A Closer Look: Families and Our Kids Living in the Residential Maze
A publication of the Ohio Legal Rights Service (OLRS)
April 2002
Contents
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Copyright © 2002 Ohio Legal Rights Service. All rights reserved.
Ohio Legal Rights Service (OLRS) is committed to improving the manner in which services are provided to children with mental health disabilities. Through a series of publications, OLRS intends to inform the public, particularly families, about Ohio's residential system for children, inform the system about families' perceptions and experiences, and foster discussion resulting in positive change.
In OLRS' first publication, the OLRS' Kids MH Survey, OLRS presented a snapshot of the way residential facilities provide mental health services to Ohio's kids. The information was not always complimentary of Ohio's system. Nevertheless, response to the survey by service providers and policymakers has been thoughtful and has resulted in positive change.
This publication is not primarily a data-driven document but rather, a review of what agencies and families have told OLRS. It is the hope that this publication will further broaden the analysis of Ohio's residential system, and result in improved services, and positive change for our kids.
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In this publication, OLRS raises an issue arising from facts presented in the OLRS Kids MH Survey, family complaints and concerns, and from investigation into service delivery to children with mental health disabilities in mental health facilities and all other out-of-home residential facilities. The issue raised is: How can a family navigate Ohio's residential system in order to be involved in a child's life? OLRS presents here a "double take" on Ohio's service delivery system. Our purpose is to foster discussion of the system and to inspire positive change for our kids.
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Not all of Ohio's kids live at home, with family. Often, kids with disabilities are removed from their own home and placed in an "out-of-home" living situation, or residential facilities. Ohio licenses residential facilities by way of different state departments, all of which license facilities under different standards. We are responsible for our kids who live in licensed facilities, and to meet this responsibility we must ask, "Can we improve?"
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Ohio licenses many different kinds of residential facilities:
- foster homes
- hospitals
- youth prisons
- detention halls
- nursing homes
- kinship homes
- residential facilities
- therapeutic foster homes
- intermediate care facilities
Our kids live in all of these places.
Four different state departments license residential facilities where our kids live:
- Ohio Department of Health (ODH)
- Ohio Department of Mental Health (ODMH)
- Ohio Department of Job and Family Services (ODJFS)
- Ohio Department of Mental Retardation and Developmental Disabilities (ODMRDD)
Departments license facilities and "beds." Some departments license beds regardless of the age of the individual assigned to the bed. Thus, a young child can live in a nursing home with adults if that nursing home has a licensed bed available to be filled. Some departments license facilities and other departments "certify" programs implemented in facilities. Some departments license facilities for other departments. Licensing is all over the place:
- Each department has different licensing standards.
- Ohio does not have a unified view of licensing.
- To get a license, a facility need only apply to the state agency, and meet that agency's specific standards.
- Licensing is not coordinated across agencies but rather, the process is different for each agency.
- Families have difficulty navigating the system.
- Families do not know who is responsible for their child or their child's rights.
As a result, which agency licenses a facility will affect the rights and protections a child has, and the standards of care a parent can expect for the child.
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|
Situation Example |
Number of Facilities Licensed |
Number of Beds Licensed |
Commentary |
| Ohio Department of Health (ODH) |
A young child living in a nursing home with 65 adults. |
Numerous |
Unknown -
children may be in these facilities, but ODH does not track this information |
ODH licenses several types of facilities (Nursing Homes, Adult Care Facilities, Community Alternative Homes, Rest Homes, Residential Care Facilities). ODH uses various licensing standards to do this. |
| Ohio Department of Mental Health (ODMH) |
25 children with mental health issues living together, and experiencing seclusion and restraint daily. |
45 facilities |
1,038 beds in which children are placed |
As of March 15, 2002, there were 45 childrens residential facilities licensed by ODMH. Facilities ranged in size from
1 - 114 beds. Of these 45 facilities,
21 have 10 or more beds. |
| Ohio Department of Job and Family Services |
A child living in 3 foster homes within a year, and with no one keeping track. |
213 facilities |
2860 beds in which children are placed - this does not include individual foster homes |
ODJFS provides a listing of facilities that the department licenses and organizations that operate individual foster homes. NOTE: According to ODJFS staff, data may be inaccurate due to on-going addition and deletion of residential providers. |
| Ohio Department of Mental Retardation and Developmental Disabilities (ODMRDD) |
The agency with the most facilities and licensed beds has a licensing directory that does not specify which beds are for children. |
1371 facilities |
11,454 beds |
ODMRDD last published an Index to Residential Facilities in December 2001. This licensing directory is not categorized by age of residents. |
There are approximately 2000 beds in which kids are placed within the Ohio Department of Youth Services (ODYS). Some of these beds are in the 10 institutions managed by ODYS. ODYS monitors and evaluates "procedures and activities" within these facilities on a "regular basis". Some of the 10 institutions are accredited by the ACA (American Correction Association). The remainder of the 2000 beds in which children are placed are in residential facilities in the community. The Ohio Department of Alcohol and Drug Addiction Services (ODADAS) certifies one of these facilities. The rest of these community residential facilities are licensed by ODJFS.
