Oklahoma State Office of Juvenile Affairs' response to the Office of Juvenile System Oversight's complaint no. 34323-04 issued August 5, 2004.

              3812 N. Santa Fe, Suite 400
P.O. Box 268812
Oklahoma City, OK 73126-8812
Main # (405) 530-2800
FAX # (405) 530-2890
J 375.3 R127r 9/2004 c.l
State of Oklahoma
Office of Juvenile Affairs
September 28, 2004
Janice Hendryx, Director
Oklahoma Commission on Children and Youth
500 North Broadway, Suite 300
Oklahoma City, Oklahoma 73102
Dear Ms. Hendryx:
At your request, transmitted herewith is a redacted version of the original Response of the Office of
Juvenile Affairs, filed September 9,2004, to the Office of Juvenile System Oversight's Complaint
No. 3423-04, issued August 5, 2004.
Sincerely,
\UJ~
Richard DeLaughter
Executive Director
RDIDB/vs
Enclosure
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OKLAHOMA STATE
OFFICE OF JUVENILE AFFAIRS'
RESPONSE to the
OFFICE OF JUVENILE SYSTEM OVERSIGHT'S
Complaint No. 3423-04
issued August 5, 2004
Richard Delaughter, Executive Director
Gary Bolin, Chief of Staff/Deputy Director September 28, 2004
RESPONSE TO OJSO INVESTIGATION
I. OVERVIEW
In 2001 and throughout 2002, the Office of Juvenile Affairs was required to respond to the
mental health needs of an unprecedented number of seriously emotionally disturbed youth who
presented with potentially life-threatening manifestations of their emotional illnesses.
The first was Juvenile "A," who had been adjudicated as a delinquent child in 1999, but who
had been a minor alleged to have been in need of inpatient mental health treatment in five petitions
prior to his 17thbirthday. While placed in a private inpatient treatment facility, Juvenile "A," after
ingesting a battery, had to undergo a surgical resection of his bowel. The private facility refused to
readmit Juvenile "A" due to the enormous potential for liability, and he was placed at the Central
Oklahoma Juvenile Center (COJC) while the Office of Juvenile Affairs (OJA) and the Department
of Human Services (DHS), serving as dual custodians, sought an alternative inpatient placement.
When no other private facility would accept Juvenile "A," OJA sought his placement at the
Department of Mental Health and Substance Abuse Services' (DMHSAS) Oklahoma Youth Center
(aye). When DMHSAS refused to accept Juvenile "A," the placement dispute was submitted to
an arbitrator pursuant to 10 O.S. 2001, § 7303-8.5 and the court's order. The arbitrator determined
the most appropriate placement for Juvenile "A" to be the OYC where he would receive increased
access to "psychiatric care and pharmacological intervention" around the clock. Throughout the
time that Juvenile "A" was confined in COJC, he was segregated from the general population,
placed in a "clean room," and on a 2:1 supervision. The same supervision was provided by OJA
while Juvenile "A" was hospitalized recovering from surgery. While placed at OYC, Juvenile" A"
was placed in a "clean room" constructed by OYC for that purpose and was also placed on a 2: 1
supervision.
During this period, there was one DHS' Office of Client Advocacy (OCA) investigation
as to Juvenile '~." It did not find his placement in the "clean room"to be in violation of any
OJA Policy or any other standard for operation.
The second of extremely emotionally disturbed youth was Juvenile "B," who was placed in
a special unit at COJC under 24-hour surveillance by two staff members as a result of a pattern of
self-injurious behavior, including swallowing metal objects and inserting objects in his penis and
rectum. On December 23, 2002, Juvenile "B" ingested a metal spoon handle and was hospitalized
for observation.
Following his discharge from the hospital, he was admitted on an emergency basis to a
private mental health facility for a mental health inpatient evaluation. On January 9, 2003, an order
committing Juvenile "B" for inpatient treatment was entered authorizing Juvenile "B"'s placement
in a long-term private inpatient mental health facility until May 2003 when he absconded from the
placement. He continued to have episodes of swallowing harmful objects while hospitalized.
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OJA's Response to OJSO Investigation
During Juvenile "B"'s stay at COJC and his segregation in a "clean room" and 2:1
supervision, there were three DHS OCA referrals. OCA did not find his placement in the
clean room to violative of OJA's Policy.
The third of severely emotionally disturbed youth was Juvenile "c." This adolescent male
arrived at Rader in February 2002, following adjudications for Arson II, Assault with Intent to
Commit a Felony and Assault with a Dangerous Weapon following multiple psychiatric
hospitalizations: During his stay at Rader, Juvenile "C" threatened suicide, inserted objects in his
penis, scratched himself, engaged in moderately severe biting of his arms, and assaulted staff and
others. Juvenile "C" had multiple emergency room visits and was eventually placed in a "clean
room" on 2: 1 supervision 24 hours a day. In November 2002, a psychological evaluation was
conducted for the purpose of obtaining an inpatient mental health commitment order for Juvenile
"c." A petition for inpatient mental health treatment was subsequently filed. While awaiting the
issuance of the court's order, Juvenile "C" inserted an object in his penis which required surgical
removal. On November 26, 2002, an inpatient commitment order was issued by the court. When
no private placement would accept Juvenile "C," the DMHSAS's OYC facility was contacted for
placement. At the time, OYC was at capacity, and OYC requested time to reduce their census in
order to provide 2 on 1 staffing. In addition, ayc sought the expertise of aJA as to whether a
"clean room" should be constructed for Juvenile "C" as had previously been provided by ayc for
Juvenile" A" and as to whether precautions needed to be taken in order to ensure the safety of other
residents. Juvenile "C" was admitted to ayC on January 7, 2003, placed on 2:1 supervision, and
placed in gloves to reduce the opportunity for self-mutilation. Juvenile "C" was discharged and
returned to Rader on July 3, 2003.
