Supporters Say License Doesn’t Fit Group Home

CAMARILLO — The teenage boy was threatening to turn a knife on himself when a Casa Pacifica staff member physically restrained him, grabbed the knife and escorted him toward the timeout room.

But the boy broke loose and ran through the center’s unlocked front gate into Lewis Road, where he was hit by a car.

His leg, ankle and arm were broken and his shoulder dislocated, resulting in the most severe injury suffered by a child at Casa Pacifica since it opened in 1994.

The June 1996 incident also brought four of the 63 citations that state regulators have filed against the center.

To critics, the incident illustrates why the center’s license to care for abused, neglected and troubled children should be revoked, as the state Department of Social Services has recommended.

But supporters say this sort of case underscores a much more complex question: whether the Camarillo center has the right kind of license and security regulations, given the range of children it cares for.

Under its license as a group home, Casa Pacifica cannot lock its doors or, in some circumstances, restrain its charges. At the same time, the center has resolved not to reject or eject any child, regardless of behavioral or mental problems.

“A different license needs to be created,” said Ventura County Supervisor Kathy Long. “And if it is going to offer greater security to the rest of the population, then parts of the facility may need to be secured.”

In fact, a group assembled by county officials is expected to release a report soon that recommends developing legislation to revise antiquated and inapplicable licensing regulations. The county advisory group might also question whether the state Department of Social Services is the right agency to provide licensing regulations for the facility.

But at least one county supervisor disagrees.

There are license and regulation problems, but only because Casa Pacifica is not conforming to them, Supervisor Frank Schillo said.

More Citations Are Filed

Even as the state is mulling the license revocation, more citations have been filed against the center. In an incident earlier this month, two youngsters from Casa Pacifica engaged in a sexual act while at a movie. A chaperon from the center was sitting two rows behind them and could not see any misconduct, according to a county memo.

Rather than have a new agency oversee Casa Pacifica, existing problems need to be taken care of, such as separating children by age, gender and behavior problems, Schillo said.

“It’s frustrating to me . . . but the point is that the state does know what they’re talking about,” Schillo said.

State officials say other group homes manage to function well under the existing rules and that locked facilities and restraints could be too severe.

“Children are not sentenced to these group homes,” said Martha Lopez, director of the state Department of Social Services licensing division. “They are placed there in hopes of getting the services they need.”

Casa Pacifica is subject to a variety of licenses, eight of them from four state departments: health, education, mental health and social services.

Only the Department of Social Services has filed citations against the facility in the past three years, and the Mental Health Department recently recertified the facility, officials said.

Social Services licenses Casa Pacifica as a group home for seven or more children, but the facility can hold as many as 78 children at any one time--ranging from youngsters just removed from abusive families to those who have spent years in foster care.

“The facility should not be licensed as an ordinary group home because it is not an ordinary group home,” said state Sen. Cathie Wright (R-Simi Valley).

“These children have such severe behavior problems that no one else wants them,” Wright said.

The same issues have arisen at other facilities throughout California. After grappling with the matter for more than a decade, the social services and mental health departments have begun to make some headway.

Emergency intervention regulations, which were shoved aside years ago because of concern from some state officials and patient-advocacy groups, have resurfaced and are scheduled for a public hearing by the fall.

These regulations take into account situations when children may need to be physically restrained to keep them from harming themselves or others--a procedure current regulations do not address.

And almost 12 years after the Legislature approved the move to lock certain treatment programs, regulations pertaining to these programs are expected to emerge from negotiations among several state agencies in the next few months.

These programs would be licensed under a new category called Community Treatment Facility, which would allow for children with severe emotional disabilities to be placed in a facility with locked front doors and perimeter fences.

Currently, however, there are no licensing categories in between a psychiatric hospital and a six-bed group home for children with minimal behavioral problems.

Casa Pacifica, with two distinct programs, really doesn’t fit into either category.

One program is an emergency shelter that accepts as many as 50 children at any one time who have been removed from their homes under court order due to neglect or abuse.

The other is a 28-bed residential treatment facility for children who have exhausted the county’s foster care and group home settings because of extreme behavioral problems.

The boy who was hit by the car was diagnosed as being severely emotionally disturbed and placed in the residential program, Casa Pacifica officials said.

State licensing officials say the agency is constantly evolving, citing the emergency intervention regulations and the new licensing category of Community Treatment Facility.

“But if someone can develop regulations that can better ensure the safety of the kids, then we’ll look at that,” said Dave Dodds, deputy director of the state’s Community Care Licensing division.

The agency’s job is to monitor and enforce standards, not exclusively develop them, Dodds said.

“Licensing is a public program and we’re in a fishbowl and that’s appropriate,” Dodds said. “But the worst thing people can do in this whole process is to try to simplify things.”

