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Completed by:
The Unsilenced Policy Team
North Carolina 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.
North Carolina Legislation
| General Oversight and Transparency | Division of Health Service Regulation Children assessed with Level II, Level III or Level IV needs require the services of mental health group homes licensed by the Division of Health Service Regulation |
| Oversight Agency | Division of Health Service Regulation |
| Which state agency oversees investigations? | Division of Health Service Regulation |
| Are investigations and outcomes visible to the public online? | Yes |
| Ban on Conversion Therapy for LGBTQA+ youth? | Partial |
| General Oversight and Transparency | §131D-10.2. Childrens camp is regulated under 10A NCAC 70 Subchapter 70J - Minimum Licensing Standards for specialized residential child child care programs and Section .0100 - Children's Foster Care Camps. §131D-10.2. Definitions - Children's Camp" means a residential child-care facility which provides foster care at either a permanent camp site or in a wilderness setting. Children's foster care camp means the term ""children's camp"" as defined in G.S. 131D-2 |
| Oversight Agency | North Carolina Department of Health and Human Services, Division of Social Services |
| Which state agency oversees investigations? | North Carolina Department of Health and Human Services, Division of Social Services |
| Are investigations and outcomes visible to the public online? | Yes |
| Ban on Conversion Therapy for LGBTQA+ youth? | Partial |
| General Oversight and Transparency | Subchapter 11C - Requirements for Programs and Juvenile Crime Prevention Crime Programs Section .0100 – General Provisions |
| Ban on Conversion Therapy for LGBTQA+ youth? | Partial Ban |
| General Oversight and Transparency | GS Chapter 122 c covers both private & public psychiatric residential facility |
| Oversight Agency | Department of Health and Human Services |
| Which state agency oversees investigations? | Department of Health and Human Services |
| Are investigations and outcomes visible to the public online? | Yes |
| Is this type of program required to be licensed by the state? | Yes, but faith-based programs may be exempted from licensing requirements |
| 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. §122C-25 a Residential facilities specifically subject to inspection at all times by the Secretary & shall be inspected on an annual basis" yet § 122C-21 states that "The Department shall ensure that licensable facilities are inspected every two years to determine compliance with physical plant and life-safety requirements." Unannounced: "At a minimum" (not a specific number listed) there will be "an unscheduled inspection without notice" (§ 122C-25 c2) |
| Are background checks required, including volunteers? | Yes. Facility shall maintain accurate and complete personnel records for each facility employee during the term of employment, must contain at least the following: info regarding employee's education, training, experience, clinical competence, professional licensure status & number (if applicable), periodic work performance evaluations, pre-employment health exams |
| Is a full-time licensed clinician required to be on staff? | Yes, 10A NCAC 13B .5203 states present or on-call 24 hours a day; (b1-4). At least one each of the following: psychiatrist, psychiatric nurse, psychologist, and psychiatric social worker; a qualified mental health professional available by telephone or page and able to reach the facility within 30 minutes |
| Does the state require notification within 24-hours of a program admitting, discharging or major treatment change for children under its care? | § 122C-223 b Within 24 hours of admission, the facility shall notify the legally responsible person of the admission. Discharge § 122C-57 d1: "Discharge of a voluntarily admitted minor shall include notice to and consultation with the minor's legally responsible person and in no event shall a minor be discharged from treatment upon the minor's request alone" |
| Is a licensed clinician required to perform a mental health evaluation upon intake? | No Information |
| Does the state require mandatory child abuse response training for all staff working with children in residential settings? | Childcare providers who have direct responsibility for the care and oversight of children, including center administrators and family child care home operators, must complete certain trainings to comply with the NC Child Care Rules. NC Child Care Rules includes employment orientation within the first two weeks of employment that offers Information regarding recognizing, responding to, and reporting child abuse, neglect, or maltreatment pursuant to G.S. 110-105.4 and G.S. 7B-301 |
| Does the state require medical response training for all staff working with children in residential settings? | The facility shall provide new employee orientation and continuing education programs for all employees to maintain the skills necessary for the performance of their duties and learn new developments in health care |
| Does state require 1:4 staffing ratio or higher? | No. 10A NCAC 13B .5203 (a2) states sufficient number of appropriately qualified clinical and support staff to assess and address the clinical needs of the patient (a3) It is up to the facility to determine its overall staffing requirements (c3) Shift ratios listed for substance abuse services, but not listed for psychiatric services. For minors, 1 staff to every 5 minor inpatients from 7:00 am to 11:00 pm; in general, one staff member for each 20 inpatients |
| Ban on Conversion Therapy for LGBTQA+ youth? | Partially |
| Are there admissions requirements? | § 122C-211 a Written application for evalaution or admission, signed by individual or legal guardian required |
| Are the guardian & admitted child required to be informed of their their rights? | 10 NCAC 13B .3303: patients are informed of their rights in one of two ways: (a1) locations posted in a public place in the facility in addition to copies available upon request; or (a2) provided a copy to each patient or responsible party upon admission or as soon after admission as is feasible. |