During the period of time that Juvenile "C" was segregated from the general population
at Rader and placed on 2:1 supervision 24 hours a day, as well as the time he was placed at
OYC, OCA made 7 visits to Rader. OCA found no violations of OJA Policy with respect to
Juvenile "C't's confinement.
II. THE SOLUTION
Because of the obvious exposure to liability the private facilities faced in accepting these
types of self-injurious juveniles for inpatient treatment, few were willing to attempt treatment and
when they did, the self-injurious behavior often persisted post-hospitalization. None was willing to
readmit following discharge of the resident. As a result, aJA was continually thwarted in its efforts
to provide mental health services to this population.
In March 2002, the Executive Director ofOIA authorized OIA staff to visit Corsicana, Texas
to review that state's mental health stabilization unit housed within a delinquent institution for the
purpose of developing a program in Oklahoma to meet this population's mental health needs. Those
participating included OJA's chief psychologist, legal counsel, Advocate General, the division
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OJA's Response to OJSO Investigation
administrator for institutions, and program staff. This group of individuals toured the facility and
obtained copies of programming for the unit, admission policy, and other relevant documents to
study and to modify to meet OJA's statutory responsibilities. In the fall of 2002, the Executive
Director also presented Legislative staff with an overview of the critical needs of this population and
the problems in obtaining private or public inpatient care. Despite recurring revenue shortfalls, OJA
staff felt that the treatment need was so critical that OJA cut other programs in order to fund a new
unit -- a mental health stabilization unit. There was no allocation by the Legislature and no grants
or other money obtained from any source to fund the unit. By August 2003, the Rader Mental Health
Stabilization Unit was fully staffed, and residents who met criteria for placement, including those
with serious behavioral problems, were admitted.
While OJSO has condemned in its report the Mental Health Stabilization Unit which had
been operational for less than one year at the time of its visit, OJA maintains that the creation of the
unit was the only responsible response to a system of private and public facilities that refused to treat
youth with these types of life-threatening emotional and neurological illnesses with attendant severe
behavioral manifestations.
Since the creation of the mental health stabilization unit, 44 juveniles have been admitted to
the unit. The median length of stay is 23 days. Once stabilized, youth are returned to the facilities
from where they were admitted. Thirty-five (35) residents have discharged from the mental health
stabilization unit. There have been seven (7) re-admissions. If the unit is unsuccessful in stabilizing
a resident, OJA may seek, through the appropriate district attorney's office, an inpatient commitment
order from the court. No petitions have been filed seeking an inpatient commitment order for male
residents since the creation of the unit. Since the creation of the unit, there has been one 5-day
emergency psychiatric hospital admission.
Attached as Exhibit" 1" are copies of the admitting criteria, resident rights, and program for
the Mental Health Stabilization Unit. The unit is not an inpatient mental health facility, but rather
an intermediate intervention to address the residents' acute mental health needs and to prevent
further inpatient commitments. It is not independently licensed by the Department of Human
Services.
III. THE FINDINGS
The Office of Juvenile Affairs finds it absolutely imperative to address the findings of OJSO
which are inadequately investigated, unsubstantiated and which result from a selective cherry-picking
of information that renders the findings biased and absent of any professional credibility.
The Office of Juvenile Affairs has obtained from the Oklahoma Commission on Children and
Youth (OJSO) a copy of a report issued by a psychologist who had been retained by OJSO in March
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OJA's Response to OJSO Investigation
2004 to review the Rader Mental Health Stabilization Unit program and to render an opinion as to
the quality of the program and the use ofthe "suicide barrel." The conclusions reached by the OJSO-retained
psychologist in his draft report clearly undermine the credibility and objectivity of the OJSO
report. After reviewing the Mental Health Stabilization Unit, the consultant states in relevant part
as follows:
I[n] conclusion, I found no significant problems with the care
provided the MHSU juveniles. I made several technical
suggestions for ways to improve written policies and program
plans for which MHSU staff and [OJA's Chief Psychologist]
seemed appreciative and promised to implement the suggestions.
Each specific concern given by [OJSO] was explained or
contradicted in a credible manner.
This conclusion, by a recognized professional in the field, was completely withheld from the OJSO
report and the "technical suggestions" were presented as significant problems in a manner which was
clearly misleading regarding the overall conclusions of the psychologist. This type of selective and
misleading presentation of investigative information completely discredits the authors of the OJSO
report.
During his site visit to the Mental Health Stabilization Unit, the psychologist also interviewed
the youth located on the unit. The youth reported "...no concerns, other than the normal wish to be
allowed to return to the general population." Again, it is of significant concern that these findings
were deliberately withheld from the OJSO report. This selective and misleading use of investigative
information completely undermines the credibility of the OJSO investigators, and the Oklahoma
Commission on Children and Youth should take immediate action to reestablish the integrity of its
investigations. '
With regard to the particular findings, OJA submits the following responses.
A. OJA's Responses to OJSO
- The Mental Health Stabilization Unit Findings
OJSO Question #1. Is the use of the suicide smock for the residents on the MHSU
consistent with OJA policy, which provides that juveniles are entitled to be protected and
cared for in a safe, caring, and humane environment?
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OJA Response: The Office of Juvenile Affairs absolutely refutes the findings of OJSO
regarding the use of the suicide smock within the Mental Health Stabilization Unit as violative of
OJA Policy or any other standard for operation. The findings contain mere allegations and provide
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OlA's Response to 01S0 Investigation
absolutely no independent verification. The suicide smock is the same as that currently used in
county detention centers. It was used by the Corsicana, Texas facility after which 01A's
stabilization unit is modeled. In March 2004, the Corsicana's stabilization unit passed an American
Correctional Association's (ACA) audit while employing the smock and other protective gear.
Because residents admitted to the unit are those who may be at risk of harm to themselves, including
swallowers, self mutilators, and head bangers, the smock, as well as mittens and head gear, are
appropriate protective clothing.
This finding should be stricken from the report as unsupported by any evidence. There is a
camera in the unit that records all activity. The film can be accessed by 0180 or any other
investigative body.
