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North Carolina ships abused, neglected kids to out-of-state facilities. Some are traumatized again.
Officials try to put children in psychiatric facilities near family. But when they can’t find a placement locally, the kids are sent to out-of-state centers — some that have been accused of physical and sexual abuse and other mistreatment.
Fred Clasen-Kelly, Kristen Johnson, Amritpal Kaur Sandhu-Longoria, Rachel Berry, Brad Zinn and Brian Gordon, The Fayetteville Observer
Locked away in the Ozark mountains, the thirsty and famished children were far from home.
Some were 1,000 miles from their families, others had no families.
There were foster kids, shipped by other states to a psychiatric residential treatment facility in Fayetteville, Arkansas. And, according to a state investigative report, the dangers around them were perilous.
Children at Piney Ridge Treatment Center went to bed hungry and dehydrated because they were not fed enough and the water fountains were filthy.
When kids woke up, they put on soiled clothes they had worn for several days in a row. Some coped with the memories of sexual abuse they had endured the night before in the facility. Others were fighting staph infections.
This is where North Carolina sent Meg Jenkins’ son across state lines to recover from child abuse.
“When he came back, he had night tremors,” said Jenkins, who lives near Charlotte. “He came back with 10 times the trauma.”
The failed therapy, unsanitary conditions and other problems the boy experienced at Piney Ridge are a common part of life in psychiatric residential treatment facilities that North Carolina relies on to help children who have been abused and neglected. A seven-month investigation by USA TODAY Network-North Carolina called “Locked Away” has revealed widespread physical and sexual abuse, medication errors and other serious failures.
North Carolina officials try to put children in psychiatric residential treatment facilities near family and other supports, but when they can’t find a placement locally, they look out of state.
Officials authorized payments for Jenkins’ son to go to Piney Ridge last year — long after violations Arkansas regulators uncovered at the facility had been publicly known. The Arkansas Department of Human Services released a scathing letter listing its findings in October 2019.
Among the violations, regulators cited Piney Ridge for excessive use of physical and chemical restraints, high rates of staph infection because the building was unsanitary, failure to provide education and failure to properly supervise kids who had inappropriate sexual contact.
That didn’t stop North Carolina officials from sending Jenkins’ son there.
At first, Jenkins felt relieved to find a place that would help her son overcome repeated sexual abuse he endured.
Some families in North Carolina wait years for specialized psychiatric services and some never get the help they need.
Jenkins’ son received almost no help at Piney Ridge because workers put in a treatment plan that was based on him writing his thoughts in a journal. It didn’t work because the teen suffers from dyslexia and can’t read or write.
He’s a teenager and stands 6 feet 2 inches tall but functions mentally more like a 5-year-old. Someone stole his clothes and shoes.
When another client at Piney Ridge physically assaulted him, he thought the staff would intervene. They never did, he told his mother later.
A USA TODAY Network investigation has found that abused and neglected children from North Carolina have been sent as far away as Utah, Missouri, Indiana and other states even when psychiatric facilities have been accused of physical and sexual abuse and other mistreatment.
California halted out-of-state placements after a 16-year-old boy was restrained at a Michigan facility last year, went into cardiac arrest and later died.
In North Carolina, officials said 572 children involved with the state child welfare system were placed in psychiatric residential treatment facilities over a one-year period and about 40 percent of them were sent out of state.
Families suffer the toll.
Long-distance placements can cause more trauma and make it difficult for kids to maintain lasting bonds with siblings and other relatives.
Experts say many families — often people of color who are struggling financially and living without reliable transportation — cannot visit or check on the well-being of kids.
At the same time, North Carolina caseworkers assigned to see after children have less ability to ensure they are safe when they are in another state.
Across the country, children put in these institutions have been punched, kicked and shoved into walls, said Sandy Santana, executive director of Children's Rights, a national advocacy group.
Under North Carolina law, children placed in a psychiatric residential treatment facility or other mental health facility that restricts their freedom of movement are entitled to legal representation and judicial review to determine if the placement is appropriate.
They don’t have the same right to judicial review in South Carolina and other states where they are housed for treatment.
Crystal Klunk knew she needed help to keep her teen daughter safe.
Klunk, 39, and her husband adopted Alexis when she was a small child, and the challenges were apparent from the start.
Alexis could remember seeing her biological mother beaten by a boyfriend and responded like many victims of childhood trauma do, by acting out. She smeared feces on walls, toppled over a bookcase and did not talk to other kids at school.
At age 10, she tried to kill to herself.
Alexis, who was diagnosed with attention deficit hyperactivity disorder, spent years bouncing between psychiatric residential treatment facilities and mental health hospitals that were ineffective.
“It felt like nobody really wanted to help and do the right thing,” Klunk said.
Last year, an agency overseen by the state recommended Village Behavioral Health, a psychiatric residential treatment facility in the foothills of east Tennessee.
The facility’s website promises children “top-of-the-line education” and engaging activities in a serene environment.
Instead, according to Klunk's account, the children roamed the campus.
They would sneak out and get into several of the abandoned vans on the property and break window glass, then use it to cut their own skin in self-harm.
They would steal away other nights and meet in an empty cabin. Kids would gather all their pills in the middle in a pile, palmed from med rounds or tongued away and spit out later for saving. They would play a game, she said, and each kid would take a random handful of pills.
