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Youth Residential Placement Task Force Draft Report

September 13, 2019


Table of Contents

I. Our Vision and Guiding Principles II. Who are the Youth

III. The Challenges IV. Progress and Commitment to Date V. Our Findings

VI. Call to Action to State Entities VII. Recommendations

a. Systems Level Improvement b. Reduce the Use of Placements c. Improve the Quality of Placements d. Improve the Safety of Placements e. Educational Quality

VIII. Making it Happen IX. How We Worked X. Who’s Who

*Please pardon any errors in style or inconsistencies; the final document will receive additional copyediting, as

well as graphic design. Full cross-references and citations will also appear in the final report*


Our Vision and Guiding Principles Philadelphia’s Youth Residential Placement Task Force seeks to improve the quality and reduce the reliance on youth residential placement outside of a family setting, across three systems: child welfare, juvenile justice and behavioral health treatment. Members of the Philadelphia Residential Task Force are committed to a vision that:

● Prioritizes the health and long-term well-being of youth and their families, ensuring that no child will be harmed and that every child will be cared for in a way that promotes their healing

● Continues to greatly reduce the number of youth in residential placement settings, using these settings only when public safety or treatment needs require doing so

● Provides a high-quality continuum of community-based services before, during, and after placement

● Improves transparency and ensures that all system decisionmakers—from youth and parents to judges—have the information they need to successfully support young people in the community

● Recognizes the racial, gender and LGBTQ-GNC disparities in our current system and actively works to eliminate them

● Includes youth and families as decision-makers ● Prioritizes a youth’s right to educational success ● Ensures that the individualized needs of each youth are met ● Propels youth to lifelong success

We believe that where residential placements remain necessary, such care must

● Be close to home, in small facilities, and for the shortest stay possible ● Keep families engaged and supported ● Use effective, trauma-responsive, evidence-based practices that are

regularly evaluated ● Protect youth from fear or experience of physical or emotional harm ● Ensure that youth receive a quality educational experience ● Support youth re-entry to the community ● Ensure that all children leave placement healthier and more resilient than when they entered ● Hold providers and system leaders accountable for the physical and emotional safety of young people in

their care Reform efforts over the past decade, both nationally and locally, have focused on reducing the number of youth placed in residential settings through child welfare, juvenile justice, and/or behavioral health systems. Research highlights that residential placements should occur only when there are intensive behavioral health needs or safety concerns, and only as a time-limited, intensive intervention designed to stabilize youth. As required by Pennsylvania law, Philadelphia continues to be committed, and is further driven, to ensure that youth are cared

Residential placements, commonly known as “congregate care” in the child welfare and juvenile justice fields, include group homes, psychiatric residential treatment facilities (PRTFs), non-PRTF institutions, state-run detention centers for delinquent youth only, and emergency shelters for dependent youth only. Some residential facilities also offer educational services on-site. Residential placement providers operate 365 days a year and are expected to house youth in a safe, 24-hour supervised environment. They should also support behavioral health needs and overall youth well-being, including educational progress.

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for in the least restrictive, most family-like setting possible and holding ourselves accountable to youth’s safety and success. The experience of residential care, and the often-traumatic life circumstances that precede it, require the most dedicated commitment to invest in the safety and restorative care for the youth receiving these services. When youth are able to remain with their families or in family-like settings, they can heal and envision a meaningful future for themselves. Providers must be properly resourced and supported and join the City in this shared vision of reform.

Who are the Youth As of April 30, 2019, approximately 861 Philadelphia youth were in residential placement, with 426 children in child welfare (dependent) residential placements, 244 in juvenile justice involvement (delinquent), and 191 youth in psychiatric residential treatment facilities (PRTF). Of the 191 youth in a PRTF, 83 also were in a dependent or delinquent placement. Philadelphia’s rate of the use of residential placement is not dissimilar to national and state rates. Approximately 10% of the young Philadelphians in dependent placement receive care in a residential placement, below the state average of 13% and the national average of 12%. Regarding the juvenile delinquent system, Philadelphia’s rate of juvenile delinquency as a proportion of the juvenile population (1.7%) is below the statewide average (1.9%). Similarly, the rate of delinquency placements is under the

A Note About the Role of the State

Philadelphia cannot succeed in improving the quality and safety of youth without leadership from the State. Increased leadership from the Pennsylvania Department of Human Services, the Pennsylvania Department of Education and the Administrative Office of Pennsylvania Courts is critical to making true system change possible. The recommendations presented here focus mainly on actions local leaders and stakeholders can take, but Philadelphia cannot bear the burden alone, nor will the recommendations be fully effective without state changes in policy, oversight and monitoring. We have included a State Call to Action on page 13. We welcome Governor Wolf’s recent leadership on child safety issues through his July 31, 2019 Executive Order.


state average. Philadelphia’s percentage is 5.4% and PA is 6.2%.1 Virtually all youth placed out of their home for juvenile delinquency are placed in residential placement facilities2. Philadelphia Department of Human Services (DHS) conducted an analysis of all youth who entered residential placement facilities during Fiscal Year 20183 and analyzed two months of data on the Commissioner’s approval process for residential placement in order to better understand this population’s service needs, service history, and demographic composition. DHS found that requests for residential placements were primarily made via court orders; additionally, common medical and behavioral considerations noted in placement requests included but were not limited to: physical and mental health concerns, risk to run away, and truancy. Additionally, in looking at the FY18 cohort’s service history, DHS found that the vast majority had received services prior to their 2018 residential placement entry. Notably, dependent residential placement youth had a history of receiving family foster care services. Youth who enter residential placement are more likely than other youth to have experienced trauma, such as physical, sexual, or emotional abuse; domestic violence; traumatic loss or bereavement; school and community violence; and having an impaired caregiver.4 These experiences, left inadequately addressed, can manifest as aggression, self-harming behaviors, problem sexual behaviors, and other high-risk behaviors that make it difficult for the youth to be successful in the community. Youth in placement may be involved in multiple systems. For instance, young people in the child welfare system may be placed in psychiatric residential treatment facilities if they have a medical need for behavioral health services. Likewise, youth in the child welfare system may enter the juvenile justice system if they are found to have committed a delinquent act. Looking at the youth who entered residential treatment during FY18, 53% had both child welfare or juvenile justice involvement and had previously received behavioral health treatment.5 Looking at youth aged 13 and above who have received dependent services in FY15, 15% were subsequently served in the delinquent system in the three years that followed. See Appendix G for more information on the landscape of residential placements across systems. Youth who are placed in Psychiatric Residential Treatment Facilities who are not child welfare- or juvenile justice system-involved often present with complex clinical profiles, including Autism Spectrum

1 https://www.jcjc.pa.gov/Research-Statistics/Disposition%20Reports/2018%20Juvenile%20Court%20Annual%20Report.pdf 2Other out of home placement options include Delinquent Foster Care, Delinquent Supervised Independent Living (SIL), and the Philadelphia Juvenile Justice Center (PJJSC). Foster Care and SIL populations compose less than 5% of the delinquent placement population, and the PJJSC is considered and utilized as temporary placement. Non-placement alternatives and services for delinquent youth exist, such as Evening Reporting Centers and In-Home Detention. Youth receiving non-placement delinquent services are not included in measures featured in this report. 3 City of Philadelphia Fiscal Year (FY) calendar is as follows: FY18 refers to July 1st, 2017-June 30th, 2018. 4 Casey Family Programs (2016). “Elements of Effective Practice for Children and Youth Served by Therapeutic Residential Care: Research Brief.” https://www.casey.org/media/Group-Care-complete.pdf 5 CBH Presentation to TF 5/13/19