OJ80 Question #2. Do the residents and direct care staff members view wearing the
suicide smock as a form of punishment?
OJA Response: The use of the suicide smock is an acceptable response to suicide attempts,
threats, or self-mutilating behavior. This finding is in direct conflict with the portion of the 0180-
retained independent psychologist's report deliberately withheld by the 0180 investigators. As
noted by 0180's psychological consultant: "The 'suicide barrel' is an unfortunate label chosen
by the commercial corporation that makes and sells the suicide smock. It is made of
indestructible cloth material and is common in use in this field. Moreover, it appears to be
used only for legitimate clinical reasons, and not for humiliation or punishment." This
deliberate withholding of investigative information of 0180's own consultant clearly undermines
this finding and again calls into question the credibility of the entire investigation.
There is no OlA policy requiring the unit's mental health treatment staff to justify the use
of the smock or to document the justification. 0180 could easily determine which residents
. presented as suicidal or self destructive and could just as easily have concluded that the use of the
smock, helmet, or gloves were indicated generally. That the psychologist for the unit and the
psychological clinician were those authorized to direct the use of the protective clothing supports
a conclusion that staff with the appropriate expertise directed its application in accordance with
professional standards. Documentation provided at the time of referral as well as consultation with
the referring institutional staff are the factors relied upon to determine placement in precautionary
equipment.
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OJA's Response to OJSO Investigation
OJSO Question #3. Do the residents on the MHSU receive appropriate mental health
treatment?
OJA Response: The Mental Health Stabilization Unit treatment modalities include group
sessions and individual sessions. A schedule of sessions, as well as all planned daily activities, are
individualized and formalized. Because of the generally low intellectual functioning of this
population, all therapeutic materials are presented to the residents verbally. Even written programs,
such as the Phillip Roy Living Skills Program, are presented verbally. This method of presentation
enables staff to ensure that the residents are comprehending the material or at least have the best
opportunity to do so. The OJSO report indicates that most of the residents were functioning on
a first grade reading level. Dealing with mental health and behavioral issues of this population was
difficult, and programs were modified to account for the intellectual deficits,
The Psychological Clinician has all her treatment notes available for review. All residents
had daily access to the clinician. Additionally, the environment on the unit itself is therapeutic and
is called "milieu therapy" in the profession.
The Mental Health Stabilization Unit is not an independently licensed facility and is not
required to meet Department of Human Services' licensing standards independently of the Rader
Center. All records, including progress notes and reports, are maintained in the residents' master
files at Rader. OJSO staff clearly did not access that me to verify whether reports were available.
All records are ultimately maintained in a master file. There may be some delay in filing notes and
reports in the master me depending on the demands of the unit. In approximately March of this year,
the Mental Health Stabilization Unit began to keep a duplicate me on site. This practice was
established for the convenience of outside oversight bodies, such as OJSO. It is not required by OJA
Policy, Terry D. Dismissal Order, or ACA Standards. Drug and alcohol treatment records provided
by off site counselors are also maintained in the master me. They were not located on site during
.the OJSO visit. Obviously, the investigating staff made no attempt to obtain the treatment records
it referenced from the drug and alcohol counselor or from the master me.
Residents do eat their meals in their rooms. This practice was modeled after that established
in the Corsicana, Texas facility. This population has difficulty setting or respecting boundaries.
Taking meals in their rooms limits the potential for physical aggression among residents.
The mental health stabilization unit residents engage in group activities and interactions.
This population is mainstreamed in the Intensive Treatment Program (lTP) school and is not
segregated from other residents. When residents are not in school because of behavioral issues, the
residents remain on cottage where assignments are received and are to be completed. Church
services are available on site as well.
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01A's Response to 01S0 Investigation
It is difficult to understand why 01S0 staff would base its finding of length of stay on the
reports of residents with such low intellectual functioning or base its assessment of the quality of
mental health treatment on their opinions. Mental Health Stabilization Unit residents with such low
intellectual functioning do not have a concept of time or an understanding that their conditions must
be stabilized prior to exiting the program. Even when a resident reports that he has "stopped hearing
voices," he must be observed until the behavior and medications equalize. Research indicates that
76 percent of those experiencing auditory hallucinations experience them intermittently, not
continuously, thus requiring consistent observation across time in order to make accurate treatment
decisions. The verbal self-report of psychotic individuals experiencing hallucinations is unreliable.
An example of this is where a resident is reported by 01S0 to have said he could hide medications
in the mittens when it is standard practice on the Mental Health Stabilization Unit to crush all
medications prior to distribution. Information regarding the length of stay for residents may be
accessed in the master file.
A new form for writing progress notes has been implemented facility-wide, not just in the
Mental Health Stabilization Unit. Efforts are being made to standardize the format for reporting.
The admissions and discharges from the Mental Health Stabilization Unit are recorded and
maintained in the master file. The Psychological Clinician modified the form for recording progress
notes to accommodate the specialized needs of the unit.
OJSO Question #4. Are there specific criteria for admission to the MHSU, and if so,
did the facility consistently adhere to it?
OJA Response: 01S0 failed to consult the master files of the residents to determine
whether the criteria for admission and the process for retention were followed. As noted earlier, a
copy of the admission and retention criteria for the Mental Health Stabilization Unit is attached as
Exhibit" 1." 01S0 provides no examples of improper admission or retention. This finding is based
upon the unverified statements of three (3) residents. Complete transcripts of the admission and
retention proceedings are available for review for each resident in the master files.
OJSO Question #5. Did the administration at the Rader Center provide the residents
on the MHSU with appropriate opportunities for education and planned activities?
OJA Response: All residents on the Mental Health Stabilization Unit attend school as their
behavior permits. When they are unable to attend school due to having been placed on suicide watch
or due to other issues, teachers bring school work to the unit for them to complete. All Mental
Health Stabilization Unit residents are restricted from vocational classes. This is due to the large
number of sharp instruments available in these classes which may have contributed to an unsafe
environment for the Mental Health Stabilization Unit juveniles or others with whom they have
contact.
