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The Unsilenced Policy Team

Massachusetts Legislation Report

2022

2022

Introduction

The ‘troubled teen’ industry is a network of residential programs that claim to provide treatment for the behavioral and developmental needs of youth. The industry’s lack of transparency and accountability has led to widespread abuse of youth, resulting in hospitalizations, prolonged trauma and death.

Today, there are an estimated 120,000 – 200,000 minors in residential programs across the United States. These youth are placed each year by state child welfare agencies, juvenile justice courts, mental health providers, refugee resettlement agencies, school districts’ individualized education programs, and by parents.

Many of these youth have trauma histories, which are only exacerbated by being removed from their communities and institutionalized. Youth with lived experience describe these programs as being carceral, harsh, and abusive.

An estimated $23 billion dollars of public funds annually are used to place youth in residential programs. Daily rates for residential treatment ranges from $250-$800, costing up to $292,000 per year, per child.

It is overwhelmingly clear that our communities and agencies are over-relying on residential placements that are negatively impacting the youth they serve.

Introduction

The ‘troubled teen’ industry is a network of residential programs that claim to provide treatment for the behavioral and developmental needs of youth. The industry’s lack of transparency and accountability has led to widespread abuse of youth, resulting in hospitalizations, prolonged trauma and death.

Today, there are an estimated 120,000 – 200,000 minors in residential programs across the United States. These youth are placed each year by state child welfare agencies, juvenile justice courts, mental health providers, refugee resettlement agencies, school districts’ individualized education programs, and by parents.

Many of these youth have trauma histories, which are only exacerbated by being removed from their communities and institutionalized. Youth with lived experience describe these programs as being carceral, harsh, and abusive.

An estimated $23 billion dollars of public funds annually are used to place youth in residential programs. Daily rates for residential treatment ranges from $250-$800, costing up to $292,000 per year, per child.

It is overwhelmingly clear that our communities and agencies are over-relying on residential placements that are negatively impacting the youth they serve.