Disorder, Intellectual Disability, complex medical needs, or other serious behavioral concerns that makes it difficult for their families to maintain them in their own homes. Philadelphia youth in residential placements are disproportionately male and people of color. They are mostly teens. Ninety percent of them are age 13 or older. For youth who entered a residential placement in FY18, 94% of delinquent youth were black or Hispanic, and 91% of dependent youth were black or Hispanic.6 For youth who entered a residential placement in FY18, the gender disparity is most pronounced among youth in delinquent care, where boys comprise 91% of placements.7 Though fewer girls are in detention and placement in the juvenile justice system, their needs are different than those of boys. Nationally, they tend to have less serious offenses, often related to peer conflict or family chaos; experience greater incidence of trauma and abuse; and have earlier ages of arrest.8 Youth placed in Psychiatric Residential Treatment Facilities reflect similar disproportionality. Black youth make up 57% of the population of youth receiving any treatment and 74 percent of the psychiatric residential treatment facilities population. Across residential placement in all three systems, approximately 75% of those in placement are black youth9; blacks represent 49% of Philadelphia’s under 18 population.10 Although data on sexual orientation and gender identity among youth in residential placement are not collected locally, national studies have estimated that LGBTQ youth make up roughly 25% of the child welfare population, despite comprising only 5% to 7% of the general youth population. On the juvenile justice side, court involved girls are more likely to report being LGBT (27% vs 11% for boys). LGBTQ youth may be more likely to be placed in residential facilities due to lack of accepting, family-based homes. For more information about the residential placement process see Appendix F.

6 Excludes delinquent and dependent placements that are also psychiatric residential placements, as those are discussed separately. 7 Excludes delinquent and dependent placements that are also psychiatric residential placements, as those are discussed separately. 8 Annie E. Casey Foundation Juvenile Detention Alternatives Initiative. 2013. A Guide to Juvenile Detention Reform: Making Detention Reform Work for Girls 9 May presentation to task force 10 U.S. Census Bureau, 2013-2017 American Community Survey 5-Year Estimates Philadelphia County Children’s Characters

PLACEHOLDER FOR GRAPHIC MAP OF THE PLACEMENT PROCESS


The Challenges Residential placement is intended to provide youth with the supervision, care, treatment, and, in some cases, the education they need to successfully transition back to their homes and communities as soon as possible. Beyond providing a safe place to live, a stay should cultivate healing such that youth leave a placement better off than when they entered. In residential placement, the challenges are to meet the needs of children without exposing them to greater trauma, undermining attachments to family, and disrupting their education. Too often, placements fail to meet those challenges. Safety: At the most basic level, residential placement providers are responsible for providing youth with a safe environment that supports health and well-being. Unfortunately, numerous studies have documented that maltreatment and abuse are too common, especially in large, institutional youth placements.11,12 Various national and Pennsylvania reports have documented abuse in residential placements, including violent assaults, sexual victimization, verbal humiliation, and maltreatment by both staff and other youth.13

One specific area of safety-related concern is the use of restraints. Pennsylvania Department of Human Services’ 3800 regulations ban the use of mechanical and chemical restraint and use of pressure points for manual (physical) restraints. While Pennsylvania has had efforts to reduce such activity underway for many years, inappropriate use of restraints still occur too often. Youth have reported that staff in residential facilities have used restraints inappropriately for convenience, as a substitution for treatment, or in a dangerous manner.

Separation from Family & Community: Placing youth in residential settings outside their home communities disrupts their connections to family, peers, schools and supportive adults in their lives. At a time when youth are forming their own identities, these relationships and community connections are especially important.14 While in placement, youths’ home visits may be highly regulated, and individuals may have difficulty seeing their loved ones on a regular basis. These weakened ties sometimes leave youth without strong support networks when they return home.

11 Juveniles for Justice and Juvenile Law Center (2018). “Broken Bridges: How Juvenile Placements Cut Off Youth from Communities and Successful Futures.” https://jlc.org/sites/default/files/attachments/2018-12/2018BrokenBridges-FINAL-WEB.pdf 12 Children’s Rights and Education Law Center (2018). “Unsafe and Uneducated: Indifference to Dangers in Pennsylvania’s Residential Child Welfare Facilities.” https://www.childrensrights.org/wp-content/uploads/2018/12/2018_Pennsylvania-Residential-Facilities_Childrens-Rights_Education-Law-Center.pdf 13https://www.childrensrights.org/wp-content/uploads/2018/12/2018_Pennsylvania-Residential-Facilities_Childrens-Rights_Education-Law-Center.pdf 14https://www.researchgate.net/publication/41192568_Reentry_of_Young_Offenders_from_the_Justice_System_A_Developmental_Perspective.

“In my group home, I got jumped and my head got stomped into the ground; I was unconscious and sent to the hospital, but my mom wasn’t contacted until hours later when she happened to call the facility to check on me and that’s when they told her. She wasn’t informed right away. [...] My mom never would’ve known what happened to her child if she hadn’t called.” Youth Advocate


Education15: Residential placement impacts educational achievement for youth who may already face multiple barriers to academic success. National research suggests such barriers can include multiple educational moves, enrollment delays or obstacles, over- or under prescribed special education services, challenges with credit attainment, and transfer of academic credits needed to graduate, and challenges connecting to an educational option upon return from placement.1617 Youth in residential placements have a legal right to attend the local public school unless a court order specifies that a particular youth must attend the school operated onsite at the residential placement (referred to as an “on grounds school”). Despite the legal entitlement to an education in the community whenever possible, youth often are educated in an on-grounds school. National research and Philadelphia stakeholders echo similar concerns: course offerings at on-grounds schools are frequently limited and assign work that is not appropriate to the child’s grade-level, or rely on cyber programs exclusively; teacher qualifications vary; mandated special education supports and services are not delivered for youth who require them; data tracking and accountability are weak; and accumulating transferable credits to apply towards graduation is difficult. As a result, youth may lose months’ or even years’ worth of progress and skill building towards high school graduation.18

15 More information about the on-grounds survey: In late February 2019, DHS collected exploratory data about 900 dependent and delinquent youth who were in residential placement facilities to better understand the educational services provided by residential placement facilities and inform future research. To collect this information, DHS surveyed providers that had both on-ground schools and more than 10 Philadelphia youth at the facility at that time. Because of lack of administrative data collected on on-ground schools, comprehensive data surrounding type, quality, and volume of educational services offered for the entire residential placement population is not available. The above data only represents the facilities and youth surveyed at that point in time. 16 Just Learning: The Imperative to Transform Juvenile Justice Systems Into Effective Educational Systems, 2014: p. 4 17 Just Learning: The Imperative to Transform Juvenile Justice Systems Into Effective Educational Systems, 2014: p. 4 18 Measuring Educational Opportunity in Juvenile Justice Schools, 2018. 'We should have done more to protect you.' Kids in placement describe abuse, isolation and lack of education, Philly.com, May 14, 2018

In February 2019, DHS surveyed providers that had both on-ground schools and more than 10 Philadelphia youth at the facility at

the time.

Of the 533 youth who were placed at a facility with both an on-grounds school, and with at least 10 Philadelphia youth present,

448 (84%) were receiving on-grounds educational services.

See footnote


Progress and Commitment to Date Residential placements are intended to be short-term, intensive interventions for youth with needs that cannot be met appropriately in less restrictive levels of care. Right-sizing the system includes efforts to provide the “right service at the right dosage and at the right time [...] — and for the shortest amount of time necessary — to achieve key therapeutic and permanency planning outcomes."19 Philadelphia’s public systems have been deploying a variety of strategies so that youth can receive the supports they need while remaining in their own homes and communities whenever possible (see Appendix G for a summary of existing support services). Significant, targeted efforts to reduce child welfare residential placements have been ongoing at the Philadelphia Department of Human Services (DHS) since 2012. They include:

● Instituting commissioner-level sign-off on any child welfare residential placement.

● Increasing the use of kinship placements significantly: o In 2019, 48% of all dependent placements were with

kin, up from 39% four years earlier. ● Targeting recruitment efforts for resource parents willing to

care for and welcome teens into their homes to expand available community placements.

● Refining prevention services, such as establishing a partnership with the School District of Philadelphia (SDP) to better support school stability and prevent truancy.