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OJA's Response to OJSO Investigation
Recreation is granted at least twice daily. All residents attend if possible. Some may have
doctor's appointments or be restricted to cottage due to self-injurious behaviors. Juveniles are
given the opportunity for recreation on the unit when this happens and are given leisure time in the
evenings. Usually, this includes both table games and a second opportunity for large muscle activity.
Residents do assist each other with school work where appropriate. Contrary to the
unverified finding of OJSO report, residents may check out writing instruments throughout the day.
A special time of one hour is also provided to the residents each evening for journal writing or
school work.
The OJSO investigator reports that three residents stated that the grievance process did not
work and they no longer bothered to file grievances. Contrary to the implications of this unverified
finding, if the OJSO investigator had consulted the Rader Advocate Defender, he would have
ascertained that from the period July 2003, through July 2004, 73 grievances had been filed by
Mental Health Stabilization Unit residents and that 62 have been resolved. In addition, there have
been 33 OCA referrals, 12 of which were investigated by OCA. Twenty referrals were investigated
as caretaker misconduct reviews. One was referred to administration. Of the 20 caretaker
misconduct reviews, three remain unresolved. It is troubling that OJSO did not include this
information in its report.
OJSO Question #6. Did the treatment plans adequately address the needs of the
residents who were assigned to the MHSU?
OJA Response: Mental Health Stabilization Unit treatment plans address the needs of the
residents, including the resident diagnosis, medications, targeted behaviors, and a review of progress
and individual therapy reports. Progress and treatment are designed to introduce coping and
treatment skills. All treatment records, plans, and progress reports are kept in a master file, and since
approximately May 2004, for the purpose of accessibility, duplicates are now kept on the unit.
Before May 2004, the idea for keeping duplicates of the master files on the unit was being
considered. Treatment plans must meet DHS standards, and discussions had also been taking place
regarding conforming the current format for treatment plans to meet DHS standards. Currently,
Mental Health Stabilization Unit practice exceeds DHS standards because treatment plans are
developed weekly as opposed to monthly, as required by DHS.
Additionally, from January to May 2004, the Psychological Clinician was working on both
the treatment plans and progress notes to fill in for an absent social worker. The clinician was
responsible for entering the information into the computer, printing out the information, and then
delivering it to the master files. At the time of the OJSO investigation, all treatment plans were kept
in a master file: Some delay in filing treatment plans in the master file was caused by staffing
shortages. Treatment, however, was always provided. In addition, the treatment plans developed
for short-term treatment in the Mental Health Stabilization Unit did not incorporate the global
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treatment plans developed for delinquent offending behavior, The goal of the Mental Health
Stabilization Unit was to stabilize behavior so that further treatment could be accomplished in the
general population, The goals of the general treatment plan were reinstituted upon the resident's
discharge from the Mental Health Stabilization Unit and his return to the general population,
B. OJA's Responses to OJSO - Solitary Confinement
OJSO Question #1. Did the administration of the Rader Center violate the provisions
of the Terry D. Dismissal Order, DHS licensure standards, ACA Standards, and OJA Policy
by keeping a resident in solitary confinement in excess of three months? .
OJA Response: alSO's characterization of Juvenile "C" as having been placed in "solitary
confinement" is irresponsible and calculated to discredit the Office of Juvenile Affairs' staff who
went to extraordinary lengths to secure Juvenile "C"'s safety and to prevent permanent damage as
a result of self-mutilization or even death. "Solitary confinement" of any juvenile is defined in the
Terry D. Dismissal Order to be:
A. Solitary confinement is the involuntary removal of a child
from contact with other persons by confinement in a locked
room, including the child's own room, except during normal
sleeping hours.
The same definition appears in OJA Rules at 377:35-11-4. OJSO's investigative staff knew that at
all times leading up to Juvenile "C"'s mental health inpatient commitment, he was never removed
from contact with other persons or locked alone in a room. At all times Juvenile "C" was placed
on 24-hour-a-day, 2: 1 supervision. Even so, Juvenile "C" was able to obtain objects and insert them
into his penis which in some cases required surgical removal. During the time that Juvenile "C"
was placed at Rader, he was hospitalized four times. The burden on staffwas enormous and the cost
of his emergency medical care for the period leading up to his inpatient commitment was $14,366.
He reported to the Rader medical staff for care 195 times while at Rader from July 2002, until his
discharge in July 2003. OJA's response to this critical situation which taxed alA's resources to the
limit was swift, competent, and appropriate by any standard with few exceptions, Not only did OJA
collectively not violate its own policies, Terry D. Dismissal Order requirements, or ACA
accreditation standards, it preserved the very life of this young man,
The Department of Human Services' Office of Client Advocacy, the State agency responsible
for child abuse investigations, investigated the same allegations of improper solitary confinement
as did OlSO, Their conclusion was that Juvenile "C" was not improperly confined. In stark
contrast to the alSO findings, the OCA investigation concluded that:
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...the restrictions that accompanied [Juvenile "e"'s] placement in
the clean room (e.g., no peer contact; limited contact with small
objects) were the minimum necessary to accomplish the purpose
for which his stay in the clean room was intended. There is no
evidence that he had suffered any deterioration or adverse
effects, physically or psychologically, and in fact, he reported in
retrospect that he liked being there because it prevented him
from harming himself. He did not lose weight or engage in
behaviors indicative of stress any different than he would have
experienced living on the unit. In fact, the decrease in self-abuse
and hospital visits had the effect of reducing stress in his life.
A copy of the OCA report is attached as Exhibit "B."
The Office of Juvenile s Oversight erroneously states that Juvenile "C" was placed in the
Mental Health Stabilization Unit on November 8, 2002. The Mental.Health Stabilization Unit did
not exist in November 2002 and was not operational until the summer of 2003. The OJSO
investigation is, in the very least, careless in reporting as fact things that did not happen. This is an
example of that kind of shallow investigating and biased reporting that characterizes the entire OJSO
report.