Her daughter would crush and snort medication. She went to the treatment facility a virgin, one who'd never even smoked a cigarette, the mother said. She came home with a taste for them, and had had sex with a boy from the facility.
When she finally saw her daughter, Alexis’ arms, legs and stomach were covered with dozens of cuts and scratches.
In July 2020, Alexis went missing from the facility and had been gone more than three hours before workers called the police or her family.
Klunk immediately drove to Tennessee and took her daughter home.
USA TODAY Network's "Locked Away" team reached out to Village Behavioral Health, but did not receive a reply.
Alexis, now 16, is living apart from her family again in a group placement a few hours away from their home in the North Carolina mountains.
“It has been hard,” Klunk said. “I haven’t gotten to be a mom to my daughter because we are fighting a system.”
In written responses to questions from USA TODAY Network, North Carolina officials said that in some cases, kids were sent to facilities in neighboring states because they were closer to the child’s family.
A compact between all 50 states stipulates that they provide the same quality of care to all youths regardless of their permanent address, they said.
North Carolina sends children to Avalonia Group Homes Inc. in South Carolina, where court records show a former staffer pleaded guilty in 2017 to criminal sexual conduct with a minor under the age of 16. She received two years of probation.
Former North Carolina Department of Health and Human Services Secretary Lanier Cansler said the state tried to launch an initiative to halt out-of-state placements, but budget cuts prevented them from being successful.
“We had issues sending patients to other states because we didn’t have (all of) the service(s),” Cansler said. “The problem with that is then we lose regulatory control.”
He said it was difficult to build robust community services given the agencies' budget constraints after the Great Recession.
“I was trying to cut $1 billion and keep the safety net,” he said.
Barbara Barnard, a nurse who worked for Piney Ridge, saw the dangers of out-of-state placements.
She said she remembers the 11-year-old girl who had been chemically restrained so many times that she began lactating.
Barnard recalled when a girl from Hawaii who had diabetes was locked in her room for three months because she was violent with staff. She didn’t attend school, therapy or get to eat at the table with peers, Barnard said.
By the time the girl left the facility, the girl’s feet were so swollen she couldn’t wear her shoes.
Barnard said she called the statewide Child Abuse Hotline multiple times over incidents in Piney Ridge.
“Just the whole environment is so loud, and so chaotic and so dangerous all the time,” said Barnard, who worked in the facility for two years.
Justin Hoover, who became Piney Ridge's chief executive officer earlier this year, said the facility has made improvements since state inspectors found violations.
Recent revelations about Piney Ridge are based on information from several years ago, Hoover said.
"We've done a ton of improvements," he said.
When she began her job at Piney Ridge, Barnard was told that she’d be dealing with “bad kids” who were conniving liars and would hurt her. She thought her job was to not get killed.
Over time, she realized these kids never had a chance to show how amazing they were.
Many of them were foster kids who had no family to turn to. They were victims of the system and had always been in the system, without enough allies to fight or speak up for them, Barnard said. Instead, they were moved from one facility to another, because there was no other place for them to go.
Out-of-state children often had a caseworker, but it was an impersonal relationship because the caseworker never traveled to Arkansas to check on the child. When Barnard would call, she said, the caseworker wouldn’t know which child she was talking about.
One boy’s caseworker just stopped taking his calls.
The court made the decision to find one supposedly troubled North Carolina boy a placement.
When they recommended New Hope Treatment Center in South Carolina, his mother saw the reviews and got a bad feeling.
The family requested anonymity in this article because the child is still a minor who has been reportedly assaulted by staffers previously and remains in psychiatric center care.
Jane, his parent we spoke with, read through the reviews, overwhelmed by how much trauma some of the children endured at the facility — sexual assault, negligent staff, dirty environment. One person wrote that staff restrained kids until they vomited.
A review stood out. “PLEASE DO NOT SEND YOUR CHILDREN HERE,” written in capital letters.
She asked the probation officer if her son could go anywhere else but was told not to make a judgment off of the reviews.
Her child has autism. Why was he going to another psychiatric center? It was her only option, her probation officer said. “I don’t feel safe with him going here,” she responded. But she didn’t want to lose her son to the state. She had to let him go.
“Here we go again,” she said to herself. This cycle had been part of his life since he was an 8-year-old boy, half of his life.
It was a three-and-a-half-hour drive to New Hope. Her son just wanted to get it over with. He had dreams and wanted to close out this chapter.
She continued calling places in North Carolina to see if beds were available. “Every day that he was there, I was worried,” she said. “Because if something happened, I wouldn’t be close.”
And when she found out that a staff member assaulted her son, those reviews came back to haunt her.
She found out that staff didn’t even take him to the hospital. The director eventually apologized to her about nobody contacting her on time about the assault.
The staff member who allegedly punched him was placed on administrative leave and eventually fired.
After visiting her son, his mother immediately got a lawyer, called the police and the department of social services.
In 2003, a 9-year-old boy had died at New Hope after being pinned to the floor for seven minutes.
When Jane reported her son’s assault to police, they reviewed the video and treated the incident as just two people fighting — a minor who is a patient and a staff member.
They closed the case.
UPCOMING
Our next "Locked Away" installment Nov. 14 gives a personal look into the diary of a suicidal teen navigating psychiatric lockup in North Carolina.
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