Massachusetts Legislation

General Oversight and Transparency 606 CMR 3: Standards for the licensure or approval of residential programs serving children and teen parents
Oversight Agency Department of Early Education and Care (DEEC) and Department of Elementary and Secondary Education (DESE)
Which state agency oversees investigations? Department of Early Education and Care (DEEC)
Are investigations and outcomes visible to the public online? No
Is this type of program required to be licensed by the state? Department of Early Education and Care (DEEC) and Department of Elementary and Secondary Education (DESE)
Is a list of licensed facilities available to the public? Yes
Are regulations only applicable to facilities receiving public funds? No Information
Can complaints be filed online? Is the reporting portal easy to find? No
Does the state conduct unannounced site visits? How many per year? Yes. At least one visit per year.
Are background checks required, including volunteers? Yes. 606 CMR 14.05 1(b) EEC (BRC)-Volunteers must complete a BRC through EEC if they are assisting a Program in an unsupervised capacity and Mass. Gen. Laws c. 71, §38R
Is a full-time licensed clinician required to be on staff? Yes. At least one member of the team shall have an advanced degree from an accredited school in social work, psychology, psychiatry or a related field, or be a certified Massachusetts school psychologist and experienced in providing direct treatment services to residents 606 CMR 3.05 (4a)
Does the state require a guardian's consent to all treatment received? Yes for medications medications except in an emergency 606 CMR 4 (k)3d
Does the state require that the guardian be notified of an emergency involving their child within 24-hours of the incident occurring? Yes
Does the state require notification within 24-hours of a program admitting, discharging or major treatment change for children under its care? Yes
Is a licensed clinician required to perform a mental health evaluation upon intake? 606 CMR 3.05 1(g)(g) Except in cases of emergency, the licensee shall admit only those prospective residents who have had evaluations by qualified professionals covering physical, emotional, social and intellectual factors relevant to the prospective residents’ situations.
Does the state require mandatory child abuse response training for all staff working with children in residential settings? No. 3.04 (7)
Does the state require medical response training for all staff working with children in residential settings? Yes. Within One Month, CPR within 6 months 606 CMR 3.04 (7a1)(7bc)
Does state require 1:4 staffing ratio or higher? No
Ban on Conversion Therapy for LGBTQA+ youth? Yes
Are there admissions requirements? Yes. 606 CMR 3.05 (1) - (1) Eligibility for Admission. (a) Each temporary shelter shall be available at all times for emergency admissions (i.e., 24 hours each day, seven days each week). (b) Each licensee shall establish written eligibility criteria for admission, as required in 606 CMR 3.04(1)(b) and shall make such criteria available upon request. (c) The program shall only admit a resident whose needs it believes can be met by the program. (d) Programs offering temporary shelter may admit residents on their own request for up to 72 hours. In order to provide services to a child beyond 72 hours, a program must obtain written consent of the parent having custody of the child or a legal guardian, a court order, or a written agreement with a placement agency. (e) Programs serving teen parents and transition to independent living programs may serve a resident who is younger than 18 years old upon a self-referral if the program assesses the resident to be a mature minor. (f) Whenever possible, the licensee shall not admit a prospective resident to a program without evidence in the referral that placement in a residential program is the most appropriate plan for the resident. The licensee shall seek information from the referral source which includes evidence of attempts to provide preventive services and an examination of possible alternatives to such placement, or a statement by the referring agency as to why placement is warranted without such attempts being made. (g) Except in cases of emergency, the licensee shall admit only those prospective residents who have had evaluations by qualified professionals covering physical, emotional, social and intellectual factors relevant to the prospective residents’ situations. (h) The licensee shall seek and document recommendations from any prior placements regarding effective and ineffective behavior de-escalation methods. (i) For emergency admissions or admissions for purposes of evaluation, the licensee shall make appropriate and adequate provisions to meet the requirements of 606 CMR 3.05(1)(f), (g) and (h) as soon as possible after admission, provided that the licensee shall initiate the admission evaluation within one week after admission. (j) A Shelter program shall have a written plan for providing referral services to children who cannot be admitted because the program has reached its licensed capacity or because characteristics of the child or the shelter make it inappropriate to admit the child. The plan shall provide for referral to another licensed or approved program, or placement agency.
Are the guardian & admitted child required to be informed of their their rights? Yes. 606 CMR 3.05 (2b) - YES -606 CMR 3.05 (2b) - The licensee shall, prior to admission, (or in the case of emergency admission, within 72 hours) provide the following written materials to the resident and his or her parents or guardian(s). If the resident objects to his or her parent receiving such information the program shall not be required to provide such materials but shall maintain written documentation of the objection in the resident's file. Information required by 606 CMR 3.05(2)(b)1. through 9. shall be provided to the resident, consistent with his or her capacity to understand. 1. Statement of purpose, as specified in 606 CMR 3.04(1)(a). 2. Eligibility criteria, as specified in 606 CMR 3.04(1)(b). 3. Description of program of unusual or extraordinary treatment, if applicable, as defined in 606 CMR 3.06(11). 4. Emergency assistance system, as specified in 606 CMR 3.04(3)(j). 5. Agency grievance procedure, as specified in 606 CMR 3.04(3)(i). 6. Name of the case manager, as specified in 606 CMR 3.06(1). 7. Rules for behavior support, as specified in 606 CMR 3.07(7). 8. Visiting, mail and telephone policies, as specified in 606 CMR 3.07(9). 9. Search policy, as specified in 606 CMR 3.07(11).
Does the state define institutional abuse and neglect? Yes. 102 CMR 1.02 - Institutional Abuse or Neglect means abuse or neglect which occurs in any facility for children, including but not limited to group homes, residential or public or private schools, hospitals, detention and treatment facilities, family foster care homes, group day care centers, and family day care homes.
Are there civil penalties for violations of institutional child abuse and neglect? No Information
Does the state prohibit mail censorship? Yes, except 1. Any restrictions or censorship must be no greater than necessary to achieve the therapeutic purpose described in the individual service plan. 2. Mail restricted or censored must be returned to the sender with reasons, therefore. 3. Staff may open and inspect a resident's mail for contraband only in his or her presence. 606 CMR 3.07 (9g)
Do the youth have unrestricted access to guardians, legal counsel, welfare advocates, religious clergy, friends and family via telephone? Telephone communications may not be monitored or unreasonably restricted unless there are specific therapeutic reasons justifying such limitations. 606 CMR 3.07 (9i) Communication with a resident's social worker, attorney, or clergy person may not be prohibited, restricted or censored. 606 CMR 3.07 (9h)
Does the state require that children be allowed visitors in private during normal visiting hours? Visits must offer reasonable privacy unless by court order and in such case only to the extent of the court order; 2. by the resident's individual service plan for therapeutic reasons only. 606 CMR3.07 (9b)
Is the facility required to provide an individualized treatment plan? Is the plan reviewed regularly? Within six weeks of admission the licensee shall assess the needs of the resident and develop an individual plan for services. Not necessarily evidence-based. 606 CMR 3.05 (4d)
Is medical and psychological experimentation on youth prohibited without the express consent of all involved parties? Yes. 606 CMR 3.06 (10a)
Is it required that youth receive education that is of the same quality and outcomes as their assigned public school? Yes. 606 CMR 3.06 (5a)
Is it required that youth receive age-appropriate sexual education, access to sexual healthcare, and menstruation supplies? Yes. Access to sexual healthcare 606 CMR 3.06 (4g4)
Are youth provided with access to advocacy services and representation? Yes
Does the state require a guardian's consent to all treatment received? Yes
Is a grievance procedure required for youth and families? The licensee shall distribute written grievance procedure to residents and parents prior to admission and to staff during initial orientation period. 606 CMR 3.04 (3j1)
Is youth consent required for all treatment received? Yes for medication unless necessary to prevent the immediate substantial and irreversible deterioration of a serious mental illness. The licensee shall inform a resident 12 years of age and older, consistent with his or her capacity to understand, about the treatment, risks and any potential side effects of medication. The licensee shall have procedures to follow if the resident refuses to consent to administration of the medication. 606 CMR 3.06 (43e)
Does the state have zoning and occupancy requirements for structures being used to house youth in residential settings? Requires Occupancy Permit 606 CMR 3.08 (1)
Is there regulation for physical restraint? Yes on Restraints, Seclusion Prohibited 606 CMR 3.07 (7j)
Is there regulation for chemical restraint? Yes on Restraints, Seclusion Prohibited 606 CMR 3.07 (7j)
Is there regulation for mechanical restraint? Yes on Restraints, Seclusion Prohibited 606 CMR 3.07 (7j)
General Oversight and Transparency Department of Mental Health - 104 CMR 27.03
Oversight Agency Department of Mental Health
Which state agency oversees investigations? Department of Mental Health
Are investigations and outcomes visible to the public online? No
Is this type of program required to be licensed by the state? Yes
Is a list of licensed facilities available to the public? Yes
Are regulations only applicable to facilities receiving public funds? No Information
Can complaints be filed online? Is the reporting portal easy to find? No
Does the state conduct unannounced site visits? How many per year? Yes. 1 per a year at least.
Are background checks required, including volunteers? Yes. 606 CMR 14.05 1(b) EEC (BRC)-Volunteers must complete a BRC through EEC if they are assisting a Program in an unsupervised capacity and Mass. Gen. Laws c. 71, §38R