This entire flawed section should be stricken from the report.
OJSO Question #2. Did the Rader Center's Superintendent, Deputy Superintendent,
and Advocate Defender violate the provisions of the Terry D. Consent Decree's Dismissal
Order by authorizing the resident to be kept in solitary confinement in excess of three months?
OJA Response: To reemphasize, Juvenile "C" was never placed in solitary confinement,
nor in the Mental Health Stabilization Unit, which was not in existence when Juvenile "C" was
placed in the "clean room." No employee violated any provision of the Terry D. Dismissal Order.
The superintendent's refusal to address the repeated allegations of solitary confinement was in
response to the harassing and heavy-handed interrogation methods employed by the OJSO
investigator. The superintendent was advised to refer all inquiries from this investigator to legal
counsel in order to avoid further conflict with the investigator.
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01A's Response to OlSO Investigation
OJSO Question #3. Did the OJA Deputy Director ofInstitutions know that the resident
was being kept in solitary confinement in excess of three months?
OJA Response: Juvenile "C" was never placed in solitary confinement. His placement in
the "clean room" was a provisional measure designed for the purpose of keeping Juvenile "C" free
from self harm while awaiting the legal process for inpatient mental health treatment. The resident
with whom alSO makes a comparison, Juvenile "A," was admitted to OYC following mandatory
arbitration pursuant to Title 10 O.S. 2001, § 7303-8.5. When the Department of Mental Health and
Substance Abuse Services was required to accept the resident, DMHSAS also constructed a "clean
room" and removed all potentially harmful substances from the room. He was placed on the same
2: I supervision. It has never been alleged by alSO to OJA's knowledge that DMHSA improperly
confined Juvenile "A" in solitary confinement.
OJSO Question #4. Did the staff members violate policy and procedure by not
completing an incident report after the resident was restrained or was searched, to detail the
reason for the search and what contraband was seized?
OJA Response: The Mental Health Stabilization Unit was not in existence at the time
Juvenile "C" was placed in the "clean room." When all private mental health treatment facilities
refused to accept Juvenile "C" for treatment for fear of exposure to liability, OJA was required to
work with OYC to accomplish his eventual placement. During this time, finger foods had been
ordered for Juvenile "C" because Juvenile "C" had inserted fork tines in his penis and threatened
to swallow a spoon. After Juvenile "C" reported swallowing an object, the Rader contracted
physician ordered a liquid diet for Juvenile "C" to facilitate taking x-rays to locate the object only.
The implication that this diet was somehow a punitive measure is irresponsible.
The inability of Rader administrative staff to locate certain activity logs that were ultimately
obtained by OJSO "through other means" leads OJA Administration to believe that the logs were
improperly removed from Rader. In addition, during the exit interview conducted by OCA, where
alA was found not to have violated the solitary confinement process, the OCA investigator indicated
that she was provided OJA documents by an OJSO investigator. The "missing logs" obtained by
OJSO should be returned immediately to OJA. Copies of search forms from the period October
2002, through January 2003 are submitted by separate cover.
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OJA's Response to OJSO Investigation
OJSO Question #5. Did the Rader Center's administration violate policy by subjecting
the resident to humiliation by assigning female staff members to watch him shower, urinate,
and defecate?
OJA Response: It should be noted that the Office of Juvenile System Oversight (OJSO)
report makes no reference to the need to take drastic measures to protect the resident from harming
himself. Nothing is said about the previous injuries the juvenile inflicted on himself, his uncanny
ability to find and secret items with which he injured himself, and the chain of unsuccessful
protective measures taken by the Rader staff to prevent further harm to the juvenile. Instead, the
OJSO report seizes on the memorandum of December 12, 2002, in isolation and built its case on that
basis.
To compound the situation, OJSO then relied on subjective reports from staff members
regarding their opinions of the juvenile's reactions rather than interviewing the juvenile himself.
There was no reference in the OJSO report to entries by the staff members in the unit logbook or the
juvenile's progress notes about their dissatisfaction with the arrangements of which they complain
almost two years after the fact. Similarly, there is no mention that any staff members filed
grievances concerning the arrangements that they now find offensive.
The Office of Juvenile System Oversight refers to a civil lawsuit from Louisiana and
apparently advances the theory that it is in some way legally controlling in Oklahoma. Such is not
the case. The Louisiana case has no precedential effect whatsoever in Oklahoma and sets no
standards or guidelines which are enforceable except as between the parties to the settlement
agreement in that case.
Finally, it must be remembered that the Rader Center is subject to the requirements of the
Civil Rights Act and must walk the tight rope between discrimination and employer discretion. If
the Rader administration had assigned only male staff members to monitor the juvenile, there was
a distinct possibility that it would have exposed itself to a claim of discrimination from both the male
and female staff members. During the period when the incidents involving the juvenile in question
were taking place, the Rader Center was defending a lawsuit in the United States District Court by
a male employee who alleged he had been the victim of gender discrimination because he was not
allowed to work on the girls' cottage. During the course of that lawsuit, the Rader Center and OJA
came under the scrutiny of the Equal Employment Opportunity Corrimission and the Civil Rights
Division of the Department of Justice. Those two federal agencies demanded that all staff be treated
alike and without regard to their gender.
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OJA's Response to OJSO Investigation
OJSO Question #6. Does the Rader Center discriminate in the psychological treatment
of the residents because of gender?
OJA Response: The Office of Juvenile Affairs is required by law to provide for the mental
health needs of its population. How it provides those services is within its discretion. For example,
no females are housed at Southwestern Oklahoma Juvenile Center so no services are provided there
for females. In its other two facilities, females have access to mental health services the same as
male residents. If a female resident requires acute mental health services, a petition for an in-patient
commitment order may be filed with the court, and an inpatient placement will normally be found
promptly. There has been, however, a history of refusal of public and private facilities to take male
residents because of the severe behavioral manifestations of their mental illnesses. Accordingly,
OlA has responded appropriately in providing services in its stabilization unit in response to the
unavailability of services outside this setting for boys. Nevertheless, all residents' mental health
needs are addressed whether through public or private means.
