthe
40hourannualtrainingrequirement.Giventhatbothfacilitieswerefoundtobein
substantialcompliancefortheFifthMonitorsReportandbecauseonlyonethird
of2008haselapsedatthetimethisreportwasdrafted,additionalannualtraining
recordswerenotreviewed.
AtHickey,allstaffreceivedtrainingintheareasrequiredbytheDepartmentin
2007,exceptforaverysmallnumberofstaffwhodidnotupdatetheirCPR
5StaffhiredafterMay1,2007arestillwithinthe12monthwindowavailableforcertification.
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certifications.AtCYF,over95%ofstaffreceivedtraininginsuicideprevention,
reportwriting,childabusereporting,verbaldeescalation,andCPMduring2007.
Smallerproportionsofstaffreceivedtraininginbloodbornepathogens(66%)and
gangawareness(63%).Thesesuccessratesconstitutesubstantialcompliancewith
thisprovision.
Recommendations
Bothfacilities
have
been
in
substantial
compliance
with
this
provision
for
approximately6months,beginningDecember31,2007.
EvidentiaryBasis Policyreview
CYF
Summarytableofannualtrainingrecordsforn=88certifieddirectcarestaff,
preparedbyDJSfortheFifthMonitorsReport
CertificationrecordsforallstaffhiredpriortoMay1,2007(n=96)
Hickey
Summarytableofannualtrainingrecordsforn=75certifieddirectcarestaff,
preparedbyDJSfortheFifthMonitorsReport
Certificationrecords
for
all
staff
hired
prior
to
May
1,
2007
(n=97)
Provision
III.B.vii
BehaviorManagementProgram:TheStateshalldevelopandimplementan
effectivebehaviormanagementprogramatthefacilitiesthroughouttheday,
includingduringschooltimeandshallcontinuetoimplementthebehavior
managementplan.TheStateshalldevelopandimplementpolicies,proceduresand
practicesunderwhichmentalhealthstaffprovideregularconsultationregarding
behaviormanagementtodirectcareandotherstaffinvolvedinthebehavior
managementplansforyouthreceivingmentalhealthservices,andshalldevelopa
mechanismto
assess
the
effectiveness
of
interventions
utilized.
Status
HickeySchool
SubstantialCompliance
(asofJune30,2008)
CheltenhamYouthFacility
SubstantialCompliance
(asofJune30,2006)
Discussion Thefollowingpoliciesarerelevanttothisprovision:
BehaviorManagementProgram
AbehaviormanagementprogrampolicysignedintoeffectonJanuary3,2008.
CYFhasbeenincompliancewiththisprovisionforover18months,andsothe
provisionis
no
longer
actively
monitored
at
that
facility.
HickeyadoptedtheprogramthathasbeeninuseatCYFduringtheprevious
monitoringperiod.Writtenguidelinesforstaffandyouthweredraftedanddirect
carestaffreceivedbehaviormanagementtraininginNovemberandDecember,
2007.Youthandstaffinterviewedunderstoodtheprogramruleswithgreat
specificity,andyouthindicatedthattheyareinformedoftheirpointtotalsand
levelsonadailybasis.Asdesigned,theBMPmeetsprofessionalstandardsinthatit
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allowsyouthtoearnpointsforpositivebehavior;aspointsaccrue,youthare
promotedtohigherlevelsthatcarryincreasingprivileges.Youthmayalsouse
pointstopurchasearangeofcompellingincentives(food,activities,etc.).TheBMP
structurewouldalsoallowbonuspointstobeaddedwhenyouthdemonstrate
additionaladaptivebehaviors(althoughthisfeaturehasnotyetbeenimplemented
ateither
facility).
Finally,
in
response
to
arange
of
minor
and
major
rule
violations,
pointsarededucted,resultinginalossofprivilegesandareducedabilityto
purchaseincentives.
Hickeyhasexertedconsiderableenergytodevelopanarrayofmeaningful
incentives.Youthonhigherlevelsarepermittedtoattendspecialevents,
tournaments,movienights,andtouseagameroomthathasvideogames,arcade
games,andotheractivities.IncentiveRoomsineachhousingunitfeature
comfortablebedding,atelevisionandDVDplayer,videogames,booksandother
comforts.Thisincentiveisopentoyouthofalllevelswhoseapplicationsare
reviewedbyapaneloffacilitystaff.Hickeyalsooperatesacommissary,stocked
usingfacilityfunds.Youthreportthattherangeofincentiveshasimprovedand
thatthe
items
and
activities
are
all
of
great
value.
In
terms
of
consequences,
a
detailedlistofminorandmajorruleviolations,alongwithallowablepoint
deductions,isarticulatedinwrittenBMPguidance.Youthwhobelievepointswere
deductedunfairlymayusetheformalgrievancesystemtoairtheirconcerns.The
Monitorreviewedthesegrievancesandfoundtheresolutiontobebothfairand
appropriate.
TheBMPPointLogswerereviewedforeachunitforthemonthsofMarchand
April,2008.Withalimitednumberofexceptions,youthareawardedpointsona
dailybasiswhentheycomplywithfacilitynormsandpointdeductionsarewithin
therangesprescribedinthewrittendocumentation.Whenyoutharetransferred
betweenunits,
their
points
were
transferred
with
them.