● Closure of poor performing providers. ● More intensive monitoring and supports with training and

technical assistance. Work has been underway in enhancing juvenile justice services and supports designed to reduce the use of placement, including:

● The Police-School Diversion program to reduce juvenile arrest rates, improve school retention, and prevent the collateral consequences of justice system involvement. This unique police-led program targets students who commit first-time, low-level delinquent acts on or about school premises. Qualified students are diverted from arrest and instead provided with Intensive Prevention Services through DHS. In the fall of 2019 School District of Philadelphia and the Philadelphia Police Department signed a new Memorandum of Understanding committing to a policy that that children under age 12 will not be arrested (with an exception for very serious crimes), and instead will be placed in diversion services through the Department of Human Services in partnership with SDP.

19 Casey Family Definition https://www.casey.org/media/Group-Care-complete.pdf

TIMELINE:

• 2012 Commissioner's Approval Process for all Dependent Residential Placements

• 2012 Juvenile Detention Alternatives Initiative with Family Court begins

• 2014 Police School Diversion Program begins

• 2016 Closure of Wordsworth Academy

• 2016 CBH Systemwide Training

• 2016 Enhanced CBH and DHS joint monitoring strategy

• 2017 CBH Request for Proposals for small Philadelphia PRTF

• 2018 New DHS Congregate Care Monitoring Tool

• 2019 Closure of Glen Mills • 2019 New CBH Psychiatric

Residential Treatment Provider Contract Standards


● The statewide Juvenile Justice System Enhancement Strategy (JJSES) which includes: o Using the Pennsylvania Detention Risk Assessment designed to provide structured

decision making in regard to detaining a youth at intake. o Determining needs of a youth and matching services to his/her risk factors using Youth

Level of Service Case Management Inventory (YLS-CMI) assessments. o Collaborating with youth and families and their legal advocates to create an

individualized case plan with short and long-term goals. o Implementing a Graduated Response System comprised of incentives and interventions

to foster pro-social behavior. ● New juvenile justice reform policies from the District Attorney’s Office with the goal of keeping

youth with low-level delinquent acts out of the Court system. Reducing the number of youth in Psychiatric Residential Treatment Facilities has been a key initiative of the behavioral health system for over a decade, with redoubled efforts since 2016, including:

● Enhanced monitoring, including increased onsite CBH presence, increased clinical oversight of youth in PRTF and increased restraint monitoring, as well as network wide training.

● Consultation with the Building Bridges Initiative in spring 2017, which includes network- wide training in Six Core Strategies (SCS).

● Release of a Request for Proposal (RFP) for Small PRTF in Philadelphia in October 2017. ● Expansion and strengthening of continuum of community-based services including performance

standards for Applied Behavior Analysis, expansion of family-based services, expansion of Hi-fidelity Wraparound for families with multi-system involvement, and the development of a new, resolution-focused Children’s Crisis Continuum.

● New performance standards for PRTF contracts, effective 2019.

System Trends Over Past 5 Years Over the past four and a half years, the total number of youth in residential placement has declined by 55% (See Figure 1). Figure 1. Total Youth in Residential Placement as of Dec. 3120

20 CBH Medicaid behavioral health claims allow for a 90-day lag for providers to submit claims for services delivered to Medicaid-eligible members. These data reflect the most complete claims processed for Medicaid-funded RTF services received through April 30, 2019

1924 18261566

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The delinquent population saw the largest drop over the past four and a half years, with a 72% decrease. Over this same time period, the RTF population dropped 58% and the dependent population dropped 29% (See Figure 2). Figure 2. Total Youth in Residential Placement as of Dec. 31, by Service Category21

In addition to working to reduce youth going into placement, City systems have moved over the past several years to increase the quality of residential services. Department of Behavioral Health and Intellectual DisAbilities (DBHIDS)/Community Behavioral Health (CBH) and DHS have worked together to conduct joint unannounced monitoring visits at providers when mutual service concerns are present. They have worked in close collaboration, including with the courts, to make decisions about intake closure of providers who were not able to provide safe, high quality care to youth. In the last year, DHS developed a new evaluation tool for all residential placement providers that assesses both compliance and quality, provides actionable feedback, reflects provider practice, and incorporates youth voice.

Geographically close placements with appropriate monitoring and programming can maintain normalcy for youth through critical emotional, social, and educational connections. Meaningful family involvement—a core piece of the vision for residential placement—is best facilitated with regular interactions, treatment involvement, and communication without the hindrance of transportation barriers to distant placements. Additionally, closer placements prevent educational disruption and allow for City agencies to provide stronger oversight and monitoring to ensure safety and adherence to contractual expectations. The latest data on youth and facility distance from Philadelphia reveals the number of distant placements is moving in the right direction. As of June 30, 2019, two thirds (66%) of youth in residential placement (excluding youth in state-run facilities) were in facilities located in Philadelphia or within 10 miles of Philadelphia’s city limits. Many youth however, are not placed close to home. About one in four (24%) youth are at least 25 miles from Philadelphia’s city limits. Placements in distant states however are rare, and all juvenile justice-placed youth were placed in facilities in Pennsylvania or New Jersey.

21 Service categories are mutually exclusive with RTF taking precedence for DHS-involved youth.

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Distance between Youth, and City Limits22

Distance # of Dependent Youth # Delinquent Youth # Residential

Treatment Youth

In Philadelphia 147 6 5

Within 5 Miles 183 2 82

5 – 10 Miles 50 81 19

10 – 25 Miles 37 0 45

25 – 50 Miles 62 0 43

50 + Miles 33 57 14

Total Youth 512 146 208 While it would be optimal to locate all residential placements within the city of Philadelphia boundaries, such efforts often face zoning challenges and neighborhood resistance, which are barriers to address for future work. New York City has had success with its “Close to Home” reform for the juvenile delinquent population. Representatives from the New York City Administration of Children’s Services presented to the Task Force on their model and implementation (further findings can be found in Appendix E.) Although it is difficult to introduce placements in residential communities, New York City found existing buildings and city resources could be repurposed to provide “close to home” services with few zoning challenges. When New York City encountered neighborhood resistance, officials found that working closely with neighbors could result in partnerships. It took several years, but new placement sites were opened successfully in New York City.

22 Dependent and Delinquent numbers are from 6/30/19 and Residential Treatment numbers are for 12/31/18 due to claims processing. Delinquent numbers do not include state-run institutions. Residential placement facilities for this report are defined as agency sites. Therefore, if an agency has a campus with separately designated buildings/cottages with their own street address then each site is counted uniquely.


Our Findings Use of Residential Placements:

1. The rate at which African-American youth are placed is highly disproportionate to their share of the overall city population. [See pages xx23]

2. School-related issues, including truancy, are a substantial driver of dependent and delinquent residential placements. [See pages xx]

3. More family-based placement options for older dependent youth are needed. [See pages xx]

4. Many young people in placement are placed outside of the city. [See pages xx] 5. The vast majority of delinquent youth in residential placements are there after a

dispositional review (vs. for the original offense), and many others are there for misdemeanors and other nonviolent offenses. [See pages xx] [Additional sources: JCJC]

Safety, Quality, and Education Within Residential Placements: 6. Philadelphia children have been harmed in residential placements through

inappropriate use of physical restraints. [See pages xx] [Additional sources: Broken Bridges; Unsafe and Uneducated]

7. The default educational environment for most youth in residential placement is the on-grounds school, where there is no state monitoring. [See pages xx] [Additional sources: Broken Bridges; Unsafe and Uneducated]

8. Residential providers struggle to hire and retain high-quality and diverse staff. [See pages xx]

9. It is difficult for youth in placement to maintain strong support networks with family and community. [See pages xx] [Additional sources: Broken Bridges]

System Oversight and Transparency: 10. State monitoring by the Department of Human Services (DHS) and the Department of

Education (PDE) are inadequate to ensure the safety and educational well-being of Philadelphia youth in residential placements. [See pages xx] [Additional sources: Unsafe and Uneducated]

11. Key stakeholders – including entities making placement decisions – lack vital information about the quality of individual providers or the needs of individual youth. [See pages xx]

12. Youth in placement feel they do not have a clear pathway for raising concerns and reporting issues in placement. [See pages xx] [Additional sources: Broken Bridges]

23 Page numbers to be updated when draft is finalized


Call to Action for State Entities While the Task Force has focused on the areas where local leaders and stakeholders have the power to make change, the responsibility for the wellbeing of youth in residential placement is shared with the Commonwealth (see Appendix H). The Task Force makes the following recommendations:

1) Across all state entities, the state must commit to investing the savings from reducing the use of residential placement into programming that supports youth in their communities and provides alternatives to residential placement.