OJSO Question #7. Did the Rader Center's administration deny the resident who was
housed in solitary confinement his right to an education and treatment from the psychological
clinician?
OJA Response: The Mental Health Stabilization Unit was not in existence at the time that
Juvenile "C" was placed in the "clean room." Obviously, there would be no record of his activities
while in the "clean room" maintained in the Mental Health Stabilization Unit.
The Mental Health Stabilization Unit was operational by August 2003. Because of Juvenile
"C"'s dangerous self-mutilating behavior, it was extremely difficult during the period of time that
the agency sought to obtain an inpatient commitment order for QJA to provide for anything other
than life-sustaining services for Juvenile "c." Juvenile "C" had a history of and ongoing
propensity for inserting objects into his penis, including paper clips, pencils, utensils, and broom
straws. Staff at the Rader Center made every effort to provide an educational environment for
Juvenile "C," but were primarily concerned with keeping Juvenile "C" free from self-rnutilizing
and life-threatening behavior. Juvenile "C" received assignments from the school which proved
to be too difficult for him. This difficulty was noted by the Administrator of Programs and corrected
by the school. Staff assisted in completing the assignments. The Psychological Clinician Supervisor
conducted regular therapy sessions with Juvenile "C," and the Administrator of Programs with a
doctorate in psychology saw Juvenile "C" daily (five days a week.)
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OlA's Response to OlSO Investigation
OJSO Question #8. Did the administration violate ACA Standards and/or OJA Policy
by not allowing the resident to participate in outdoor recreation?
OJA Response: While the Office of Juvenile Affairs sought an inpatient commitment order,
Juvenile "C" was placed in the "clean room" to control his environment for substances which could
be used for self-rnutilization. It was impossible to control the outdoor environment to ensure that
Juvenile "C" would not obtain objects to insert into his penis. It was also the case that fellow
residents would provide Juvenile "C" objects for insertion purposes. Because of this repeated self-mutilization
behavior, outdoor recreation, while attempted, was terminated and contact with other
residents was eliminated. It was the highest priority to keep Juvenile "C" from self-mutilization.
OJSO Question #9. Did OJA attempt to obstruct OJSO's investigation by not
providing documents and instructing staff to decline requests for interviews by OJSO?
OJA Response: The OJSO investigator so harassed the superintendent of Rader that he
sought legal advice with respect to his obligation to be interrogated by the investigator. Because of
the investigator's heavy-handed interrogation methods, legal counsel to the superintendent advised
him to direct the investigator to her for inquiries or document requests. As previously addressed,
missing alA documents in the possession of OlSO should be returned to alA immediately.
OJSO Question #10. Did the Rader Center's administration attempt to conceal from
the ACA auditors the fact that the resident was kept in solitary confinement, by placing the
resident on the MHSU while the audit took place, and then returning him to the seclusion
room when the audit was completed?
OJA Response: It should be noted that there was no mental health stabilization unit in
existence during the period of time that Juvenile "C"was placed in the "clean room." Rader staff
made twoattempts to reintegrate Juvenile "C" back into the general population, one of which
occurred during the audit.
OJSO Question #11. Did the OJA Executive Director, the OJA Deputy Director of
Institutions, and the Rader Center's administration violate the provisions of the Terry D.
Consent Decree's Dismissal Order, ACA Standards, and OJA Policies by keeping two male
residents locked in solitary confinement in excess of forty days?
OJA Response: From February 10, 2004, through February 18, 2004, two residents were
engaged in a series of staff assaults. One of these had also engaged in inciting a riot. Because the
assaults were escalating in frequency and severity, the Director of OfA ordered the residents not to
be returned to their units.
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OJA's Response to OJSO Investigation
Rader Procedure provides for admissions to a crisis management unit upon the directive of
the administrator on duty. Once admitted to the Crisis Management Center (CMC), the two
juveniles in question continued to receive a full range of services including educational, medical, and
recreational services. Activity logs for each juvenile reflect all activities undertaken while housed
in the CMC. In addition to placement pursuant to directive, a juvenile may request placement in the
CMC.
Attaclunent 7 to the 01S0 Report does not indicate that residents were locked in their rooms
22 of24 hours each day, as alleged in the OJSO report. Further, the OJSO report does not allege that
the residents were, in fact, locked in their rooms 22 of 24 hours. The inclusion of this information
by 01S0 appears to be for effect only and not for the purpose of obtaining a meaningful response
from OJA.
The residents housed in the CMC were not placed in the solitary confinement room within
CMC. The door to the solitary confinement room had been destroyed by one of the residents.
The juveniles remained on the unit pending the filing of criminal charges. It was deemed to
be unsafe for staff and other residents, as well as themselves, to be returned to the general
population. There had been several assaults on staff the week preceding confinement.
Special management of these two juveniles required continued segregation from the general
population. A specialized treatment plan was developed for the juveniles while they remained
segregated in the CMC. This response to the juveniles' assaultive behavioral issues is consistent
with ACA Standard 3 JTS-3E-01.
OJSO Question #12. Was the Advocate Defender aware that residents were housed in
solitary confinement, and did the Advocate Defender fail to report to the DHS Office of Client
Advocacy allegations of abuse and/or neglect and violations of the Terry D. Consent Decree's
Dismissal Order?
OJA Response: The Advocate Defender was concerned that continued placement of the two
juveniles in the CMC beyond 72 hours violated Rader Procedures, not that the youth were
being held improperly in solitary confinement. The Advocate Defender, therefore, had no reason
to file a complaint with OCA regarding solitary confinement.
