After learning about sanctions issued to Centers for Youth and Families in May and June, Texas officials decided not to send any more youths to the Little Rock psychiatric facility pending more information, emails show.
While Texas paused referrals to Centers, officials in Idaho were unaware of the letter of reprimand and corrective action plan entered earlier this year by state officials in Arkansas until approached with questions by the Arkansas Democrat-Gazette.
Texas and Idaho -- along with Alaska and Arkansas -- send children to the nonprofit facility for residential treatment.
Officials and parents in those states received varying levels of information about the issues at Centers because there is no uniform reporting system.
"Yes, I definitely think let's hold off on referring youth to them [Centers] until we get the additional information we discussed," reads a July 8 email from Jillian Bonacquisti, director of placement services for the Child Protective State Office in Texas. The email goes on to question the difference between a "formal corrective action" and an "adverse action."
Centers for Youth and Families is licensed as a psychiatric residential treatment facility, one of 13 in the state. It treats children with emotional issues, at-risk youths and kids who have experienced trauma, among other services.
The corrective action agreement, dated May 5, was part of an effort to address issues such as restraint incidents that broke children's bones, failure to immediately report to a state licensing unit two instances in which children were hurt and incidents of sexual contact between youths.
The letter of reprimand, issued after a June 1 meeting of the Child Welfare Agency Review Board, was one of only two instances since at least 2009 that the board has used this form of discipline. The letter was not an official action against the center's license.
It's unclear if any other states send youths to Centers. Facilities like Centers aren't required to report what states their child clients are from, according to the Arkansas Department of Human Services.
There's also not a uniform system for alerting parents about issues at the facility -- like the reprimand and correction plan. State watchdogs don't know the identities of all children staying at residential treatment facilities, and Centers officials said it only notifies families who request it.
As of last month, no new kids from Texas had been placed at Centers since the spring, a Texas Department of Family and Protective Services spokeswoman Marissa Gonzales said July 29 in an emailed response to questions.
"I'm thinking adverse action would signify moving all the kids from that placement," a July response to the Bonacquisti email from Sofia Gallegos, the lead program specialist with the Texas State Office Placement Division, reads.
Centers officials said in written responses to reporters' questions Thursday that the Arkansas facility "continues to get referrals from the state of Texas, in fact, as recently as this week."
The Texas spokeswoman didn't respond last week to a request for more details about an apparent end to the admission pause.
Arkansas Department of Human Services' Division of Child Care and Early Childhood Education alerted Texas to the corrective action plan May 7, emails obtained through a public records request show.
Idaho hadn't been informed about the letter of reprimand or corrective action agreement until the Arkansas Democrat-Gazette sent questions about them July 22, Niki Forbing-Orr, a spokeswoman for the Idaho Department of Health and Welfare, wrote in an emailed response.
"Idaho Medicaid had not been informed regarding the letter or corrective action plan until receiving this inquiry," Forbing-Orr wrote. "The Idaho Medicaid team reached out immediately to Centers for Youth and Families and requested more information as well as a copy of the reprimand and corrective action plan."
The state has had "positive experiences at the facility, but will monitor the situation carefully," she added.
Responding to a question about Idaho regulators not being informed, Centers officials wrote that "No adverse action had been imposed on The Centers by the state." They didn't directly address whether the Idaho official's account was accurate.
"Our programs continued as before the [corrective action agreement]. Additionally, Centers was under no obligation to report the [corrective action agreement]," the nonprofit's statement continued.
Arkansas staffers alerted only states that had requested to be notified of problems or incidents discovered during inspections, said Amy Webb, communications chief at the Arkansas Department of Human Services.
Texas requires its caseworkers to have contact with kids at least once per month -- either by phone or video conference. A licensed social worker is contracted to visit each child once a month, Gonzales wrote. A full policy on "interstate placements" states that the kids affected by these placements are either children in state custody after abuse and neglect at home or private placements for adoption and specialized residential care.
Idaho Medicaid case managers and utilization management nurses review clinical files and speak with the children's' treatment teams at least once per month. If the kids are in foster care, Idaho Division of Family and Community Services caseworkers visit every 60 days.
A spokesman for the Alaska Department of Health and Social Services didn't respond to requests for comment about recent issues, but inspectors from Alaska found problems related to those cited in the corrective plan during a 2020 Centers visit, records show.
Officials identified issues with restraint reporting and interviewed three children who said they'd been physically restrained, with some reporting a "very painful" experience, monitors wrote in a Nov. 27 report. One child told them Centers staff members "squeeze my hands when I act out and it hurts."
An undated, three-page plan of improvement and appendix materials that Centers submitted to Alaska describes efforts to address the issues in detail, including reporting restraint incidents, the creation of restraint quality-improvement processes and a new client advocate role.
Based on Alaska's audit, "we received feedback that clients didn't always trust to report critical information to their treatment team," Centers wrote.
Asked this month about Alaska's findings last year, Centers said "restraints often are not comfortable," and highlighted a more recent switch to a new "de-escalation and restraint program."
The latter shift took place as part of the corrective plan with Arkansas, according to a document describing the plan.