By NANCY WEST, InDepthNH.org

CONCORD – The Office of Child Advocate released a report Thursday saying there were more than 20,000 incidents of children being restrained or secluded in the state’s residential facilities during a recent five-year period, with 15,544 of them involving restraints.

The Office of Child Advocate report said it began two years ago seeking Division for Children Youth and Families’ compliance with incident reporting as required by law.

But until last month only consistently received reports of child deaths, other critical incident reports, and all incidents occurring at the Sununu Youth Services Center.

State Child Advocate Moira O’Neill concluded that as a result there has been insufficient oversight of Department of Health and Human Services practices.

“We know little about those incidents,” O’Neill said. She cited the lack of comprehensive review and reporting required of the department under RSA Chapter 126-U.

“Without context, without details of who, what, where and when, we cannot identify whether the problem is inadequate treatment, insufficient staff training, or other systemic issues.”

By comparison, New Hampshire public schools reported 5,245 restraint incidents and 3,429 seclusion incidents from school years 2015 to 2018.

O’Neill is the first to hold the position of child advocate after lawmakers created the Office of Child Advocate to oversee DCYF, which had been under scrutiny by the public and lawmakers because of two highly publicized homicides of children under their care in 2014 and 2015.

Gov. Chris Sununu nominated O’Neill, but Jeffrey Meyers, who recently left as commissioner of Health and Human Services, publicly disputed portions of OCA’s reports on several occasions.

DHHS has declined to adopt statutorily mandated rules to guide its oversight of facility practice and reporting, O’Neill said. “An annual report to the legislature is only an aggregate sum of restraints and seclusions in a year. The reports lack the informing details that give meaning to what happened, to whom, by whom, why and what came next.”

O’Neill said she has at times been disappointed in DHHS’ efforts to discredit her office’s reports and instead defend the agency rather than address the concern about children.  One such case involved the system learning reviews on child deaths.

“They minimized our findings by suggesting we surveyed ‘only 12 DCYF caseworkers.’ In fact, they are comprehensive reviews that involved participation of six teams of six to eight DCYF personnel staff including bureau chiefs and other administrators,” O’Neill said.

O’Neill added: “We have a good working relationship with DCYF Director Joe Ribsam.” He is generally responsive and appreciates the work OCA does, O’Neill said.

Gov. Sununu and the Department of Health and Human Services didn’t immediately respond to requests for comment about the latest report.

On Wednesday, the Executive Council held a public hearing on Sununu’s nomination of Lori Shibinette to become the next Health and Human Services commissioner. Shibinette previously served as DHHS’s deputy commissioner, but not since the Office of Child Advocate has been in existence.

Children affected

O’Neill said DCYF places about 400 New Hampshire children for treatment per year in residential facilities, often because of past abuse, neglect and exposure to other adverse childhood experiences.

“Years of research have failed to find any therapeutic benefit or improvement in behavior resulting from restraint and seclusion. Instead, the harmful physical and psychological effects of restraint and seclusion have prompted most states to establish laws restricting use,” O’Neill said.

“It is well documented that restraining or secluding a child has adverse effects developmentally, emotionally and sometimes physically.”

State law is designed to ensure limited use of these practices, careful collection of information about each incident, periodic, regular review of facility records, and transparent reporting to state decision makers by the department.

“However, obtaining information and data from the department on these incidents has thus far been elusive,” according to the report.

O’Neill said in recent weeks the department has finally established an infrastructure to receive reports and information from residential programs to monitor the care of children. At the same time, many of the residential facilities have stepped up to minimize restraint and seclusion practices and to establish more effective therapeutic approaches to meet children’s needs.

“Ultimately,” O’Neill said, “the goal is to eliminate the practices of restraining and secluding children. If care is informed by the sciences of child development and trauma, children will experience better outcomes that alleviate the necessity for harmful restraints. Staff will also be less likely to suffer injury and other adverse consequences.”

Federal laws, facility and DCYF initiatives, and recent changes to New Hampshire law have positioned New Hampshire to make positive changes. “But we are not there yet.” O’Neill said. “There is still work to be done. The good news is small steps are being taken to get there.”

High risk

The report said children placed in institutions have the highest risk of being restrained, and yet the restraint and seclusion are done out of public view. These children experience trauma or diagnosed post-traumatic stress disorder at a rate more than twice that of combat veterans, according to the report.

They may suffer from hyperactive, impulse and dysregulation disorders, sensory disorders, depression, anxiety, suicidality, and other psychopathologies. Restraints and seclusion traumatize or re-traumatize children, setting back recovery, the report said.

 Although banned in many states, the use of prone (face down) restraints, a potentially lethal practice, is still in use in New Hampshire, the report states.

“At least four providers and the Sununu Youth Services Center, (New Hampshire’s correctional facility for children) continue to restrain children in prone positions, suggesting either a refusal to comply with the law or different interpretations in terms of its use,” according to the report.

According to the report:

• Three providers reported over 2,000 restraint incidents from 2014 to 2018. They were Spaulding Youth Center (2,168 incidents), Crotched Mountain School (3,880 incidents), and Easter Seals Zachary Road (5,205 incidents).
• Institutions reporting the highest use of seclusion included Pine Haven Boys Center (442 incidents), Easter Seals Zachary Road (667 incidents) and Spaulding Youth Center (3,408 incidents).
•  In 2018, one institution, Spaulding Youth Center, comprised nearly 89 percent of all seclusion incidents in the state.
• Only two of New Hampshire’s residential treatment facilities, Pine Haven Boys Center and Spaulding Youth Center, and the state-run Sununu Youth Services Center reported recent use of seclusion, although nine facilities reported use of seclusion at least once from 2010 to 2018.