On April 1, 2004, the Advocate Defender made a referral to OCA based on an allegation that
the juvenile was being confined to his room for 22 of 24 hours. On April 2, 2004, the Office of
Client Advocacy declined to investigate the complaint and referred it back to OJA Administration
for review which did not require any further investigation or response. A subsequent disposition
was made by OCA on June 7, 2004, which made the allegation a caretaker misconduct review. The
facility, not OCA, investigated the allegation. A finding of "not confirmed" was made on July 2,
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OlA's Response to OlSO Investigation
2004. The Advocate Defender supplied a copy of the referral and all grievances requested upon the
OlSO investigator's arrival at the institution.
OJSO Question #13. Did the Rader Center's administration violate OJA Policies, ACA
Standards, or the Terry D. Consent Decree's Dismissal Order by denying the residents' rights
to an education and assistance from their teachers?
OJA Response: Educational materials were supplied to the two juveniles on the CMC unit
on a daily basis. The CMC is similar in concept and program to that where a juvenile is "restricted
to unit" as a programmatic response due to severe behavioral problems that endanger them or
others. In the latter cases, education is provided on the unit in the same manner as in the CMC.
OJSO Question #14. Did the Rader Center's administration report all serious incidents
in a timely manner to the DHS Office of Client Advocacy?
OJA Response: The Advocate Defender did not report that a resident had been locked in
a room for three months because it did not happen. Similarly, he did not report that two residents
in the CMC were improperly held in solitary confinement because they were not. The allegation
filed with DHS' OCA was that a resident of the CMC had been confmed to his room 22 of24 hours.
He did not report that the Psychological Clinician was not visiting the CMC resident. It is, therefore,
impossible to know what "correct information" was sent to OCA by OJSO. The Office of Client
Advocacy has not advised OlA of any further disposition of the referral.
OJSO Question #15. Does the Advocate Defender for the ITP at the Rader Center.
ensure that grievances are collected, properly assigned, and resolved in a timely manner?
OJA Response: The Advocate Defender performed his responsibilities in a timely and
professional manner. The Advocate Defender was not, however, responsible for delays in resolution
of grievances occasioned by staff absences, crises, coordinating of juvenile activities with staff
schedules, or other unanticipated conflicts.
There were 101 grievances filed by ITP residents in February and March of 2004, and
October and November of2003. Eighty-four (84) grievances have been resolved. Grievances
involving allegations of abuse, neglect, or caretaker misconduct are referred to OCA for
investigation. All other "daily living" type grievances are assigned for disposition to the Rader staff
who is in a position to resolve the grievance.
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OJA's Response to OJSO Investigation
OJSO Question #16. Did the Administrator of Programs of the ITP deny juveniles
recreation time as a form of punishment?
OJA Response: The Office of Juvenile s Oversight criticizes the Mental Health Stabilization
Unit in is first full year of operation for allegedly misidentifying youth as escape risks. It cannot be
determined from the report which resident and for what period of time the resident was allegedly
misidentified as an escape risk. However, there was an occasion when two residents were found to
have secreted tooth brushes for the purpose of using them as stakes to climb a fence. They also had
made a shank as a weapon to aid in their escape. Another resident was implicated. Outdoor
recreation was terminated for a weekend until it could be investigated to determine the identity of
the third resident who might similarly be in possession of contraband. Once investigated, the
residents were restored to outdoor recreation. The juvenile, identified by OJSO as obese with a
degenerative bone disease, was not on the unit during this event. A resident may, however, also be
restricted to the cottage for inappropriate behavior regardless of physical attributes.
OJSO Question #17. Did the Rader Center violate DHS licensing standards, ACA
Standards, and OJA Policies by serving unpalatable food and not allowing the juveniles to
have second helpings?
OJA Response: The Office of Juvenile s Oversight finds reports from staff and residents
that the food served in the Mental Health Stabilization Unit was of poor quality. However, there is
no record of staff's having complained independently of the OJSO investigation about the quality
of food. The dietician responsible for meal planning for Rader is also responsible for meal planning
in the Mental Health Stabilization Unit. Food service and distribution meet ACA Standards. Mental
Health Stabilization Unit residents receive the same food as all other Rader residents. Snacks are
maintained on the unit and available for residents when needed.
As a result of the medications this population ingests, they often experience the feeling of
hunger even though they have had plenty to eat. Obesity is a problem in the population generally
as well as at the Rader Center. Overeating is not healthy for youth. Striking a balance between need
and desire is critical. Portion size exceeds standards and the meals are nutritionally balanced. Youth
in the Mental Heath Stabilization Unit are counseled that one of the side effects of their medications
is the feeling of hunger. Psychological staff respond to the youth's perception of hunger
appropriately.
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OJA's Response to OJSO Investigation
OJSO Question #18. Did the Rader Center violate state law or OJA Policies by
allowing juveniles to prepare and/or serve food on the MHSU?
OJA Response: Higher phase juveniles from other units are allowed to help in the kitchen
without supervision for food distribution, not for preparation, as part of their program objectives.
Staff is present on the unit where the food is served. The Department of Health has not found this
practice to be violative of health standards.
OJSO Question #19. Did the Rader Center violate OJA Policy and/or ACA Standards
by not providing adequate hygiene items to the juveniles?
OJA Response: Reports of the inadequate hygiene items stem from residents' complaints
about the type of shampoo provided, not the lack thereof. For safety reasons, shampoo is dispensed
in the Mental Health Stabilization Unit from a single bottle of shampoo when residents shower.
Residents have on occasions ingested shampoo as a self-injurious behavior. It is against Rader
policy for staff to bring outside unapproved hygiene items into the Rader Center for residents. There
were no complaints filed by staff regarding the quality or quantity of hygiene items for the Mental
Health Stabilization Unit outside the OJSO investigation. There were no grievances filed by
residents with respect to shampoo.
OJSO Question #20. Did the Rader Center violate ACA Standards or DHS licensing
standards by not providing adequate bedding for the residents on the MHSU?
OJA Response: Resident bedding consists of special mattresses of foam having no metal
attachments. There was an occasion when Rader had a problem regarding a mattress order, and a few
juveniles had to sleep temporarily on tom mattresses. When a resident is on suicide watch, the
resident must remain monitored and this sometimes involves the resident's sleeping on a mattress
placed on the floor near the monitor. The resident continues to maintain his bed and other facilities
in his single occupancy room and is returned to these as soon as possible.
