Michigan department announces child care reforms after death
Lansing — The Michigan Department of Health and Human Services is implementing emergency rules that would prohibit some forms of restraint within child care facilities with a goal of eliminating all restraint from the state's foster care facilities after a 16-year-old died two days after being physically restrained April 29.
The rules issued Thursday prohibit any restraints that restrict breathing, including prone restraints in which a child is lain face down while being restrained inside the 154 child care institutions licensed by Children's Services Agency. The edict also limits how long and under what circumstance a child can be restrained
Families must be notified within 12 hours and the state within 24 hours of restraint usage under the new rules.
The department released a number of recommendations as well, including the elimination of seclusion and coercive restraints, the limitation of lengths of stay in residential facilities and improvement of MDHHS oversight of facilities.
"We know that safety is really about not only what’s going on at the facility but our ability to oversee that," said JooYeun Chang, executive director for the department's Children's Services Agency.
The changes come in the wake of the May 1 death of Cornelius Frederick, a 16-year-old at Kalamazoo's Lakeside for Children. Staff laid across the child's upper torso for 12 minutes in order to restrain the teen for throwing food. Frederick died after suffering a heart attack.
The state has stopped its contract with Lakeside, suspended the facility's license and is working to revoke the license. A subsequent review of state rules governing restraint and the oversight of facilities where such measures might be used led to the eventual rules and recommendations announced Thursday, Chang said.
The information gathered under emergency rules on instances of restraint — including the circumstances, efforts to diffuse the situation and staff members present — will give the state a comprehensive look at restrain use in child care institutions, which include foster care residential services and juvenile justice facilities.
"That kind of data will really enhance our ability to keep kids safe," Chang said.
Many of the rules issued Thursday are already being implemented at Wolverine Human Services facilities, said Judith Fisher Wollack, CEO for the agency and president of the Associations of Accredited Child and Family Agencies.
Wolverine, a private nonprofit that contracts with the state, serves about 400 kids through 10 programs that range from foster and adoption services to residential stays in secure facilities, Wollack said.
The agency has gradually reduced its use of restraint, but it will take some time to eliminate it completely, she said. Most employee training on restraint is how to avoid it with some instruction on how to properly restrain a child.
Still, the agency and similar facilities are in need of more guidance she said.
"There needs to be clear cut guidelines and training on what does this mean, and what exactly is defined as restraint," she said.
The department opted for emergency rules rather than go through the 6-12 month regular rulemaking process because of the pressing need to avoid another situation like the one at Lakeside, Chang said.
"These things were so patently on their face dangerous and the ability to track and monitor facilities was so critical to prevent another event like what happened at Lakeside," she said.
Still, she noted, there are circumstances where some form of restraint is allowed, specifically when a child is a danger to his- or herself, other residents or staff.
But, by and large, "restraints are often overutilized as a means of behavior modification or control," Chang said, when kids at the facilities are meant to receive therapeutic help.
The department also is analyzing the "overrepresentation" of children of color at institutions and looking to increase family and youth engagement regarding child care institutions. The state has been working to reduce the need for placing children in foster care facilities in general, Chang said.