2) The Pennsylvania Department of Human Services (PA DHS) must update its system standards, increase its capacity for monitoring, and make data about system safety more transparent, including data regarding the use of restraints in educational and non-educational settings.

We are encouraged by Governor Wolf’s Executive Order on Vulnerable Populations and that PA DHS has begun the process of revising the regulations. PA DHS regulations and guidance, PA Code 3800, for residential facilities have not been updated for many years nor require state-operated placements to comply. PA DHS needs to update its regulations, manuals, and guidance to reflect recent research on adolescent brain development and the impact of childhood trauma, current therapeutic approaches and child safety, including ensuring the safety and wellbeing of children who attend on-grounds schools. The standards should apply not only to licensed facilities but also to state operated facilities. The standard should be not just keeping kids safe but promoting healing from trauma and receiving effective treatment.

PA DHS must also increase resources for regular monitoring of licensed providers. The department can create safer, higher quality facilities by making system and provider data more transparent to system partners at the county level and to the public. It should make data about incidents, citations, and provider quality available in real time to all system partners in a modernized, online user-friendly format. The bulletin issued in August 2019 is a good first step. Additionally, the state should share data that reflects trends over time for providers. And it should review and adjust the appellate process for child abuse reports in a way that affirms the rights of children to be free from physical force in residential placements. 3) The Pennsylvania Department of Education, together with PA DHS, must monitor, evaluate and collect data on the education youth receive while in residential placements. Such monitoring should include ensuring that youth have access to public school and that on-grounds schools provide youth with a quality education that supports them to stay on track to graduate.

PDE and PA DHS have issued joint guidance regarding the rights of children in placement to education in local schools, but there is currently no compliance mechanism. PDE should require local school districts to report on the number of children in their district in a residential placement, the number of youth in placement accessing local public school resources (as compared to an on-grounds school), and the use of alternative education for youth in placement. This information should be made public.


PDE currently conducts no on-site monitoring of on-grounds schools except for site visits for Special Education Monitoring once every six years. The process to raise concerns or complaints about is not clear. PDE should devote additional targeted resources to monitoring on-grounds schools, including curriculum alignment with state standards in order to maximize credit transferability, teacher quality, instruction modalities, provision of special education services and programs, accomodations for students with qualifying disabilities, and language instruction programs provided to English learners. The Department should make the results of this monitoring transparent by publishing publicly available “educational performance” reports. Additionally, PDE should make the processes for filing complaints accessible so that parents and the public understand whom to contact with concerns about the quality of education at the on-grounds school. It should also make more information about all on-grounds schools available on the PDE website.

4) The Pennsylvania Supreme Court and the Administrative Office of the Pennsylvania Courts (AOPC) should continue to lead collaborative efforts, including training for judges, and support an environment which includes all stakeholders.

The AOPC coordinates a statewide task force dedicated to reducing the use of residential placement. The Supreme Court of Pennsylvania and the AOPC should continue to provide leadership and support, including training, to local courts to foster a collaborative environment in which all system partners work together for the betterment of Philadelphia’s youth.


Recommendations

System Level Improvements 1. The City and all partners, including Family Court, will develop a comprehensive cross-system strategy with agency-specific plans to further reduce the number of children in residential placement, while simultaneously increasing the number of community-based alternatives. City and court leadership, advocates, and families agree on the goal of safely reducing the use of large, far-away institutions in favor of family- and community-based alternatives to meet the needs of Philadelphia’s youth. A comprehensive cross-systems strategy built from agency-specific plans will be created by April 2020 to outline steps needed to achieve, over the next three years, additional appropriate reduction in residential placement and the simultaneous creation of community-based alternatives to support children and youth in their communities.

● City agencies and other system stakeholders, including Family Court, will develop specific strategies designed to further reduce the number of children in residential placement. The work will build upon the cross-systems workgroups in place; creating agency specific plans will allow for successful implementation of goals related to each department’s mandate and the larger systemic goals.

● The plans will detail numeric goals and practice principles designed to achieve these reductions. The Task Force recognizes the independence of the judiciary, which is not bound by numeric goals, but rather the specific needs of each youth.

● The plan will be data-driven to inform what community supports and diversion programming are needed.

● The Managing Director’s Office will work with partners to make the reports publicly available, with regular progress reports; there will be opportunities for review and input, with specific opportunities for feedback from youth and families.

● The plans will include details on how the agencies can continue cross-systems collaborations and agency programs to achieve the outlined goals and resource the effective strategies currently in place.

● The planning process will identify new resources that are needed and report to City and City Council leadership on the new resources required for implementation of the recommendations in this report.

“If that money [from placement was put] in our communities, we can do a lot more good with it.” Youth Advocate


2. The City will issue a public Annual Progress Report of the system with provider profiles including state citation and safety data to increase transparency regarding the quality of services offered by providers under contract with City agencies. At present, stakeholders, including parents, youth, the Court, Probation, DHS and DBHIDS/CBH, advocates, attorneys and clinical staff do not have detailed information about residential placement providers’ quality, educational services, or outcomes. The State should share information with stakeholders regarding critical incidents, safety and license violations. Additionally, an annual report published by City agencies will allow all parties to make better data-informed placement decisions based upon knowledge of the conditions and outcomes at provider facilities. Provider-specific data and data on progress to reduce the use of residential placement will help drive accountability for system improvements.

● City agencies will publish provider-specific data obtained through monitoring. o Specific data points will include measures to assess safety, therapeutic

outcomes, education outcomes, and compliance. (see Appendix I for these data elements).

o Metrics will build from DHS’ new residential placement monitoring tool. ● In order to keep youth safe, the state must adjust its communication protocols to

ensure real time sharing of the following: o Serious incidents o Licensing violations o Pending and confirmed child abuse reports o Licensing status o Annual progress of providers

3. The City will engage experts to work with local leaders and youth to develop and make public a set of specific strategies to eliminate racial, gender, and LGBTQ-GNC over-representation in placements. Available data show that there is overrepresentation of African-Americans in residential placement; 72-76% of youth in residential placements are African-American (compared to 49% of the city’s under 18 population).24 Separately, there are concerns that girls in the juvenile justice system face special challenges that the system is not currently addressing properly. There are no local data on sexual orientation, but national data indicate that LGBTQ-GNC individuals also are overrepresented in residential placement. Engaging national experts to work with leaders from across the local systems will help Philadelphia isolate areas for change, by doing a detailed analysis of disparities at each decision point and implementing short term initiatives such as implicit bias training. The experts will work closely with individuals with lived experience to help Philadelphia identify and implement specific short- and longer-term strategies to reduce the numbers of African-American males and LGBTQ-GNC individuals in residential placement.

● The City will engage national experts to work with local systems leaders and youth and families with lived experience to identify and oversee the development and implementation of strategies to reduce disparities.

24 76% of delinquent non-RTF, 74% dependent non-RTF and 72% RTF.


● The work will use best practices to collect local LGBTQ-GNC data so that disparity analysis can be completed.

● Based on the expert recommendations, the City will design and implement strategies to address disparities in race, gender, and LGBTQ-GNC status and to support programming that meets each group’s needs.

● As strategies are implemented, the impacts of work will be reported in the annual report (see Recommendation #2).