The suicide smock and mittens have been used eleven times since September 2003. Mittens
are used to prevent the resident from inflicting self-harm. The mittens are worn until the resident's
condition has been stabilized. The smock is used to prevent residents from self-destructive and
suicidal behaviors. For example, residents attempting suicide by using their clothing are put in the
smock as a preventive measure. The smock is a treatment tool that was successful in Corsicana,
Texas. There were no resident grievances filed with regard to smock or mittens.
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OlA's Response to OlSO Investigation
C. OJA's Response to OJSO - The Conclusion
It must be noted at the outset that it is both surprising and disappointing that the OlSO
investigator made no effort whatsoever to contact the Assistant Attorney General to verify what was
reported to him by the Rader employees and his other unnamed sources. That omission not only
exhibits a lack of courtesy, but a startling departure from good investigative technique. Had the
investigator made such inquiries, he would have learned that the Assistant Attorney General had no
knowledge of the letter of June 28, 2001, sent to the Office of Juvenile Affairs' Executive Director
by Rader employees.
With respect to the petition of August 14,2003, a document presented more than two years
after the earlier letter, the first concern of the Assistant Attorney General was to ascertain if any
criminal violations had occurred. The answer to that question was made by the Chief of the General
Counsel Section and First Assistant Attorney General, fonnerlya district attorney, and his opinion
certainly carries great weight. No credible person has disputed the opinion about the lack of criminal
violations.
Following a determination that no criminal violations had occurred, the Assistant Attorney
General sought a method by which the facts behind the various allegations and accusations in the
employees' petition could be discovered. The allegations were so broad and lacking in detail that
a thorough investigation was necessary. That investigation, no matter how it was to be done, would
of necessity require the complaining employees to provide names, dates and times, and
circumstances about their complaints.
At the time this matter arose the Office of Juvenile Affairs was in the third year of shrinking
budgets and cost-cutting. As a result, there was no money to pay for an outside investigation to be
performed, The complaining employees did not even hint that they would be willing to pay for an
outside investigation. They also rejected the idea of an investigation by OJA's Office of Public
Integrity. As a compromise, the complaining employees agreed to voice their complaints to a panel
made up of two members of the Board of Juvenile Affairs and a representative from the Governor's
Office.
On the date of the proposed meeting, the employees' representative appeared and announced
that none of the employees would participate or even appear for the meeting. Their purported reason
for declining to be involved was their distrust of the entire upper level of OlA administration. This
decision by the employees was made prior to the time of the proposed meeting but was not conveyed
to OJA. As a result, the representative of the Governor's Office, the OJA Deputy Director for
Institutional Services, and an Assistant Attorney General made the trip from Oklahoma City to the
Rader Center for no purpose. Unknown to the employees, the two members of the Board of Juvenile
Affairs had changed their position and decided not to attend the meeting.
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OJA's Response to OJSO Investigation
The net result was, and remains today, that OlA's Executive Director does not have any
details about the various complaints made by the Rader employees in their petition. The Assistant
Attorney General invited the employees' representative to prevail upon the employees to provide the
needed information by filing grievances, attending employees council meetings and speaking with
supervisors. The employees have chosen instead to repeat their one-sided and uninformed versions
of events to others.
The Office of Juvenile Affairs' Office of Public Integrity cannot investigate complaints
against "Rader" in general, nor can it investigate vague claims against individuals without details
as to who, when, where, what, and how.
It is unfair, unreasonable, and illogical to expect OJA to respond to what are essentially
anonymous complaints.
It is also very disturbing that the favorable opinions of the OJSO consultant, as memorialized
in his Consultation Report, are not reflected in the OJSO report. This obvious omission raises
questions about the integrity of the authors of the OJSO report and the efficacy of the entire OJSO
investigative process. It offends every notion of professionalism and reflects an abuse of authority
by OJSO investigators.
D. OJA's Response to OJSO's Recommendations
The Office of Juvenile Affairs is always committed to improving existing practices and
implementing new programs which benefit the youth committed to its custody and provide for the
safety of its staff. In the past, OJA has welcomed the input from its various oversight bodies and
accrediting and licensing entities that provide suggestions for improved operations for OJA. This
has been true with respect to OJSO and its assessment and recommendations which OlA has
historically found to be helpful.
this OJSO report, however, represents a significant departure from OJSO's past practices.
Because the report is unsupported in fact and manifests such negative bias, it is not helpful and
provides no useful direction for implementing change.
This report is but one in a continuing list of recent inquiries by OJSO that lacks objectivity
and sound investigative practices. The Office of Juvenile Affairs is well aware of its responsibility
to provide a safe environment for its charges. The State of Oklahoma has in place multiple checks
and balances to ensure this mandate. The Office of Client Advocacy, the American Correctional
Association, the Department of Health, DHS Licensing, the Advocate Defender, Judges, the
Legislature, and of course, the Oklahoma Commission on Children and Youth, all work every day
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OJA's Response to OJSO Investigation
to ensure good care and treatment for Oklahoma troubled youth. To imply that residents are not safe
and are mistreated by the administration of this agency suggests that all these oversight bodies have
failed in their mission. They have not. .
The OJSO report on Juvenile "C" is a collection of unsubstantiated findings void of fact and
presented in a manner designed to impugn the integrity of the Office of Juvenile Affairs, the Office
of Client Advocacy, the American Correctional Association, the Attorney General's Office and the
Board of Directors of the Office of Juvenile Affairs.
It would seem, the Oklahoma Commission on Children and Youth has lost its objectivity and
vision as it struggles to investigate systemic issues within the child serving community. Slanted,
one-sided reports accomplish very little. The OJSO should immediately take steps to review all
aspects of this "investigation" to determine true findings of fact.
The Office of Juvenile Affairs will assist OJSO in this endeavor.