Residential Facilities:

Improved Data and Enhanced Oversight Would Help Safeguard the Well-Being of Youth with Behavioral and Emotional Challenges

GAO-08-346: Published: May 13, 2008. Publicly Released: May 13, 2008.

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Federal funding to states supported more than 200,000 youth in residential facilities in 2004, many seeking help to address behavioral or emotional challenges. However, federal investigations have identified maltreatment and civil rights abuses in some facilities. GAO was asked to provide national information about (1) the nature of incidents that adversely affect youth well-being in residential facilities, (2) how state licensing and monitoring requirements address youth well-being in these facilities, and (3) what factors affect federal agencies' ability to hold states accountable for youth well-being in residential facilities. GAO conducted national Web-based surveys of state child welfare, health and mental health, and juvenile justice agencies and achieved an 85 percent response rate for each of the three surveys. We also visited four states, interviewed program officials, and reviewed laws and documentation.

Youth in some residential facilities have experienced maltreatment including sexual assault, physical and medical neglect, and bodily assault that sometimes resulted in civil rights violations, hospitalization, or death. Survey respondents from 28 states reported at least one death in residential facilities in 2006. National data submitted to HHS from states show that 34 states reported 1,503 incidents of youth abuse and neglect by facility staff in 2005, but these data are understated due to state barriers in collecting and reporting facility-level information. Specific facility information that was reported and that could help target federal investigations was generally not shared with relevant agencies, such as DOJ's Civil Rights Division, because there was no formal mechanism to share this information. All states have processes in place to license and monitor certain types of residential facilities, but state agencies reported several oversight gaps. Some government and private facilities--particularly juvenile justice facilities and boarding schools--are often exempt from licensing requirements by law or regulation. In addition, licensing standards do not always address some of the most common risks to youth well-being, such as suicide. State officials reported that they are unable to conduct annual on-site reviews at facilities, in part because of fluctuating levels of staff resources. Few state agencies reported suspending or revoking a facility's operating license, in some cases due to lack of alternatives in placing the displaced youth. HHS, DOJ, and Education hold states accountable for youth well-being under federal grant programs, but their authority is limited and monitoring practices are inconsistent. These agencies do not have the legal authority to hold states accountable for youth well-being in private residential facilities unless they serve youth under programs that receive federal funds. Agency officials also said they lack authority to require suicide prevention, and other requirements were inconsistent across programs. Agencies did not always include facilities in their state oversight reviews, and were inconsistent in addressing state noncompliance.

Recommendations for Executive Action

  1. Status: Closed - Not Implemented

    Comments: In 2008, HHS (and DOJ) indicated that they are conducting state oversight consistent with existing statutory authority and resources. GAO responded that the agencies should go beyond its existing efforts to identify ways to enhance their oversight of state accountability for youth well-being. For example, HHS could include residential facilities in federal oversight reviews or modify the conditions of participation for relevant grant programs to require states to give priority to facilities that are accredited or held to recognized standards of care. In FY12, ACF reported that it continues to believe that its current oversight activities are commensurate with existing statutory authority and resources; it took no additional action to address this recommendation.

    Recommendation: To help ensure that the existing federal regulatory structure protects youth well-being across government and private residential facilities supported by federal programs, HHS, Department of Justice, and the Department of Education should work to enhance their oversight of state accountability for youth well-being in residential facilities. Such efforts could include ensuring that residential facilities are included in federal oversight reviews and on-site visits to states.

    Agency Affected: Department of Health and Human Services

  2. Status: Closed - Implemented

    Comments: The Office of Juvenile Justice and Delinquency Prevention (OJJDP) has taken, or plans to take, several actions to promote interagency and interdepartmental collaboration to enhance federal agency coordination to address state accountability for youth well-being in residential facilities. OJJDP staff will develop a plan to inform the Council members about the Civil Rights Division's (CRT) work and request information from Coordinating Council on Juvenile Justice and Delinquency Prevention (Coordinating Council) agencies about their federal training, technical assistance, and funding opportunities that can be of benefit to states, local communities and others in improving conditions of confinement in residential facilities. The goal is to identify appropriate federal staff in non-DOJ agencies who will act as liaisons to OJJDP and CRT about these opportunities. CRT training for OJJDP's State Relations and Assistance Division (SRAD) staff on CRT's activities and applicable laws, policies, and procedures will be scheduled. CRT will provide this training to make OJJDP/SRAD staff aware of circumstances that would warrant a referral to CRT. OJJDP staff, including the OJJDP Research Coordinator, conferred with CRT staff to discuss potential data sources that could provide further insight to CRT and others on conditions of confinement in residential facilities. In addition, OJJDP is exploring the possibility of disseminating information about CRT activities through OJJDP's website and publications, which could educate the public about how CRT can assist individuals who are concerned about the treatment of children and youth in residential facilities within CRT's statutory purview.