4. The City will leverage and expand the use of integrated data to increase coordination and communication among all services a child is receiving, including education. When a child enters the child welfare, juvenile justice, or behavioral health system, many individuals become involved, including DHS and Community Umbrella Agency (CUA) workers, DBHIDS/CBH care managers, contracted behavioral health providers, teachers and school district officials, legal advocates, police officers, probation officers, and judges. Often, those helping a youth or family do not have complete information about the youth’s history needed to support the best decision-making, or a way to coordinate all team members. Similarly, when systems leaders are planning policies and resource allocation, they may be doing so based on data from their own agency, without the means to know how their population intersects with other system partners. The City’s CARES Integrated Data System has the potential to provide a platform for cross-systems data analysis. Currently, the CARES system integrates City Health and Human Service data regularly and Police data as needed but does not include court or education data.

● The City will work with the courts and the School District to integrate juvenile justice (e.g., risk scores, charge data, etc.) and education data (e.g., school enrollment, credit transfer, graduation data, suspensions and expulsions) with City data to allow for cross-systems planning to support reducing residential placement and increasing local alternatives (Recommendation #1).

● The integrated data will be used to determine the need for additional preventive, diversion, placement, and post-placement services; identify where those services will be located; and support requests for additional resources that may be needed.

● System partners will explore options to create integrated data solutions to support child specific care coordination for youth at risk of residential placement as well as those already in placement.

● All data sharing will be done in ways that protects the rights and safety of youth and are consistent with federal and state law including the Juvenile Act and Rules of Juvenile Court Procedure, the Family Educational Rights and Privacy Act (FERPA), the Health Insurance Portability and Accountability Act (HIPPA) and the Mental Health Procedures Act.


Reduce the Use 5. Juvenile justice system partners including Family Court, the District Attorney’s Office, Defender Association, Police, Juvenile Probation, advocates and DHS will prioritize the use and expansion of prevention and diversion services for youth in the juvenile justice system. Philadelphia juvenile justice system partners are committed to greatly expanding the availability of prevention and diversion programming and making sure that pathways to those alternatives are clear for all. To achieve the next level of reforms and ensure that all youth at risk of involvement in the juvenile justice system are properly matched with appropriate preventive and rehabilitative interventions, system partners will work toward approaches that are strength-based, incorporate restorative justice principles and collaborative decision-making.

● The City will bring all stakeholders (e.g., youth, families, communities, probation, prosecutors, public defenders, community supports, victims, educators, judges) to a common table to further examine the decision-making process from pre-arrest to placement to identify and implement additional system and decision-making improvements.

● System partners will identify policy and practice changes that would prioritize diversion for all youth under 12 and for all misdemeanors.

● System partners will increase diversion efforts, such use of Intensive Prevention Supports and Evening Reporting Centers to minimize the need for detention and placement.

● The courts and Juvenile Probation will work to increase the consistent use of validated assessment tools to inform juvenile delinquent dispositions and well-informed decision-making, while prioritizing necessary community-based services.

● Court and other system representatives will acknowledge, and take into consideration, the perspective of youth and families at every court hearing and incorporate youth/family asset-based models when determining diversion or placement options.

● The City will invest in additional diversion options which keep youth in community settings both before and after Court involvement.

6. Juvenile justice system partners, including the Police, District Attorney’s Office, Defender Association, Family Court, and Juvenile Probation, will monitor the number of youth sent to residential placement for nonviolent offenses or technical probation violations beginning in 2020—with the goal of minimizing the practice. In Philadelphia, the most common reason a juvenile justice-involved youth enters residential placement is because of a disposition review (as opposed to a new allegation) and often the issue prompting placement is violation of probation conditions. The youth has been previously arrested, found guilty of a delinquent act, and subsequently adjudicated delinquent and placed on probation. Probation may include requirements related to school attendance, specified curfew, and drug testing. If repeated violations occur, the youth may be court-ordered to a residential placement. Philadelphia will commit

Youth from Young Adults Leadership Committee (YALC) shared that they were hurt by the lack of dedicated time to speak in proceedings and felt only able to speak when initiated by the Judge. The Juveniles for Justice youth advocacy recommended that there is guaranteed time for youth to speak at each hearing.



Youth from Young Adults Leadership Committee (YALC) shared that they were hurt by the lack of dedicated time to speak in proceedings and felt only able to speak when initiated by the Judge. The Juveniles for Justice youth advocacy group recommended that there is guaranteed time for youth to speak at each hearing.


to begin collecting data and making it public in 2020, with the goal over the next three years of minimizing the number of youth entering placement due to nonviolent offenses or technical probation violations (defined as violations where the noncompliance by an offender under supervision is not by itself a criminal offense and generally does not result in a conviction).

● System partners will explore options for matching youth, based on individual-specific needs and strengths, with programs to which they might be referred, either voluntarily or involuntarily. Partners will explore the creation of a resource unit within Juvenile Probation or DHS, to occur in conjunction with youth, family, Judge, and advocate input. Partners will work together to continue to move beyond supervising and surveilling youth toward a culture of supporting and connecting youth to community resources and supports.

● System partners will examine and improve policies related to the overuse of GPS monitoring and drug testing to ensure they do not inappropriately result in placement decisions.

● Courts, Probation, District Attorney’s Office, and advocates will ensure that no youth has more than three conditions of probation and that school attendance is not inappropriately used as a requirement of probation that can result in placement.

● System partners will explore whether the law and available resources will allow Philadelphia to end probation supervision for youth if the remaining conditions are only payment of fines and costs and will examine options to reduce the number of youth who remain on probation because of failure to make payments.

7. DHS will continue to develop additional child welfare prevention programming and local community- and family-based alternatives, partnering with DBHIDS/CBH to support youth with behavioral health needs who are dependent or delinquent. One of the key priorities of child welfare work nationally and in Philadelphia is to increase the use of community-based and family-based options for dependent placement. Most child-welfare involved young children can be served in these settings and never need a residential placement. The picture is a bit different for teens. More than 90 percent of youth in residential placement in the child-welfare system are over 13 years old, partially because fewer resource parents are accepting of older youth and feel able to address adolescents’ behavioral needs. Continuing to increase funds for family homes for teens and supporting those caregivers with skills and resources to address challenging behaviors can bolster the success of local alternatives to placement.

● DHS will increase recruitment and retention supports for quality kinship and foster care families and build cultural competence and caregiver skills to support older youth with complex needs.

● Consistent with the multi-year plan described in Recommendation 1, DHS and DBHIDS/CBH will expand home/family-based behavioral health interventions designed to prevent the need for residential placement, including exploring the New Jersey model of targeted support at time of the first out-of-home placement (see appendix E).


8. The School District of Philadelphia (SDP) will work to prevent the need for placement among public school students by providing preventive supports at school for all youth and ensuring the needs of youth at risk of entering the juvenile justice, child welfare, or behavioral health system are addressed in school-based comprehensive planning and budgeting. For many youth, school problems result in contact with the juvenile justice system and, ultimately, residential placement. With the right supports available at school, youth who are struggling academically, socially, or emotionally can receive the assistance they need to stabilize, stay enrolled, and succeed. In recent years, the School District and its partners—DHS, DBHIDS/CBH, and the Court--have expanded preventive supports available in schools by adding counselors at every school. They are implementing the STEP (Support Team for Education Partnership) Program, making changes to truancy processes, and making new resources available at Comprehensive Support & Improvement (CSI) schools. The district will continue to work toward ensuring that all schools have preventive, evidence-based and data-driven interventions.

● SDP will continue, as part of its annual planning and budgeting cycle, to review the need for preventive supports to improve school climate and address the social and emotional needs of at-risk youth, especially those already involved in child welfare, juvenile justice, and/or behavioral health systems.

● SDP will continue to work to prevent the need for placement among SDP students by ensuring suspensions and expulsions follow regulatory requirements.

