State school accused of using isolation, restraints on troubled boys who need treatment

Iowa’s main institution for troubled boys often puts teens with mental illness in isolation or straps them to beds in ways that are banned in most similar facilities, a new report alleges.

The scathing report on the State Training School for Boys at Eldora, titled "Unlicensed and Unlawful," was released Monday by Disability Rights Iowa. The group’s allegations about mistreatment at the state’s Toledo facility for troubled girls helped spark that center’s closure in 2014.

The Boys State Training School at Eldora houses more than 100 teens who have been found to be delinquent in juvenile court.

“There’s a view of it as a punishment facility, but the statute says it’s for treatment and rehabilitation,” said Jane Hudson, executive director of Disability Rights Iowa.

Hudson's group is not seeking an immediate closure of the Eldora facility but is demanding major changes.

The school's superintendent, Mark Day, strenuously defended the program in an interview Monday. He said most of the school's residents proved too angry and violent for other programs.

"They sent them to us because they could not manage their behaviors," he said. "We take kids they can't handle."

Disability Rights Iowa defends the legal rights of people with disabilities, including mental-health issues. The new report says two-thirds of the Eldora facility’s residents are on psychiatric medications.

But the school has scant mental -health services, and it relies on seclusion rooms and physical restraints to control boys who act out, the report says.

“Sadly, this continues to victimize youth who have high rates of childhood victimization,” it says.

The report’s findings include:

Three-quarters of the facility’s residents have been placed in seclusion at some point. Six percent of those incidents lasted longer than 24 hours, which violates national standards, the report says.

Staff members often restrain boys with an apparatus called “the wrap.” The report describes the device as “a restraint bed with a strap for each arm and leg, and then a Velcro body wrap that is applied over the full body. This has been used multiple times on students with high mental-health needs and well-documented histories of childhood trauma instead of providing therapeutic interventions.”

The Eldora school is not required to have a state license, which means it is not subject to regular inspection by the Iowa Department of Inspections and Appeals. Licenses are required for most similar programs, such as Polk County’s juvenile detention facility and state institutions for people with mental illness or intellectual disabilities. Under the licensing rules, such facilities would be fined and could be suspended if they used physical restraints on children the way the Eldora facility does, Disability Rights Iowa lawyers said.

The school’s shorthanded mental-health staff includes a full-time counselor who is referred to as a psychologist, even though he is not licensed as one.

Disability Rights Iowa is a federally chartered group that can file lawsuits to try to force changes in how people with disabilities are treated. It recently filed a federal lawsuit against Iowa’s governor and Department of Human Services for cuts in in-home services to disabled Iowans since the state hired private companies to run its Medicaid program. The new report says the group might file another lawsuit if the state doesn’t improve treatment of boys at the Eldora facility.

The school was founded in the 1880s. Its residents average 16.7 years old and stay for an average of 10 months, the department says.

Day, the superintendent, said Monday he agrees with Disability Rights Iowa that mental-health services should be improved at the facility.

"Like every other program in this state — and I would hazard to guess every other program similar to this in the country — we would love to have more resources," he said.

But mental-health professionals are scarce, and so is money, he said.

The school, like most other state programs, faced a significant cut this year, losing about $800,000 out of last year's $12 million budget. Department spokeswoman Amy McCoy said administrators will try to implement the budget cut without harming services.

Day defended the school's use of "the wrap." He called it "a swaddling device," with no sharp edges, metal or leather. He said staff members try to minimize the need for restraints, but they use the cloth and canvas device in a way that's safer than trying to hold aggressive teens. He added that some out-of-control students ask to be placed in "the wrap" to calm down.

"It is a de-escalation chamber for them," he said. "They don't trust themselves. They know their propensity, their proclivity for violence, and they engage in that. We've had numerous students frequently say, 'I'm going to keep this up until you put me in the wrap.'"

The wrap is generally used for 20 to 60 minutes, Day said. Its use did not draw objections from experts from the University of Iowa and Drexel University in Pennsylvania, he added.

Nathan Kirstein, a lawyer for Disability Rights Iowa, countered Monday that Eldora students his group interviewed had been put into the wrap unwillingly. He added staff could use other measures, such as weighted blankets, to soothe agitated students without restraining them.

Day also denied the allegation his school overuses seclusion of students. Most such sessions last less than an hour and they are only invoked when necessary to calm outraged teens, he said.

Day acknowledged that the counselor the Eldora school's "psychologist" does not have a state psychology license. He said the employee has 30 years of experience and has a master's degree in psychology.

A spokeswoman for the Iowa Department of Health confirmed later Monday that state employees are exempt from requirements that they have doctorates and psychologists' licenses in order to legally call themselves psychologists.

In his defense of the school, Day emphasized how serious the students' behavioral problems can be. They include teens who have assaulted, robbed, sexually assaulted or even killed other people, he said.

"I've got students here convicted of murder, manslaughter, aggravated manslaughter," he said. "I've got 20 or 30 with charges of sexual offending. I've got weapons charges, gangbangers, dozens of convictions for robbery, many, many aggravated assaults and assault with injury, and assault against a police officer."

The program's students typically have failed in eight to 10 other programs before being court-ordered into the Eldora facility, Day said. The school, which is not fenced, offers classes and training. Students learn skills, such as welding, carpentry and baking, and they can earn high-school diplomas, he said.

"We keep them safe. We give them a successful discharge," he said. "We keep them from running away, we them from hurting themselves, and we keep them from hurting others."

Day said if legislators required the Eldora school to comply with state licensing requirements, they would have to pay for significant changes on its campus. One of the main changes would be to stop having up to 30 students sleep in a large, open room, he said. That setup helps the staff keep students safe but would not be allowed under current licensing rules.

Department of Human Services officials noted the facility is accredited by the American Correctional Association and can be investigated by state inspectors if problems are reported.

Disability Rights Iowa lawyer contend the national accreditation is "toothless," and they want the school to undergo regular inspections by independent state experts who oversee most similar programs in Iowa.

Disability Rights Iowa lawyers said many of the students suffered abuse or other traumas as children, which had not been sufficiently addressed. Many of their criminal charges stemmed from times when they lashed out in previous treatment programs, said Emily Ehlers, a staff lawyer for the group.

“These kids are struggling with mental-health issues,” she said. “Law enforcement looks at this as a behavior issue — that these kids are trouble.”

The group's allegations include that students who lack money are prevented from making long-distance calls to their parents or other relatives, whose support they need. Day denied the allegation. He said students can call home at least every other week at the school's expense, and they are provided with free paper, envelopes and stamps to write letters home.

In the long run, Disability Rights Iowa wants to see the state strengthen programs in the community so they can handle all the students now at the Eldora school. But the group doesn't want to see the state abruptly close the Eldora facility the way former Gov. Terry Branstad closed the Toledo school for troubled girls or state mental hospitals at Clarinda and Mount Pleasant.

"We don't want a knee-jerk political reaction that leads to chaos," Kirstein said.