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For some kids, the practical effects of the current licensing system can be devastating:
- lack of appropriate treatment
- suffering abuse
- suffering neglect
- violations of rights
- life with adult strangers
- being secluded
- being restrained
- life without stability
- losing their family support, involvement, and connection
The effects on some families include:
- separation
- exclusion
- disempowerment
- disregard
- loss
- failure in monitoring
- failure in keeping track
When families are forced to access residential services,
in order to meet their kid's needs, families lose opportunities and/or power to make parental decisions to protect their child. Family input may be excluded in daily life decisions about treatment, informed consent, medications, seclusion and restraint, and education.
Families feel left out. Families are kept out of the "information loop" and frequently are not told when their child has been abused, injured, or is ill. Families must often relinquish custody to get needed services for their child.
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It is time to take three steps toward positive change. Our kids deserve better.
Step 1: Unify the Licensing System
Unify the licensing system so that families can expect
comparably exceptional services from
any residential facility in Ohio.
- Establish a single state licensing body responsible for licensing all residential facilities where kids live.
- Establish common standards for all residential facilities in which kids live.
If we unify the licensing system, our kids have a better chance to receive comparably exceptional services
no matter where they live.
Step 2: Expand the Purview of Licensing
Expand the purview of licensing beyond health and safety to encompass
service provision that is tailored to the
unique needs of Ohio's kids.
- Establish standards which will regulate treatment, not just health and safety.
- Support family involvement by empowering families with tools and means to monitor and address service problems in an effective and timely manner.
If we expand the purview of licensing, our kids have a better chance to receive the treatment they need and to have family support in their daily lives.
Step 3: Evaluate Residential Facilities and Publish the Results
Evaluate residential facilities and publish the results in reports which show whether services result
or do not result in positive outcomes for kids.
- Conduct more frequent, more regular,
and more careful monitoring of facilities.
- Monitor where kids are "placed" to assure
they live in places appropriate for their age.
- Conduct better monitoring of kids if they
move from facility to facility, and/or if they
move between systems.
- Monitor and accurately account for
all kids living out of their family home.
- Develop readily and publicly available reports
in which results of evaluations are published.
If we evaluate residential facilities, our kids have a better chance to be protected through enforceable rights; to be free from abuse, neglect, seclusion and restraint; to live in stability in places that are right for them; and to be served by a system which is accountable to them.
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So, if we look closely at the residential system in Ohio today, we can see that:
- Ohio does not have a unified view of licensing.
- Licensing is not coordinated across agencies but rather, the process and standards for each agency are different.
- Families have difficulty navigating the system and so, families are left out and kids are short-changed.
But, if we come together to unify the licensing system, expand the purview of licensing, and evaluate residential facilities and publish the results, we can make positive change for our kids.
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This publication was produced by the Ohio Legal Rights Service, 50 West Broad Street, Suite 1400, Columbus, Ohio 43215-5923. Telephone 614-466-7264/800-282-9181 TTY 614-728-2553/800-858-3542 Web site: http://olrs.ohio.gov
Ohio Legal Rights Service and this publication are funded in part by grants under the following federal laws:
- Developmental Disabilities Assistance (DD) Act, administered by the Administration for Children and Families;
- Protection and Advocacy for Mentally Ill Individuals Act (PAIMI), administered by the Center for Mental Health Services of the U.S. Department of Human Services; and the
- Rehabilitation Act of 1973 as amended, administered by the Office of Education Services and the Rehabilitation Services Administration of the U.S. Department of Education.
Ohio Legal Rights Service does not discriminate in provision of service or employment because of race, color, religion, sex, sexual orientation, national origin, military service, disability, or age.
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