There are no disputes there. Everyone agrees that complex public-policy issues and the lives of vulnerable children are at stake.

Some critics say the subjective interpretation of regulations that don’t address how to deal with children who have extreme behavioral problems complicate matters even more, because the facility is held responsible when resulting problems arise.

“Some of the struggles that have evolved over the last year between Community Care Licensing and Casa Pacifica come from this gray area of how regulations should be interpreted and implemented, resulting in personality conflicts that don’t need to be here,” Supervisor Long said.

Others activists statewide believe inventing a new license category is only a quick fix and doesn’t really get at the core of the problem. “We don’t necessarily need to create a new licensing category, but rather create acknowledgment that different kinds of clients have different kinds of needs,” said Nina Grayson, executive director of California Assn. of Services for Children.

Regulations need to clearly define extreme behavior problems and how to deal with them, Grayson said. Taking another look at “emergency intervention regulations is a good start because it clearly acknowledges the fact that you need to have a way to intervene with kids that behave inappropriately,” she said.

License for Locked Facilities

Many have also suggested that Casa Pacifica should apply for a Community Treatment Facility license so that youngsters with the most difficult behavior problems could be placed in a locked facility and receive more intensive therapy.

Staff members now physically restrain children who attempt to leave the facility--a practice that has cost Casa Pacifica many citations because children have received injuries--ranging from a broken jaw to minor rug burns.

“The Community Treatment Facility option is a very important addition right now,” said Don Kingdon, a county mental health official working temporarily in Child Protective Services.

“It’s the only thing that’s going to keep us from having to export our children out of state, which would be a serious mistake in the long haul.”

Over the last three years, 15 children have been removed from Casa Pacifica because of disruptive behavior and placed in juvenile hall, a psychiatric hospital or a locked facility out of state.

To avoid moving Casa Pacifica’s most difficult children out of California, Kingdon suggests that another cottage be built at Casa Pacifica that could serve as the Community Treatment Facility where children would stay no longer than one year.

“We could build a hybrid that [the state departments of] mental health and social services would work with Casa Pacifica to develop,” he said.

Only those diagnosed with mental disorders, as opposed to those who have difficult behaviors because of trauma, would be placed in the locked facility, Kingdon said.

Steve Elson, director of Casa Pacifica, agrees with that approach.

“There is no question we need secure capability with some of the kids,” Elson said. “In the case of the boy who was hit by a car in Lewis Road, if the gate was lockable, staff would have intercepted him and the accident never would have happened.

“This is, however, not to say that there’s been times we’ve made poor judgments and things have happened and that’s clearly our fault,” he added. “Some things should be viewed as a violation and we need to correct it, no question.”

Recognizing the need to lock doors and getting permission to do it are two different matters.

The state now has only 120 beds in locked facilities at mental hospitals, and Los Angeles County has already spoken for 100 of them.

Even with the proposed Community Treatment option, the Legislature is expected to authorize only 400 beds statewide, said Gary Pettigrew, deputy director of the state Department of Mental Health.

“We believe there are children that have such severe needs that a locked facility is appropriate,” Pettigrew said. “The fact that it has taken us over 10 years to actually have a regulations package that we’re comfortable with--one that balances rights of children and the need to have a semi-secure facility--is evidence of how hard it has been to reconcile those differences.”

But advocates remain concerned about locking doors.

“Unfortunately, there’s an increasing number of kids in the foster care system throughout California that have tremendous behavioral problems,” said Jim Preis, executive director of Mental Health Advocacy Services.

“But oftentimes locked doors and restraints are used as an alternative to having enough staff members to provide a high enough level of service and treatment,” Preis said.

For Casa Pacifica, the Community Treatment Facility approach could also resolve another point of contention: the center’s commitment to accepting all children, regardless of their problems.

The facility takes in children who have exhausted the county’s foster care and group home settings because of severe behavior, ranging from setting houses on fire to physical and assault. “Casa’s mission is to take children who are in need of a safe harbor without qualification,” said attorney Linda Kollar, who filed a defense to the state’s charges last week.

But state regulators say the “no-reject, no-eject policy” is part of the problem. “Casa Pacifica has repeatedly accepted and retained children who are out of control, prone to assaultive behavior . . . or children who exhibited behavior that Casa Pacifica was unable to deal with,” according to a Department of Social Services report.

Shelter officials defend their mission. “We have set forth our goal to take these needy and challenging children and the department has thrown it in our face that the no-reject, no-eject policy violates their statutory scheme,” Kollar said. “It is very overreaching for the Department of Social Services to make that claim.”

But if the program’s intent is to meet the needs of every child, proper assessment should be done up front, said Dodds.

“If they can do that with every child, I wouldn’t argue with that policy,” Dodds said. “But do they have that ability? I don’t know that anyone has that ability.”