| Is medication prescribing and monitoring required to be by a licensed physician? | Yes. 10A NCAC 13B .1917 - Prescribing & monitoring required to be by a licensed physician. For licensed facilities: (b) all medications or drugs to be administered and discontinued must be in accordance with signed physician's orders which are recorded in the patient's or resident's medical record; (b1) only physicians, registered nurses, licensed practical nurses or physician assistants, if in accordance with the assistant's approved practice, shall administer medications. |
| Does the state define institutional abuse and neglect? | Yes. 7B-301 covers any person or institution who has cause to suspect that any juvenile is abused, neglected, or dependent. Page 25 & 26 of CPS Intake for Out of Home Care Provider CPS Reports include protocol for when reports involve institutional placements |
| Are there civil penalties for violations of institutional child abuse and neglect? | § 122C-24.1: Type a1 & Type a2 violations that are not corrected is subject to civil penalty of up to $1,000 each day that the violation continues beyond specified time for correction. Type A1 violations: administrative & civil penalties for violations and failure to correct violation - Type A1 violations: death, serious physical harm, abuse, neglect, or exploitation; Type A2 violations: No civil penalties for actual violation but civil penalty for failure to correct violation - Type A2 violations: substantial risk that death or serious physical harm, abuse, neglect, or exploitation will occur |
| Does the state prohibit mail censorship? | § 122C-62 a1 states that adult clients have the right to receive and send sealed mail |
| Do the youth have unrestricted access to guardians, legal counsel, welfare advocates, religious clergy, friends and family via telephone? | Yes. §122C-62 c states that minor clients have a right to communicate and consult with parents/guardians, legal counsel, private physicians, private mental health, and client advocate |
| Are phone calls private from other youth and staff? | 122C-62 b1 Adults have a right to make and receive confidential telephone calls. §122C-62 d1 Youth have a right to "make and receive telephone calls" |
| Does the state require that children be allowed visitors in private and during normal visiting hours? | Under appropriate supervision, receive visitors between the hours of 8:00 a.m. and 9:00 p.m. for a period of at least six hours daily, two hours of which shall be after 6:00 p.m.; However, visiting shall not take precedence over school or therapies" (§ 122C-62 d3) |
| Is the facility required to provide an individualized treatment plan? Is the plan reviewed regularly? | §122C-57: "Each client within 30 days of admission to a facility shall have an individual written treatment or habitation plan implemented by the facility." 10A NCAC 13B .5204 a-d: Within 24 hours of admission, they must complete admission assessment (a1); within 72 hours, "preliminary individual treatment plan shall be completed and implemented" (a2); within 5 days, comprehensive individual treatment plan; outpatient: plan 30 days of admission to treatment (a3) |
| Is medical and psychological experimentation on youth prohibited without the express consent of all involved parties? | Requires written consent |
| Is it required that youth receive education that is of the same quality and outcomes as their assigned public school? | Minors shall receive educational services in accordance with federal and State law, if the child is eligible to enroll in public schools (§ 122C-451 a) |
| Is it required that youth receive age-appropriate sexual education, access to sexual healthcare, and menstruation supplies? | No |
| Is youth consent required for all treatment received? | For voluntary clients, they can withdraw their consent at any time (§ 122C-57d). Any treatment can be refused at any time. (§122C-57e) For involuntary clients, treatments may be given despite refusal of client and/or client's legally responsible person if any of the following are true: 1. the specific treatment measure is necessary to promote "a realistic opportunity of improving the client's condition" 2. without the specific treatment measure, there is a significant possibility the client will harm self or others. §122C-57 f "electroshock therapy, the use of experimental drugs or procedures, or surgery other than emergency surgery may not be given without the express and informed written consent |
| Does the state have zoning and occupancy requirements for structures being used to house youth in residential settings? | Yes. GS 122: Article 2: § 122C-21 (2) states that the purpose of the article is provide enforcement of basic rules governing construction, maintenance, and operation of licensed facilities. |
| Is there regulation for physical restraint? | § 122C-60 a: Physical restraint is permitted only when there is imminent danger of abuse or injury to the client or others, when substantial property damage is occurring, or when the restraint or seclusion is necessary as a measure of therapeutic treatment and must be reported. Further, only staff trained in restraint and seclusion may utilize it. |
| Is there regulation for chemical restraint? | No Information |
| Is there regulation for mechanical restraint? | Restraint is defined as meaning both physical and mechanical restraint. Both are permissible |
| Is there regulation for seclusion? | § 122C-60 a: Physical restraint is permitted only when there is imminent danger of abuse or injury to the client or others, when substantial property damage is occurring, or when the restraint or seclusion is necessary as a measure of therapeutic treatment and must be reported. Further, only staff trained in restraint and seclusion may utilize it. |
| Is there a Bill of Rights for youth in care? | Yes |
Additional Information
Unsilenced Program Database: North Carolina Programs
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