● SDP has developed a Trauma Plan that assesses schools’ needs and determines which trauma training will be implemented and commits to implementing the plan and providing resources to do so.

● SDP will ensure that resources to address truancy are targeted in ways that can be most effective in reducing the need for placement.

9. System partners will work together to ensure that youth requiring special education services are properly identified, that they receive the services identified in their Individualized Education Program (IEP) or 504 plans and that their IEP and 504 plans are made available to system decisionmakers. Youth who are interacting with the court system, as part of juvenile justice or child welfare involvement, have or may have a disability and need special education services or accommodations to address it. Information about these needs is not always apparent to judges when they are determining whether a child should be placed in residential placement. Systems partners will work together to ensure that all youth who have such needs are assessed and appropriately identified, are evaluated and re-evaluated for Individualized Education Program and/or 504 Plans as needed, receive services and that this information is available to decision makers—particularly judges and probation officers.

● Systems leaders will work together to ensure processes that allow for all children with such needs to be promptly and appropriately identified, receiving services in the least restrictive environment.


● In addition, system partners will collaborate to develop processes to ensure that judges and other decision makers receive information in a way designed to make information about a child’s disability or special education status readily available and can probe whether any identified behavior of the youth is resulting from his/her disability or health condition (e.g., behavioral or mental health).

● Data to be shared include Individualized Education Program (IEP) and 504 disability data with the purpose of improving shared decision-making.

● The goal is to make special education and disability information available in the pre-adjudication period, as well as during a youth’s time in placement.

Improve the Quality

10. To keep youth close to home, the City will develop new small, delinquent, dependent, and behavioral health treatment residential programs within Philadelphia to keep youth close to home. Placements should serve no more than 10-12 children. Research has shown that the best residential programs are small in size and accessible to the communities they serve, and help youth maintain family relationships and achieve successful community reintegration. The City is committed to providing residential care within or as close to Philadelphia as possible, but implementation is challenging. As of December 31st, 2018, only 22 of 130 dependent sites, two of 36 delinquent sites, and one of 48 Behavioral Health sites were within Philadelphia County.25 While Philadelphia’s system leaders have taken steps to support the development of best-practice programs, providers seeking to open new, smaller, community-based programs have faced community and political barriers. Successful national efforts demonstrate that the goal of bringing placement sites close to youths’ communities and decreasing the number of youth at each site can be accomplished with collective will, effective practices, and quality programming.

● Consistent with the multi-year plan described in Recommendation #1, DHS and DBHIDS/CBH will work with providers to develop new programs while also aligning current and future programs with federal Family First Prevention Services Act requirements (see Appendix I for more on this legislation).

● SDP and other local educational entities will work to strengthen their capacity to serve youth placed in Philadelphia residential placements

● The City will help providers increase their understanding of City zoning and licensing processes. ● The City will facilitate the opening of new service sites by exploring flexibility in zoning and

changes to policy and practice. ● City Council, the Zoning Board of Adjustment and City leadership will work collaboratively to

prioritize the development of these programs across all districts. 25 Residential placement facilities for this report are defined as agency sites. Therefore, if an agency has a campus with separately designated buildings/cottages with their own street address then each site is counted uniquely.

“WE THINK THERE SHOULD BE MORE OPTIONS FOR YOUTH TO STAY CLOSE TO THEIR COMMUNITIES” YOUTH ADVOCATES AND AUTHORS OF BROKEN

BRIDGES:


11. Service contracts with City agencies will ensure youth and families receive clear information on rights, grievance procedures, and key contacts’ information. In conversations, families and youth with lived experience reported that they did not know how to address concerns that arose before, during, and after placement. Although information on rights, who to contact with concerns, and whom to go to for help is already required, changes are needed to ensure that such information is always easily accessible for families and youth.

City contracts will require that providers ensure that youth and families get information about their rights and responsibilities within the program, as well as names and contact information for key people involved in their care, both within and the program and across systems. All system partners must enforce the expectation of timely response to youth and families under their care.

● All youth will receive written and oral information, provided plainly and in their primary language, outlining their rights regarding physical safety, communication with family and their lawyer, food, sanitation, religious observance, restrictions against isolation, and how any behavior issues will be handled. Providers will also publish this information on their websites.

● City agencies will ensure that provider staff are trained and adopt new protocols that ensure children are supported, nurtured and appropriately informed about why they are being placed and understand the information about their rights and how they can reach out for help beyond the staff of the facility

● A newly-created position, that of the Philadelphia Youth Services Ombudsperson (described in Recommendation 15), will review and respond to grievances about information access.

“Parents don’t know their rights. I really felt

by myself.” Parent


12. The City will require all residential programs to make family involvement a central component of program delivery. Residential placement disconnects youth from their families, homes and communities. While family involvement is an expectation in all settings, what that means is not clear enough. Distant or inaccessible placements too often prevent regular visitation and involvement in therapies, and families report that sometimes contact has been denied or limited based on youth’s behavior. Research confirms that guardians should be involved throughout the entire process of placement to best support lasting youth outcomes. Frequent time with family provides the opportunity for practicing the new approaches learned in treatment. Youth must continue to be a vital part of everyday family life. Family members must be viewed as guiding stakeholders, with their feedback sought and incorporated into the youth’s services and ongoing program development. Providers will show family involvement as an active and foundational piece of their program delivery.

● DHS and DBHIDS/CBH contracts will require providers to implement programs or policies that elevate family involvement including:

o Providing coaching and training to parents to ensure that parents develop the skills needed for their child to be successful at home. Providers should maintain contact with families after discharge to support a successful transition and ongoing stability.

o Developing staff capacity to interact with families and youth in a culturally competent and supportive way that removes blame and focuses on mutual respect, parent capacity, and skill building.

● Providers will adopt practices that allow youth to have the opportunity to communicate with their families without undue conditions, including assisting youth and families with transportation to and from the placement location as clinically appropriate and providing translation services when needed. Tele- and video-conferencing

“It’s not that we don’t love our children; we don’t love the behavior and want help.” Parent “I wasn’t looking for a break from my child—fix the problem, teach me how.” --Parent “I asked the facility to teach me skills to help my son. I shouldn’t have had to even ask.” --Parent “While in placement, I lost contact with all my friends. My recommendation is that all youth should remain in contact with their family members. The contact method I recommend is phone calls and visitation at least 2 times a week. Guardians should have the right contact information and [...] also have involvement in our education, medical and behavioral or mental health decisions.” --Youth Advocate


options should be made accessible to supplement, but not replace, in-person visitation. ● Access to family interaction will not to be restricted for disciplinary reasons, nor will it be a

privilege to be earned. ● System partners will develop a set of family engagement quality standards and measures for

accountability and program monitoring for all three systems.

What do guardians think family involvement looks like?

Our strengths are worked into care and treatment plans We are kept in the communication loop regarding our child

o At least weekly, adult staff give us detailed status and progress updates o We get notified in real-time if our child runs away from placement o We can always reach staff at the placement in cases of emergency

We participate in a pre-admission orientation meeting hosted by providers to: o Have a conversation about program expectations, components, policies and outcomes o Answer our questions and share contact information for future questions

We can expect to communicate regularly with our child through in-person visits, calls and/or video communication and when something unexpected comes up

Our culture is seen as central to our identities and respected Providers recognize the impact of placement on our whole family and support us through efforts like

groups, sibling support, and peer support partners We are educated on strategies for our child to successfully transition back home through pre-discharge

meetings with all family members The time we spend during visits are spent on bonding activities with our child, not conversations on any

poor behavior

-Created by DBHIDS Family Member Committee, September 2019


13. The City and providers will expand paid peer advisor/credible messenger positions for youth and adults with lived experience to help families and youth understand options, self-advocate, and navigate the system. In the behavioral health system, the use of peers is essential to success for youth and families. “Peers” are those with lived experience who have personally faced similar challenges, either directly or as a family member. Peers provide advice, information, support, guidance, and comfort to youth in residential placements and to their families. They help youth and families make informed decisions; assist in obtaining services; serve as advocates, mentors, facilitators for resolution of issues; aid in community reintegration; and help improve functioning and coping skills. In child welfare, these peers can assist with the trauma of out-of-home placement and pathways to independence. In the juvenile justice system, such individuals, often referred to as “credible messengers” connect with youth who are at risk of juvenile justice involvement or have chronic juvenile justice involvement. The addition of peers/credible messengers at provider programs and across the wider system strengthens authentic partnerships across all levels of service.