Although
the
core
componentsoftheprogramhavebeenadequatelyimplemented,mechanical
problemscontinuetoplaguetheBMP.Alargenumberofcalculationerrorsare
notedthroughoutthepointlogseitherinsummingpointsforthedayorin
tallyingthevariousdeductionsthataretaken.Whilevery,veryfewoftheerrors
arelargeenoughtoresultinchangestotheyouthslevel,ifleftuncorrectedfora
significantperiodoftime,theycouldeventuallydoso.Further,inaneffortto
motivatestafftocompletethedocumentationproperly,ifstaffdidnotsigntheline
onwhichpointdeductionswerenoted,thesepointswererestoredtotheyouth.
AlthoughtheMonitorsupportseffortstoencouragestaffaccountability,this
particularremedythreatenedtounderminethesystemasawhole.Amethodfor
staff
accountability
that
does
not
impact
the
youths
points
so
significantly
is
recommended.Untilthenumberofcalculationerrorsdecreasestoanacceptable
level,morefrequentaudits(e.g.,every2or3days)isrecommended.
Finally,HickeyusesGuardedCarePlanstosatisfythesecondportionofthis
provision.Theseplans,developedbyayouthstreatmentteam,outlinespecific
actionstobetakenwithyouthforwhomtheBMPhasnotbeenparticularly
effective.
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Insummary,thestructureoftheBMPatbothfacilitiesisadequateandbothhavea
mechanismforconsultationbetweenmentalhealthanddirectcarestaffforyouth
whoarestrugglingwiththeBMP.AtitsmostbasicleveltheBMPiscapableof
reinforcingfacilityrulesandencouragingpositivebehavioramongyouth.Although
notrequired
by
the
Agreement,
the
BMP
could
be
used
to
advance
each
youths
individualtreatmentgoals.Awardingpointswhenyouthdemonstrateadaptive
skillsandachieveindividualtreatmentobjectivesisasensibleintegration.Further,
byfocusingoncatchingtheyouthdoingtherightthing,staffwouldhavean
opportunitytobeapositiveandbenevolentforce,whensooftentheirrolesare
limitedtosanctioningtheyouthandenforcingrules.
Recommendations CYFhasbeeninsubstantialcompliancewiththisprovisionfor23months,
beginningJune30,2006.Hickeyisinsubstantialcompliancewiththisprovisionas
ofJune30,2008.
EvidentiaryBasis CYF
Provisionwasnotactivelymonitoredduringthisperiod
Hickey
Youth interviews,n=11
Staffinterviews, n=11
ReviewofPointLogsfromallcottagesforMarchandApril2008
Reviewofwrittenprogramguidanceforyouthandstaff
Interviewswithfacilityadministrators
Provision
III.B.
viii
StructuredRehabilitativeProgramming:TheStateshallprovideappropriate
structuredrehabilitative
programming
to
youth
in
the
facilities.
Status
HickeySchool
SubstantialCompliance
(asofOctober25,2007)
CheltenhamYouthFacility
SubstantialCompliance
(asofOctober25,2007)
Discussion Thefollowingpoliciesarerelevanttothisprovision:
Recreation
Giventherelativelyshortlengthsofstayamongdetainedyouth,thePartieshave
agreedthatintensiverehabilitativeprogrammingmaynotbefeasible.However,
bothagreed
that
this
provision
suggests
that
youth
should
be
engaged
in
structuredactivitiesthroughouttheday,i.e.,thatthedailyscheduleshouldnotbe
dominatedbyunstructuredfreetime.Implementingapredictablestructurewitha
highlevelofactivityisessentialtomanagingthebehaviorofadolescents.In
addition,structuredgrouptimeshouldbeusedtobegintoaddresstheissuesthat
broughttheyouthtothefacilityinthefirstplace.Programstoimprovedecision
makingskills,selfregulation,frustrationtoleranceandcommunicationare
essential.
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SincetheinceptionofthisAgreement,thedailyschedulesatbothfacilitieswere
fortifiedwithadditionalprogramming.Notonlydodirectcarestaffconductgroups
onthehousingunitsthroughouttheweek,mentalhealthstaffalsoengageyouth
inrehabilitativeprogrammingthroughouttheweek(e.g.,AggressionReplacement
Training,interactive
journaling,
victim
awareness,
etc.).
Both
facilities
have
also
devisedanarrayofstructuredrecreationalopportunitiesandtournamentsfor
youthsothatfreetimeisnotdominatedbytelevisionandboardgames.Areview
ofunitlogbooksandinterviewswithstaffandyouthindicatedthatstaffdonot
deviatefromthepublishedschedule,exceptinemergencysituations.
AtCYF,thewoodworkingshopandnewceramicsclassreceivedveryfavorable
reviewsfrombothstaffandyouth.Thenewvolunteercoordinatorbroughtfour
additionalweeklygroups(empowerment,characterdevelopment,jobreadiness,
andselfadvocacy)tothefacilityduringthelatterhalfofthemonitoringperiod.At
Hickey,newrecreationalopportunitiesweredevelopedandtheMonitorsnoted
muchimprovedstructureduringtheyouthsfreetime.Whiletheseprograms
havenot
fully
coalesced
into
an
integrated
rehabilitative
package
that
is
focused
onteachingadaptiveskills,theyarefarmorestructuredandinteractiveand
successfullylimityouthsidletimetoacceptablelevels.
Recommendations Bothfacilitieshavebeeninsubstantialcompliancewiththisprovisionfo