    Recommendation: To help ensure that the existing federal regulatory structure protects youth well-being across government and private residential facilities supported by federal programs, HHS, Department of Justice, and the Department of Education should work to enhance their oversight of state accountability for youth well-being in residential facilities. Such efforts could include ensuring that residential facilities are included in federal oversight reviews and on-site visits to states.

    Agency Affected: Department of Justice

  3. Status: Closed - Implemented

    Comments: Among its efforts to address this recommendation, the Department of Justice's (DOJ) Special Litigation Section (SPL) contacted one of the authors of HHS' Centers for Disease Control report "Suicide Trends among Youths and Youth Adults Aged 10-24 years - United States," dated September 7, 2007, to see if SPL could access information about suicides (and any other information about deaths) in residential and juvenile justice facilities. Discussions on this outreach effort are ongoing. Additionally, SPL contacted the Office of Civil Rights for the Department of Education (DOE) to request information it may have regarding deficient educational services in any juvenile justice or publicly-run residential facility. Discussions on this outreach effort are also ongoing. Finally, SPL had previously contacted HHS' Centers for Medicaid and Medicare Services (CMS) to ask that CMS share its surveys of public psychiatric residential treatment facilities for children with SPL. SPL recently received that information from CMS. According to DOJ, SPL's outreach efforts could result in access to data that will enable the Department to more effectively use its investigative resources.

    Recommendation: The Attorney General should work with HHS, the Office of Juvenile Justice and Delinquency Prevention, and Education to obtain access to other sources of relevant information within relevant subagencies, such as HHS' Centers for Disease Control and Prevention.

    Agency Affected: Department of Justice

  4. Status: Closed - Implemented

    Comments: DOJ agreed with this recommendation and took steps to obtain access to the NCANDS data. The agency learned that the data was not collected in a way useful for the Civil Rights Division (CRT) to enforce the Civil Rights of Institutionalized Persons Act (CRIPA). The data were incomplete and dated and did not contain specific information CRT requires to enforce CRIPPA, i.e., it would not allow CRT to target investigations among states and facilities.

    Recommendation: To help target federal civil rights investigations among states and facilities that can provide maximum benefit, the U.S. Attorney General should work with the Secretary of HHS to obtain access to the NCANDS case-file data for residential facilities.

    Agency Affected: Department of Justice

  5. Status: Closed - Implemented

    Comments: HHS stated that the number of states reporting case-level data and the quality of data submitted has improved over the years, and that its Administration for Children and Families (ACF) will continue to work with states to improve the collection of information wherever possible and feasible. In 2010, HHS reported that the Child Maltreatment 2008, case-level data were received from 49 states, including the District of Columbia and Puerto Rico. The agency also reported that its technical assistance efforts related to the remaining two states' ability to report case-level data continue.

    Recommendation: To help policymakers craft solutions that best address the magnitude of maltreatment and other threats to youth well-being in residential facilities, and also to facilitate federal oversight across states and agencies, the Secretary of Health and Human Services (HHS) take action to determine what barriers remain in those states that do not report case-file data for residential facilities to National Child Abuse and Neglect Data System (NCANDS) and explore options to help states address existing barriers.

    Agency Affected: Department of Health and Human Services

  6. Status: Closed - Not Implemented

    Comments: Aside from contacting the Department of Justice (DOJ), the Department of Education has not taken any action on this recommendation. As part of the Coordinating Council on Juvenile Justice and Delinquency Prevention, Education awaits final implementation plans from DOJ and will participate in any future activities deemed necessary to enhance oversight.

    Recommendation: To help ensure that the existing federal regulatory structure protects youth well-being across government and private residential facilities supported by federal programs, HHS, Department of Justice, and the Department of Education should work to enhance their oversight of state accountability for youth well-being in residential facilities. Such efforts could include ensuring that residential facilities are included in federal oversight reviews and on-site visits to states.

    Agency Affected: Department of Education

 

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