● The City will increase the use of peer advisors/credible messengers throughout the system. ● All residential providers will be required to have on-staff paid peer advisors/credible messengers

for both youth and their families as part of a cultural shift towards family and youth-driven services.

o Peer advisors/credible messengers will: ▪ engage with youth and families prior to admission, ▪ coach family members on how to advocate for their children ▪ be included in the hiring of residential staff, and ▪ be a valuable member of the youth’s treatment team

“I would have wanted someone to advocate [for me] in court and explain the long-term impact on my life.” Youth Advocate from Youth First Initiative


Improve the Safety

14. The City will require contracted providers to improve the quality of frontline residential program staff through wages, benefits, and training improvements. Staff quality is critical to creating a culture of emotional, physical and behavioral safety. Front line staff at residential facilities spend the most time with youth and have challenging and high stakes jobs, for which they often receive low pay and insufficient training. Improper restraint usage and cases of abuse towards youth may occur as the result of poorly trained or supported employees. Wage increases, competitive benefits, supervision, coaching, and training can help increase staff competency and quality, attracting and retaining compassionate staff. As much as possible, staff should reflect the demographics of youth in their care—so that youth may feel better supported and understood.

● DBHIDS/CBH and DHS will work with providers so that by July 2024 all residential providers, contingent on available resources, raise the minimum wage for direct service employees to $18/per hour and offer competitive benefits.

● Contracted providers will employ strategic hiring practices to:

o Implement a plan to hire diverse staff at all levels of the agency who reflect the population served;

o Involve youth and families in setting up criteria for staff qualifications;

o Identify candidates who support the shared mission to provide compassionate, nonrestrictive care and provide prospective candidates the opportunity to spend time on the units before hiring, to provide exposure to the realities and requirements of the work;

● Providers will deliver consistent supervision to all staff, including real time, on-the-job coaching and feedback.

● Providers will create a robust training plan that includes training and ongoing coaching (see Appendix K for a list of training topics).

● Providers will meet specified benchmarks related to vacancies, turnover, and staff diversity. ● To prevent incidents, providers will adopt such practices as requiring a licensed therapist on

staff 24/7 and/or allowing a direct-care staff member to “tap out” by swapping places with a less emotionally elevated coworker, thereby to supporting conflict de-escalation.

“None of these service and support suggestions are possible until: a) Caring and dedicated people are hired in the beginning b) Adequate compensation for those Direct Support Staff who are caring for our loved ones occurs and stop paying these people pennies but expect them to do dollars’ worth of care.” -Parent Youth consistently spoke of their desires for staff to genuinely listen to them, want to help them, not intimidate them, and put themselves in the youths’ shoes. -Conversations with Youth Advocates


15. The City will establish an independent Youth Services Ombudsperson position to receive and investigate concerns from youth and families about safety or services. Currently, no single point of contact exists for concerns about services in youth residential placement. In conversations with multiple advocate groups, youth said they felt there was no safe way to report mistreatment while in placement. DHS has the Commissioner’s Action Response Office (CARO), which is responsible for addressing complaints about DHS, CUAs, or other providers. Additionally, CARO responds to family concerns about DHS services. DBHIDS/CBH, too, has processes to receive and investigate complaints and concerns in accordance with state standards and requirements. Establishing one independent point of contact would clarify where youth and families should report their concerns and would improve the City’s ability to receive, investigate, and act on information quickly.

● The City will identify national models for this role, including operating authority, funding, and staffing.

● The City, working with youth and families, will design a response process that is safe, user-friendly, accessible, anonymous, fast and secure.

● DHS and DBHIDS/CBH will establish provider contract requirements and oversight to ensure youth can speak openly away from facility staff or other youth, and that families receive information on how to contact the office.

16. The City will require that providers adopt evidence-based models to reduce or eliminate manual restraints and to install video cameras. The use of manual restraints in residential placements is one of the most restrictive crisis management and de-escalation methods used by staff when a youth is in imminent danger of hurting him/herself or others. Though facilities use manual restraints as a last resort, the practice is common enough that stronger training and post restraint debriefing practices are warranted to ensure that youth are not harmed. The use of manual restraints is traumatic for the youth being restrained, other youth in that facility, and staff. It can diminish an individual’s sense of control and sometimes result in physical harm. Even when physical restraints are administered correctly, significant injuries and even deaths occur in residential treatment placements across the U.S. As an alternative, Community Behavioral Health is supporting its network of Psychiatric Residential Treatment Facilities to use an evidence-based and trauma-informed model, The Six Core Strategies to Reduce the Use of Seclusion and Restraint developed by the National Association of State Mental Health Program Directors. In addition, installing video cameras (to be used consistent with federal and state law) throughout placements would enable better monitoring of all individuals and would capture any restraint use or injuries, which can be used for oversight and later training.

“We need the person to listen and give the same energy to everyone, treating all the youth the same without favoritism. There needs to be someone on your team who takes the report and know that the report won’t fall on deaf ears, confident that in the next 24 hours, someone follows up.” Youth Advocates, Authors of Broken Bridges


Residential providers will: o Update program policies to reflect

advanced restraint elimination practices so that restraint use is reduced by 25% by 2021;

o Adhere to benchmarks for reducing or eliminating restraints and report data against those benchmarks, with contract consequences for not achieving the restraint goals;

o Contingent upon available resources, install cameras in all common areas with multiple views to monitor and document interactions between staff, youth, and visitors;

o Preserve videos for at least one year and provide them promptly upon request to DBHIDS/CBH and DHS as part of incident reporting and oversight monitoring.

● Providers will implement quality monitoring and improvement to include: o Appropriately training staff who review videos of restraints; o Ensuring required staff ratios and youth supervision protocols are followed; and o Ensuring that the daily program schedule is adhered to.

Education Quality

17. School District of Philadelphia and City leaders will ensure youth have school stability when appropriate and immediate enrollment within the School District of Philadelphia or in the host district for out-of-county placements, as well as access to the full range of educational opportunities available to other students in public schools. Federal law and state guidance affirm youth’s right to remain in their school of origin, or in a public education setting where the residential placement is located. Too often, however, the default assumption or court order directs that youth attend an on-grounds school. A “Best Interest Determination” (BID) conference, required when a child enters or changes placement, is a vehicle for shared decision-making regarding any school changes. This structure generally functions well in Philadelphia but is utilized less in out-of-county placements. Strengthening this process and affirming youth educational rights through the court process can help shift this trend and improve compliance with existing laws. The new Court rules, including recently adopted Juvenile Court Rule 148, which seeks to ensure school stability for youth will also help improve youth’s access to education.

● Child advocates and the Defender Association will work with systems to ensure staff and volunteers are trained to elevate youth rights and support educational continuity in court hearings and placement decision making.

● DHS, DBHIDS/CBH, SDP, and other local education agencies will work together to ensure BID meetings are held to ensure school stability to discuss choices about school placement and to ensure that all systems prioritize education in the least restrictive setting with appropriate supports.

Youth from YALC urged that video footage be protected, unable to be modified, and reviewed by the right people outside of their provider.


● Through BID conferences, SDP and DHS will ensure transportation to quality schools within the school district for youth in placements within 10 miles of Philadelphia.

● The City will gather data related to education at host districts as part of City contract requirements by requiring:

o Providers to report data on the number of youth educated at on-grounds school, in the mainstream or alternative schools of the host district school, or in a special educational setting,

o Providers to report all new residential placements to the local host district promptly and consistently, so that host districts are on notice of their legal responsibilities to educate youth.

o Providers to report data regarding individual notifications and convening of meetings with parents or other educational decisionmaker regarding the right of their child to attend local public school.

