Children were restrained or secluded more than 20,000 times in residential youth behavioral health facilities in New Hampshire over a five year period from 2014 to 2018. That’s the finding of a new report from the Office of the Child Advocate, an independent watchdog agency that oversees the state’s Division for Children, Youth, and Families.
The report examines the use of restraint and seclusion at the state-run Sununu Youth Services Center and at about two dozen private residential facilities which are certified by DCYF to provide treatment to children placed by the state.
The report provides a rare system-wide look at how restraint and seclusion are used on children who are placed outside their homes by the state because of behavior, developmental disability, or chronic mental health conditions.
Moira O’Neill, who heads the Office of Child Advocate, says ultimately New Hampshire should strive for a future with as few incidents of restraint and seclusion as possible.
“There’s no science that says restraining kids is helpful,” said O’Neill. “It may stop a behavior in the moment, and I certainly acknowledge that it may keep someone safe in the moment, but it’s not going to improve that child. And in fact, it may harm them.”
One of the report’s most significant findings involves the use of prone restraints, a type of potentially lethal hold, banned in some other states, that involves holding a child stomach-down on the floor.
According to the report, staff at the Sununu Youth Center and at four private facilities in the state use prone restraints.
New Hampshire law prohibits the use of restraints that “obstruct a child's respiratory airway or impairs the child's breathing or respiratory capacity or restricts the movement required for normal breathing.” Though the word “prone” is not included in the statute, the Office of Child Advocate interprets the language to effectively ban the use of prone restraints in New Hampshire. The OCA report cites the legislative testimony of a former state chief medical examiner who told lawmakers the prone position can impair breathing.
But as the OCA report points out, the view that prone restraints are categorically illegal in New Hampshire is not universally held. According to the report, some private residential facilities continue to defend the practice, as do some staff at the state Department of Health and Human Services.
At the Sununu Youth Center, despite the fact that internal policy states “youth in restraint shall not be left in a prone position due to the possibility of positional asphyxia,” the OCA report finds that since August of 2018, Sununu Center staff placed children in prone restraints at least 20 times. In 10 instances, the prone restraint included the use of handcuffs. The population at the SYSC has fluctuated between 10 and 20 children in recent months.
That finding seems to contradict an earlier investigation conducted by the New Hampshire Attorney General’s office, which found that the use of prone restraint was not a routine occurrence at Sununu Youth Center. The AG also asserted that Sununu Center internal policy quoted above does not in fact prohibit prone restraints.
That AG investigation was prompted by a 2018 report from the Disability Rights Center which found a “pattern of inappropriate restraints and excessive use of force by [Sununu Center staff] against the children housed there.”
Amidst the disagreement over whether prone restraints are allowed under New Hampshire law, the OCA report recommends the state Department of Health and Human Services explicitly prohibit the practice in its policies for the Sununu Youth Center and for private residential facilities it certifies or contracts with.
A Lack of Data
Overall, the use of restraint and seclusion in youth residential treatment facilities is trending downwards in New Hampshire, according to the report. From 2015 to 2018, their use declined by 37 percent. In any given year, there are approximately 400 children placed by DCYF in residential treatment facilities in New Hampshire.
In response to the Child Advocate’s report, Jake Leon, spokesperson for the Department of Health and Human Services, highlighted the decline in the use of restraint and seclusion and attributed it to the efforts of DCYF employees.
Leon said state health officials “have been establishing a culture of safety and system of care to expand access to community-based services and increase clinical care at community residential programs."
He also said the health department will begin including requirements to decrease the use of restraints and seclusion in future contracts with residential facilities.
Beyond the aggregate level, O’Neill says it is difficult to know how restraint and seclusion are being deployed in residential facilities in New Hampshire.
“We found that there were 20,000 incidents in a period of five years, but we don’t know anything about that,” said O’Neill. “Was that 20,000 kids? Was that 20,000 different staff? Was that one kid? Was it a particular time of day?”
Under state law, the Office of Child Advocate is supposed to be notified of incidents including the use of restraint or seclusion of any children placed under DCYF’s authority within 48 hours.
The report states that the Office of the Child Advocate only began to receive those reports beginning last month, and that the current process “does not accommodate the 48-hour timeline.”
O’Neill says with more detailed data on each instance of restraint and seclusion, policy-makers could identify trends and find ways of reducing the use of those techniques.
This post has been updated to include a response from the New Hampshire Department of Health and Human Services.