TMCNet:  Crisis brings KidsPeace to a crossroads: High number of restraints, spike in police calls bring state probe. Can the 125-year-old agency survive?

[December 16, 2007]

Crisis brings KidsPeace to a crossroads: High number of restraints, spike in police calls bring state probe. Can the 125-year-old agency survive?

(Morning Call, The (Allentown, PA) (KRT) Via Thomson Dialog NewsEdge) Dec. 16--The spacious athletic complex is among the best in the area, and the dorms overlook 300 acres of rolling hills and roaming buffalo on the nearby Trexler Nature Preserve.

But amid those serene surroundings, a firestorm has erupted at KidsPeace, leading to a state investigation and the resignation of Chief Executive Officer C.T. O'Donnell.

Seven youths suffered broken bones while being restrained this year at the residential treatment facility in North Whitehall Township, where violent battles are being waged almost every day. Staff -- many only slightly older than the youths they're helping -- walk a fine line between counselor and prison guard.

In the past year, KidsPeace counselors were attacked dozens of times by youths who punched, kicked, bit and stabbed them.

At the same time, numbers released by the state Thursday show staff members were forcibly restraining out-of-control youths several times a day -- a rate state officials found alarming. And police responded to KidsPeace roughly three times a week, doubling the calls of the previous year.

In a Nov. 3 incident, a teenage girl knocked a counselor unconscious and assaulted two others before staff members could restrain her, and an incident in July involved so many youths that police from five forces were called.

The escalating violence and reliance on physical restraint has brought an investigation by the state Department of Public Welfare and ended O'Donnell's eight-year run as head of KidsPeace, where he was credited with increasing numbers but criticized for accepting more violent youths.

State officials say the turmoil at KidsPeace raises new questions: Are the methods used behind the walls of KidsPeace an effective means of turning around youths who are often one step from prison? Or are they the result of putting some of society's most troubled teens in the hands of people who lack the training to handle them?

License in jeopardy

Richard Gold, deputy secretary of the state's Office of Children, Youth and Families, is working with KidsPeace to install new policies while the state determines whether to restore the $170 million operation's permanent license in Pennsylvania. At issue is KidsPeace's heavy reliance on physical control measures, which resulted in 2,900 restraints in the past year, he said.

"We will not permit anyone to continue to use physical restraints at this level," Gold said Thursday. "To its credit, KidsPeace has been very much open to mapping out a new plan that I believe will bring drastic culture change there."

That change is already under way, said Lorrie Henderson, who assumed duties as acting president last week. KidsPeace is changing restraint policies, reducing the number of youths in each house and will no longer accept the kind of aggressively violent youths that have caused many of the problems, Henderson said. The organization treats youths ages 4-21 from Pennsylvania and neighboring states whose problems include emotional distress, violent and sexually aggressive behavior, addiction and suicidal tendencies.

"We can't help everyone," Henderson said. "When you get to a point where a kid is so physically violent that you are spending all your time dealing with that, it's hard to keep your focus on counseling and teaching. We know that now."

KidsPeace officials say physical restraints are already down more than 50 percent since state officials arrived in August.

In October, the Welfare Department halted new admissions to KidsPeace as it investigated cases where youths were injured while being placed under restraint. Six weeks of no new clients prompted KidsPeace to lay off 79 workers and slash its 2008 budget by $20 million.

KidsPeace remains on a temporary license until May 1, and counselors inside the embattled facility worry that new restraint policies may be putting them more in danger.

After 125 years, one of the nation's largest programs for youths in crisis finds itself in crisis.

"We are practicing what we teach our kids," said Mark Stubis, KidsPeace vice president of communications. "You can go through crisis, and if you do the right things, you can come out of it stronger. We believe we are doing the right things to address this."

125 years in the Valley

KidsPeace was started in 1882 by soon-to-be Bethlehem Steel President William Thurston. The Thurston Home for Children opened in Bethlehem after a smallpox epidemic left the region with a high number of orphans. It remained a tiny home, called Wiley House, with just 30 youths, but grew explosively beginning in the 1970s. That growth has continued over the last 15 years, with new centers opening in Maine in 1991, in Minnesota in 1998 and 2002, in Georgia in 2004 and in Florida, which opened two last year. KidsPeace now serves 10,000 youths a year in 65 centers and hundreds of foster homes in 10 states. Its 1,500 local workers, among its 2,400-member national work force, make it the Valley's 12th-largest employer.

But with growth has come controversy. In 2004, KidsPeace paid a $1.9 million settlement after the U.S. attorney's office in Philadelphia determined it overcharged Medicaid for counseling. Federal authorities determined KidsPeace could not be reimbursed for paying counselors to ride the bus with clients. KidsPeace had argued they were necessary to keep order. Its buses still include counselors, but KidsPeace does not bill for them.

Frequent calls to police

According to state police at Bethlehem, between July 2006 and July 2007, police made 159 trips to the main KidsPeace campus in North Whitehall Township, including 120 for reported harassments, assaults or sexual assaults. That nearly doubles the 80 responses of a year earlier.

Sgt. Edgardo A. Colon, Criminal Investigation Section supervisor for the Bethlehem barracks, said not every report turned out to be a crime, but the drastic increase is reason for concern.

"It's something we've noticed, something we've begun to track and analyze," Colon said. "We've been in contact with the state and they are aware of the situation. We're all working to reduce the number of incidents there."

In the Nov. 3 incident, a suicidal 15-year-old girl assaulted 22-year-old Kathleen Opolsky of Schuylkill Haven. Like many KidsPeace counselors, Opolsky is a recent college graduate starting her career in social services. The teen grabbed her by the hair and punched her repeatedly, knocking her unconscious, according to a report by state police at Bethlehem. She then assaulted two other KidsPeace counselors before being restrained, police said. She is charged with three assaults, Colon said.

What was more troubling to police is that no one called for an ambulance or contacted authorities. Stubis said that KidsPeace administration officials were never told Opolsky was unconscious, but staffers did drive her to the emergency room. Opolsky's mother, Donna Opolsky, said her daughter still gets therapy for her head and back injuries. A report was filed four days later, when a second counselor involved in the assault went to state police, police said.

"You think your kid is going to be safe at work," said Donna Opolsky from her Pottsville home. "Well, now I worry every day about her. The way this happened has left a bad taste in my mouth."

Stubis said the KidsPeace supervisor who witnessed the incident didn't report it to administration for two days, but he said KidsPeace is not legally bound to report assaults against staff to police.

"In the past, we left that up to the staff member," Stubis said. "We've decided that in the future, if a staff member is injured, we will report it to police whether the staff person does or not."

Kathleen Opolsky, who still works at KidsPeace, did not return phone calls.

Former KidsPeace counselor Jeff Wimmer, who said he performed more than 200 restraints during his five years as a counselor, said he was punched and scratched across the face by a 15-year-old boy under KidsPeace's care. He said KidsPeace supervisors told him not to report the incident to police, but he did anyway. The teen was committed to juvenile detention after describing Wimmer's car in open court and threatening to kill his wife, Wimmer said.

A year later, in 1998, when Wimmer heard the teen was coming back to KidsPeace, he called the boy's probation officer and was fired. Wimmer contends the firing was a repercussion for defying orders against filing charges, but KidsPeace officials said he was fired for contacting the probation officer.

"They discouraged us from filing charges because then the kid would be taken to detention and we wouldn't get insurance reimbursements for his treatment," Wimmer said. "The counselors are well-meaning people who want to do good for these kids, but administration is fixated on dollars and cents."

Stubis said money plays no role in such decisions, and KidsPeace doesn't discourage any worker from contacting police. However, staff members are asked to consider whether incarceration is the right place for a youth to continue healing, he said.

"We're not running an ice cream shop here, so we expect outbursts," Stubis said. "Often you must decide whether such an outburst is an emotional act by a kid in need, or a criminal act."

But Gold, the state deputy secretary, said KidsPeace has discouraged workers from reporting assaults. He said that must change if KidsPeace wants to keep its license.

There have been other times when calling police was unavoidable. On July 28, police from five forces, including three state police barracks, were called to KidsPeace to restore order when dozens of youths clashed outside their residence halls. A fight between "a high number" of youths escalated when at least four youths assaulted six counselors trying to break it up, Colon said.

Reason for restraint

KidsPeace officials said the increased incidents are largely the result of handling youths whose problems seem to get "more acute" each year. Stubis said KidsPeace often accepts clients whom other facilities could not help, in essence serving as a last hope to keep a child from incarceration or institutionalization. Roughly 2,000 of the 5,000 youths it houses each year are suicidal or prone to self-injury, he said. That explains why it is sometimes necessary to restrain youths to prevent them from hurting themselves or others, Stubis said.

Any time staff members put their hands on a youth, even to grab an arm, it is considered a restraint, Gold said. Many times, restraints are more intense and require holding down youths until they can be calmed.

Although state Department of Public Welfare officials are reviewing the entire KidsPeace operation, it is the restraint techniques that have brought such scrutiny -- and not for the first time.

KidsPeace came under fire in 1993 when 12-year-old Jason Tallman of Barnegat, N.J., died while being restrained, and again in 1998 when 14-year-old Mark Draheim of Pelican Island, N.J., died while being restrained.

After each death KidsPeace adopted a new restraint method to reduce the risk of suffocation. Tallman and Draheim both died of suffocation.

The method it used until recently, called Professional Crisis Management, involves several steps in which counselors try to defuse the problem through verbal means. When that fails, three counselors physically restrain the youth.

There are many variations, but in general, one counselor stands on each side, each grabbing a wrist while hooking their arms around the upper arms of the youth. A third counselor grabs the feet, and together they lay the youth face-down on a padded mat.

While state officials question the method, their bigger concern is why KidsPeace counselors have to use it so often. The real problem, Gold contends, is that KidsPeace staff -- many of whom are recent college graduates in their early to mid-20s being paid $10 to $13 an hour -- are not properly trained to prevent youths from progressing to the out-of-control stage.

"All behavior is learned," Gold said. "One of our jobs is to teach youths how to get what they want without violence. Physically restraining a kid would seem to run counter to that. We expect our providers to introduce new ways in which they do not have to use physical restraints -- at all."

In fact, Gold is leading a mission to move all Pennsylvania facilities to a point where restraints are rarely necessary. Counselors will be retrained to head off problems before getting physical, and Gold points to Wordsworth Academy in Philadelphia as evidence it can work.

In 2002, counselors in the 124-bed, $37 million-a-year treatment program for youths in crisis were restraining about 100 youths per month when they decided there had to be a better way. Staff was increased and incentives such as better work hours were used to attract older counselors who would command respect. But mostly, Wordsworth brought about a culture change, said Vice President Mike Britcher.

"We stopped taking things away from bad kids, and started giving things to good kids," Britcher said, noting a youth with the best behavior can earn a single-bed room with cable. "If I wanted bouncers and baby-sitters, then that's what we'd hire. This is all about rapport with the kids."

Today, Wordsworth counselors perform fewer than 10 restraints per month, he said.

That may be possible at facilities that accept youths with fewer problems, but not at KidsPeace, counselors say.

"I invite anyone who thinks that to perform my job for one day," said a KidsPeace counselor who said he performs more than 50 restraints a year. "I think it would take one shift to change their mind."

In fact, he contends that the state's order to stop "prone restraints" -- those in which the youth is taken to the floor -- is more dangerous. Rather than putting the youth on the floor, where they can be easily controlled but also where most injuries have occurred, counselors now restrain youths in a standing position.

"You try and control a 250-pound kid from a standing position," said the counselor, who requested anonymity because he is still employed by KidsPeace. "When their adrenaline gets pumping, some of these kids throw us around like rag dolls. Restraining from the standing position is a lot more dangerous for everyone, including the kid."

Counselors at KidsPeace are about to be "re-educated" in techniques similar to those used at Wordsworth, and Gold expects restraints and police responses to drop drastically.

"We believe they are moving in the right direction," Gold said. "But if their numbers don't go down, remember, we have power over their license to operate in this state."

A loss of that license would leave a tremendous void, Valley children and youth officials have said. Having KidsPeace so close allows local families to participate in their children's healing, they say.

Hope to children

At KidsPeace's main campus in North Whitehall, youths can play most any sport on one of the nine athletic fields, or take advantage of the $10 million Donley Therapeutic Center, which includes racquetball courts, a six-hoop basketball facility, an Olympic swimming pool and a theatrical stage. In addition, a $4 million capital campaign is under way to add new facilities at its campus in Salisbury Township.

"The needs of children have increased dramatically. They are coming to us sometimes from horrific conditions,"O'Donnell said a few weeks before resigning. "We like to say these facilities are a way of providing the very best to kids who have been through the very worst."

The mission, O'Donnell said, is to give hope, health and healing to children in crisis. As part of that mission, the ratio of students to teachers in a KidsPeace classroom is 4-1.

"Hi, I'm Shaniqua," says a 15-year-old KidsPeace girl in one of those classrooms, extending her hand to greet visitors. "I'm going to be a real estate agent. And 10 years from now, I'm going to sell a house to myself."

At the main campus, youths live in dormitory-style residence halls. Those with moderate behavior or emotional problems often live at Patriot Center and more violent youths diagnosed with "conduct disorders" often stay in Inventor Center. Athletes Center is for teens who have more intense emotional problems, and Pioneer Center is one of the state's only private residence hall for youths who have been sexual abusers or victims.

Each home is staffed 24 hours a day, and residents generally live two to a room for about $300 a day, according to tax records KidsPeace files as a private nonprofit corporation. Though the residence halls cannot by law be locked, many have push bars that take 20 seconds to open, to prevent a teen from fleeing on impulse.

Youths with more acute problems stay at the 54-bed KidsPeace Hospital on the North Whitehall campus, with more intensive counseling and doctors, for a fee of about $700 a day. Most of those fees are paid through insurance, Medicaid payments or through county contracts with social service or juvenile authorities, but a small percentage is paid by private people.

Virtually every youth in the hospital is suicidal or prone to self-injury. Some have behavioral problems that stem from abuse; others have emotional problems.

Scribbled on the drawing board in the room of an 8-year-old girl from Kutztown suffering from auditory hallucinations are the words, "I love you Mom and Dad."

In another room, a stuffed bear rests on the bed of a 7-year-old boy whom relatives couldn't stop from walking into traffic after his mother died in a car accident.

The hospital, colorfully decorated with hopscotch boards on the carpet and dancing children on the walls, is a locked facility that is the only stand-alone children's psychiatric hospital for 75 miles.

KidsPeace's facilities and its success at healing youths have earned it annual approval from the Joint Commission of Accrediting Healthcare Facilities, the nation's largest independent body for evaluating heath-care providers.

The state must decide whether to extend its temporary license or restore its permanent license. It also could revoke its license, but because of KidsPeace's size and good track record, that is unlikely, Gold said.

Stubis said the current problems don't erase KidsPeace's many successes.

He talks about James, a violent 7-year-old Lehigh Valley boy who repeatedly hit and kicked his mother and even bit his teachers. After a stint at KidsPeace, he's back at school and thriving. Or Marc, a 16-year-old who went to KidsPeace Hospital after trying to slash his wrists, overdose on drugs and electrocute himself. He's no longer suicidal and is now in residential treatment.

Stephanie Cortese considers herself one of those stories. Cortese was an angry 15-year-old when she arrived at KidsPeace in North Whitehall from Albany, N.Y., in April 2003. She said she'd suffered years of physical and sexual abuse and was kicked out of or ran away from at least four other youth facilities before arriving at KidsPeace. She'd attempted suicide several times, used whatever sharp objects she could find to habitually cut her body and compulsively pulled out clumps of her hair.

In her more-than two years at KidsPeace she was assaulted, or assaulted others, several times, and was restrained countless times, she said.

"Deserved most of it," Cortese recalled. "I was mad at the world."

In September 2005, after making a lot of enemies, but more friends, Cortese said she left KidsPeace as a more mature 18-year-old.

Today, she has a full-time job as a receptionist in Herndon, Va., is in a two-year relationship and is starting an adult life she's certain will be better than her childhood.

State officials now ponder whether KidsPeace should be credited or blamed for the path youths like Cortese take toward healing.

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