18. Supported by the School District of Philadelphia, the City will establish mechanisms for local assessment and improvement of youth’s education while in placement as part of expanded City contract requirements for residential placement providers. Most on-grounds schools at residential facilities are licensed through the Pennsylvania Department of Education (PDE) State Board of Private Licensed Schools. There are no common curriculm and staffing standards governing on-grounds schools and no requirement that these schools align with state standards. Many schools also fail to provide individualized special education services to students with disAbilities. Monitoring of the overall academic program only includes submission of documentation. The only on-site monitoring of these schools is related to compliance with special education requirements, and that happens just once every six years. As a result, the quality of education at on-grounds schools is highly variable, and youth can lose months or years of learning time and sometimes the chance to graduate. The City does not have explicit authority to oversee the quality of education at these schools. However, DHS and DBHIDS/CBH hold the contracts for social services with the providers and are responsible for child well-being which includes education progress. SDP has education expertise that can be utilized, for example, in acting as an external evaluator assessing quality as a required term of DHS and DBHIDS/CBH contracts. SDP can also ensure that students who return to Philadelphia schools, particularly those with disAbilities, receive the quality education they need.

● The City, with support from SDP, will establish mechanisms for incorporating measures of education quality at on-grounds schools into City contracts. The City will develop a plan by September 2020, for implementation in 2021. Education quality measure will ideally include teacher qualifications, type of instruction provided to students, the provision of special education services to meet student needs, curriculum alignment with SDP, and credits awarded to students.

● The City will make information about the quality of on-grounds education services available publicly, especially to judges, to inform decision-making about the appropriateness of requiring attendance at on-grounds schools. This information shall include the specific elements identified above.


19. System partners will improve timely information sharing and collaboration to minimize disruptions to educational progress and support youth’s educational transitions, credit accumulation, and progress to high school graduation. Too often, young people who attend school or take classes while in residential placement return to Philadelphia to discover that they do not have enough core-subject credits to be on the expected grade level. National research suggests challenges to educational progress for youth placed in residential facilities include multiple educational moves, enrollment delays, barriers securing educational records (including special education and behavioral evaluations), connecting to an appropriate school upon return from placement, and timely credit transfers. Research shows that students lose 4-6 months of academic progress with every school change, and youth sent to residential facilities have often experienced multiple school changes prior to their current placements.26 When youth change schools during a residential placement, the law states that child welfare agencies and local educational agencies must collaborate to ensure immediate enrollment and transfer of academic records. Comprehensive academic records should inform school decisions and roster assignments for youth, but key pieces can sometimes be missing or delayed. The School District of Philadelphia will ensure consistent implementation of established procedures for expedient transfer of academic records, for shared planning when youth return from residential placements, and for assessment and transfer of credits when youth return.

● For any new school enrollment, SDP and providers will continue to ensure prompt transfer of education records, appropriate rostering, and credits earned.

● DHS and the Court will work to institute timely discharge planning back to SDP for all placement types, building on DBHIDS/CBH-SDP protocols for psychiatric residential treatment facilities.

● SDP will grant credits for students returning from placement consistent with its published policies and procedures including consideration of graduation eligibility based on completion of IEP goals for students with an IEP.

● System partners will identify and pursue strategies for youth to complete credits started in the School District of Philadelphia if enrolled mid-year in schools outside SDP and complete credits begun in schools outside SDP if re-enrolled in an SDP school mid-year.

26

“My son was told he had zero credits though he was in the 11th grade. They sat there and told him that. If I hadn’t kept paperwork and advocated for him, he’d

have gotten no credit.” Parent

“I resided in placement for 2 years and none of my credits transferred when I went back to my community school. Because of that, I had to restart the 9th

grade all over again.” Youth Advocate


Making It Happen This report makes recommendations that have the potential to further reduce the number of children placed in residential facilities and to improve the quality of services for youth who are placed so that no children are harmed in these facilities. Protecting and ensuring that Philadelphia youth thrive is a shared responsibility, and implementation of the recommendations will require the concerted effort of leaders and staff across many organizations. The participating City government agencies and other entities represented on the Task Force are committed to implementing these recommendations to the extent that resources and legal authority allow. The members of the Task Force strongly encourage all organizations referenced in the recommendations to commit to do the same. Additionally, the Task Force members, including City entities, commit to providing regular updates on implementation progress to all bodies charged with the oversight of entities referenced in these recommendations. The Task Force urges City-related, state entities and the boards of directors of system partner non-profits to also take up this charge. The participating City and City-related entities are committed to using existing cross-systems forums to continue facilitating multi-agency collaboration to implement program and policy changes, and to support coordinated data collection, analysis and reporting. Additionally, the Managing Director’s Office will convene, at minimum, bi-annual implementation check-in meetings for all agencies and participating stakeholders to facilitate this cross-systems communication, seek input and support progress on the implementation of these recommendations. Finally, the Task Force will reconvene annually to hear updates on the progress implementing the recommendations and to further support the work.

Action Items within 90 Days: Open a new small psychiatric residential

treatment facility (PRTF) in Philadelphia Develop the DHS Residential Placement Report Implement a Trauma Responsive Plan in the

School District of Philadelphia Host a Juvenile Justice Summit on trauma

informed practices for dependent and delinquent judges, probation staff and other stakeholders

Make additional investments in Evening Reporting Centers to allow more youth to stay in their homes while receiving supervision, as well as positive supports

Implement onsite technical assistance training for The Six Core Strategies to Reduce the Use of Seclusion and Restraint at PRTFs

Provide clear documents to youth and families on their rights, grievance procedures, and key contacts' information


How We Worked

In the wake of a child death at the hands of staff at a Philadelphia residential facility in 2016, the Department of Behavioral Health and Intellectual DisAbility Services (DBHIDS) and Department of Human Services (DHS) conducted reviews of all psychiatric residential treatment facilities contracted with DBHIDS/Community Behavioral Health and DHS and made a summary report available to City Council. In Spring 2018, Philadelphia City Council’s Committee on Children and Youth held hearings focusing on the broader scope of residential placements. During these hearings, the Committee heard from courageous youth who formerly resided in residential placement, along with education and youth advocates, and City officials regarding challenges with residential placement. Following the hearings City Council passed a resolution creating the Task Force (the resolution text can be found in Appendix A). The Managing Director’s Office and City Council appointed the Task Force co-chairs and the 25 members with expertise in the child welfare, juvenile justice, child behavioral health and education fields, including advocates, youth, and families with lived experience, service providers, and government leaders (a full list of Task Force members may be found in Appendix C). Although the First Judicial District Family Court Division was not a formal member of the Task Force, Court Administration participated in the development of this report. The Task Force received input from more than 170 stakeholders at public comment sessions and conversations with youth and family advocates (the Task Force formally recognizes these contributions in Appendix D). The Task Force met 13 times, beginning in November 2018 and concluding with the release of this report in October 2019. Task Force members also had the opportunity to talk with national experts and governmental leaders and participate in a residential placement site visit in December 2018 (see Appendix E for a Summary of National Best Practices and Models influencing the Task Force Recommendations). The Task Force’s work was also informed by two compelling reports released by the advocate and youth communities, Unsafe and Uneducated from Children’s Rights and Education Law Center and Broken Bridges from Juvenile Law Center Juveniles for Justice. Two public sessions were held to solicit public testimony and feedback on the draft of this report. Additionally, to further capture community voices, the co-chairs held five smaller conversations with youth and family representatives, whose experiences and suggestions were instrumental in the creation of these recommendations.

Documents

z } µ Z Z ] v ] o W o u v d l & } Residential... · Title: Microsoft Word - 9.13.19 Full Text Draft_Youth Residential Placement Task Force Report Author: Victoria.Hepp Created Date: