Two state agencies have placed a moratorium on sending youths in their custody to Good Shepherd Services, a Baltimore County residential treatment center cited by regulators for not providing proper supervision after one patient reported being sexually assaulted and others showed signs of overdose after taking medicine stolen from a medical cart.
The Department of Juvenile Services contracts with Good Shepherd, a nonprofit organization, to provide intensive mental health services to young offenders who have been committed. Agency officials said the program failed to comply with departmental policies and standards.
The Department of Human Resources, which oversees the state's child welfare system, including foster care, declined to say what prompted their moratorium but noted that the agency "strives to ensure that each program complies with applicable laws and regulations designed to protect children."
Lack of supervision and other problems were documented by the state Department of Health and Mental Hygiene, which regulates residential treatment centers, according to public records obtained by The Baltimore Sun. Regulators investigated a number of incidents this year, interviewing staff members and residents and reviewing surveillance video from the facility.
In the case of one resident who reported to staff that she was sexually assaulted on two occasions by another resident, the regulators noted in a report that "failure to enforce facility policies and procedures designed to protect residents may have put [a resident] at risk for the alleged assaults."
After three residents exhibited signs of overdose and surveillance video showed that one of them had raided a medicine cart, the regulators concluded that "the facility staff failed to safely store medications, which affected the health and safety of all residents on the unit."
In another incident, several youths attacked other residents who were on a "hit list," according to a report.
Michele Wyman, president and CEO of Good Shepherd Services, declined to discuss the incident reports but said her staff is highly trained and that the center has taken steps to address the problems. The coed treatment center houses as many as 75 young people, ages 13 to 21, who are suffering from severe emotional and behavioral problems.
"We consider ourselves a learning organization," she said, "which means you look at any kind of deficiency as an opportunity to examine and improve."
The departments of juvenile services and human resources also imposed moratoriums on sending youths to Mary's Mount Manor therapeutic group home in Anne Arundel County. State officials declined to specify problems there.
Health department officials, who respond to complaints at residential treatment centers and group homes, said no incident reports have been filed this year at Mary's Mount.
The group home, which houses up to eight teenage girls, is under contract to house and provide counseling to young offenders and foster children.
Chloe Perez, CEO of the nonprofit Hearts and Homes for Youth, which runs Mary's Mount Manor, declined to comment on the moratoriums.
Youths at both facilities have been diverted to other locations. State officials declined to say how long the moratoriums would last.
Both programs are part of a network of treatment centers and group homes that care for young people who have been committed in the juvenile justice system or are in foster care.
There are about 5,000 children in the state's foster care system.
An average of 575 juvenile offenders are committed on any given day, many of whom are placed in group homes or residential treatment centers for long-term commitments.
Group homes are designed to provide a family-like setting and are regarded as an alternative to institutionalization.
Residential treatment centers provide psychiatric and psychological treatment for adolescents who need 24-hour-supervision and a restrictive environment.
These centers have come under increasing scrutiny nationwide from children's advocates and government agencies that are demanding better outcomes and lower costs, a group of trade associations for residential treatment centers acknowledged in a statement earlier this year. The group said it would work to identify best practices.
"The consensus view is that kids with behavior issues can and should be treated in their own homes, or somewhere else in the communities," said Ira Burnim, legal director of the Judge David L. Bazelon Center for Mental Health Law, a Washington-based group that advocates for adults and children.
Burnim said the treatment centers often keep children away from their homes by putting them in places with a potential for abuse and where they can learn unhealthy behavior from other teens. He also said many have insufficient and untrained staff.
"The situation often devolves into a battle for control," he said.
In Maryland, residential treatment centers cost an average of $423 a night, and therapeutic group homes cost an average of $255 a night, according to state data.
Debbie St. Jean, director of the Juvenile Protection Division of the Maryland Office of the Public Defender, said some residential centers don't provide adequate treatment, noting that juvenile offenders get about 45 minutes a week in individual counseling sessions.
"It isn't as though these kids are in a milieu that is therapeutic," St. Jean said.
Luciene Parsley, managing attorney at Disability Rights Maryland, said that many of the agency's clients report not feeling safe at Good Shepherd and other residential treatment centers because of incessant fighting and violence.
Residential treatment centers are required to send Disability Rights Maryland, formerly the Maryland Disability Law Center, reports of any incidents resulting in serious physical injury. Under federal law, the organization has statutory authority to conduct investigations of suspected abuse and neglect of individuals with disabilities in such facilities.
Parsley said that Good Shepherd has not been complying with the documentation requirement. For example, she said, an incident in which a child was taken to the hospital did not result in a serious-incident report to the agency. "We're looking into rectifying that," she said.
Wyman defended the center's programs, saying it provides as much counseling as a youth may need beyond the once-a-week sessions, and that it tries to "do normal things for kids."
She said youths committed there have extensive treatment programs that are reviewed every 28 days. The residents also have a family advocate, and the goal is for them to be reunited with their families.
She said that her philosophy as a leader is that "transparency is always the best approach." She said, "We do not hesitate to properly report each and every injury deemed serious.
"In our environment, we believe even one physical altercation is too many, and we are focused on creating the safest setting possible," she added. "Because of the complexity of illness seen in our population, we do sometimes have pockets of volatile behavior that is not dissimilar from other institutions across the country caring for similar populations."
Wyman noted that many of the young people "bring histories which are filled with persistent aggression as well as fractured relationship issues that are replayed in a new setting." But she said they learn new skills through the program to reduce aggression.
She also acknowledged that in some cases, juvenile offenders would be better served in less restrictive programs.
"We all recognize that there's a level of trauma that comes with this setting," she said. "When a child can be managed in the community, they absolutely should be."
Several "statement of deficiency" reports filed by state health regulators this year detailed conditions at Good Shepherd.
According to the records, the alleged sexual assaults were reported to police, but staff didn't document them in the resident's record for six days, potentially delaying support and services for the victim.
The three residents who showed signs of overdose required medical care in the emergency department, and one stayed there overnight for observation, records show.
The records also detail several altercations between residents. In one case, a resident was thrown against the wall and hit her head in Good Shepherd's school, which didn't have video surveillance. Staff members didn't investigate the incident, according to the records.
Staff members also failed to intervene when one female resident walked into a classroom that wasn't her own, threatened another teen and hit her in the head, landing the victim in the hospital, records show.
In another incident, two residents made a hit list and beat two other residents, who suffered concussions. "The facility staff were unable to provide sufficient safeguards in the school to prevent the injuries," the records state.
Wyman said a moratorium is "serious."
"But it is an opportunity for everyone to pause and evaluate," she said.