Pubdate: Sun, 09 Mar 2008
Source: Day, The (New London,CT)
Copyright: 2008 The Day Publishing Co.
Contact:  http://www.theday.com/
Details: http://www.mapinc.org/media/293
Author: Ted Mann

DEFICIENCIES IN TREATMENT OF YOUTHS AT STONINGTON
INSTITUTE PERSIST

Critics Says State DCF Failing In Its Oversight Role

Hartford - In 2006, a team of state inspectors halted admissions to
the adolescent drug-abuse treatment programs at Stonington Institute,
saying the private facility had woefully insufficient staffing, poorly
trained workers and a dim concept of the remedies it was being paid to
provide to troubled youths.

Now, after nearly two years of monitoring by state agencies and
assurances from Stonington Institute's management that it is
correcting those problems, the facility's critics say there has been
little meaningful improvement -- and that the state's own Department of
Children and Families has failed to exercise aggressive oversight of a
program in which it places struggling kids.

Stonington Institute is now the subject of parallel investigations by
state Child Advocate Jeanne Milstein and Attorney General Richard
Blumenthal, both of whom expressed concerns last week about the
strength of supervision currently being provided by DCF.

Those charges provoked a vigorous defense from the child-protection
agency, where authorities said they are doing their best to sustain
improvements in the Stonington Institute program, which serves a
narrow but vital niche: treating young people with both mental health
and substance abuse problems.

But the agency's patience seems to be flagging, as some of the
violations for which DCF cited the program in 2006, and as far back as
2002, have surfaced again and again.

"They've been under a microscope for a while," said Louis Ando, the
chief of DCF's Bureau of Continuous Quality Improvement, in an
interview last week.

Upset last month by what they saw as back-sliding on some of the
violations first identified in 2006, including inadequate staffing
levels and quality of treatment, DCF officials called in executives
from the institute and its parent company, the Pennsylvania-based
private hospital chain Universal Health Services Inc., or UHS, Ando
said.

Stonington Institute executives and UHS "had been working on some of
these issues for an extended period of time, and we had seen
improvement plateau," Ando said.

But the meeting ended with the agency at least partially reassured.
Stonington Institute has recently brought in a new operating officer
and clinical director, Ando said, and DCF officials are hopeful. The
facility -- licensed for 45 beds -- is currently limited to 27, but with
the potential to grow back to its original size, with approval from
the department and if no more violations are found. There were 21
clients living there as of last week.

"I thought that we were uncharacteristically unkind," Ando said, "in
that we said, 'Tell us how this is different. Tell us what you're
going to do.' And we came up with a few reasons why we think we're at
a point where they can make some kinds of improvements. That doesn't
necessarily mean that we have stopped our monitoring."

That doesn't sit well with critics like Milstein.

"DCF can sometimes be a very irresponsible parent," Milstein said, in
an interview, along with Mickey Kramer, the associate who has led her
staff's investigation of Stonington Institute. "Responsible parents
would not put their child in a place that continues to be a problem.
It's one thing if there's a problem and the problem gets solved, but
this is two years later. Responsible parents don't do that."

          On July 7, 2006, a team of inspectors and licensing officials
from DCF and the Department of Public Health arrived unannounced at
the main residential campus of Stonington Institute, on Swantown Road
in North Stonington.

They did not like what they saw.

According to a review of its findings, the team found an eager but
inadequately trained staff, poor supervision of the mentally ill and
substance-addicted clients living on the premises, and significantly
lax security.

Though it is a residential drug-treatment center, Stonington Institute
did not then have on staff a single "master's level" clinician or a
licensed drug and alcohol counselor, the team found.

Perhaps most damning was its review of the facility's "program
model/philosophy" for treatment.

While Stonington Institute's executives claimed to abide by a number
of different treatment models, the summary's authors wrote, "there is
no evidence that training in these modes of care has been provided,
that the treatments are delivered with fidelity, that integration of
the models has been achieved at either a conceptual or a practical
level, or that the clinical staff could adequately describe the model,
much less deliver it effectively."

In the intervening months, DCF and DPH officials have conducted
frequent site visits and extensive negotiations with the facility's
executives. Those have produced some success, DCF officials said.

But some of the agency's efforts are seen as laughably minor by
critics like Kramer, of the child advocate's office, and Blumenthal.

One such instance could be found in the voluminous reports that
Stonington Institute filed with DCF to document progress on the
corrective action plan adopted after the 2006 violations were
uncovered. The status report was among a large number of records and
site visit reports obtained by The Day under state open records laws.

The report outlines efforts to correct the fact that staff members had
been previously unschooled in the institute's model for treating
children in its care this way: A team of staffers, the document says,
"met on 11/30/06 and began research of the model via the internet."

"The people who actually care for the kids, which is, you know, the
vast majority of hours in the day, had absolutely no training germane
to the needs of the kids that they were being asked to serve," said
Kramer, who made a site visit in the spring of last year, months after
that update report was sent to DCF. (The child advocate's office was
never informed of the initial 2006 violations, she noted.)

"There is no treatment occurring," she said. "And that is not to say
that they don't have some highly qualified, well-intended
practitioners working within that program, but there's no program to
operate from."

Stonington Institute has attributed many of its problems to staff
turnover. Amid frequent staff turnover, it is difficult to get new
hires trained and ready to work with clients, executives have said, in
an argument that Ando and DCF said they received with sympathy.

DCF officials have also distanced themselves from what they feel is
the child advocate office's overly aggressive approach to programs,
like Stonington Institute's, that attempt to right the lives of deeply
complicated and troubled kids, often with imperfect methods and results.

"We know that these kids are not, you know, dropouts from the Mormon
Tabernacle Choir," Ando said. "We know that they're in these programs
because they have significant issues. And we know that those issues
are not going to go away by nature of their magical admission to a
particular program."

The child advocate's role, he added, "is to hold up that mirror and to
say 'This is the "perfect" and you should be doing it.' And our role
is to strive towards the perfect without holding the good hostage."

Kramer, the associate child advocate, offered an indignant
rebuttal.

"If you were the parent of one of the 21 kids, and you found out about
this, what would you think?" she said. "You want to leave your child
in there in that program, in that program that's struggling to just
stay alive?"

          Stonington Institute is not new to intrigue.

The facility's president and chief executive officer, William A.
Aniskovich, is a former Republican state senator from Branford whose
defeat for re-election came shortly after press reports raised
questions about whether his position on the legislature's
Appropriations Committee afforded him the ability to direct state
funds -- via DCF clients -- to his employer.

The election defeat also followed closely on UHS' purchase of
Stonington Institute, known legally as Stonington Behavioral Health,
for more than $40 million. Democratic critics of Aniskovich suggested
that figure had been inflated by the state business that the facility
began to attract after the formation of its adolescent treatment unit
in 1999.

Aniskovich has long denied any impropriety.

The enforcement actions have cut into Stonington Institute's bottom
line. The facility received roughly $4.8 million in payments from DCF
in both the 2005 and 2006 fiscal years, but that number dipped to
roughly $2.6 million in fiscal 2007 -- reflecting the first admissions
restrictions imposed by the state.

A request for comment on this article from Stonington Institute was
referred to a regional spokeswoman for its parent company, UHS.

Stonington Institute officials have been "working closely" with DCF
and the public health department, said Judith A. Merel, a regional
director for community relations at UHS, in an e-mailed statement.

"Over the last year, Stonington has effectively addressed issues
raised by these regulatory agencies, and continues to work
collaboratively with them for continued quality improvement," the
statement said. "There are currently no licensing actions that are in
place from any external regulatory agency indicating their concurrence
with the overall quality of inpatient and residential substance abuse
psychiatric programs."

But that statement was immediately contested by DCF.

"There's clearly concerns we've got about the program," said Gary
Kleeblatt, the agency's communications director. "I don't think we
could have made it any clearer."

Kleeblatt said DCF officials were surprised by Merel's contention that
there are no "licensing actions ... in place," and cited some of the
very measures that DCF has offered as proof it is exercising
oversight, including its restriction on the number of children who may
be admitted to Stonington Institute, its departmental review of any
clients before they may be admitted, and its three weekly visits to
the program -- "far more than normal" for a treatment facility not
under scrutiny.

          Meanwhile, others wonder how such staffing problems --
including a 2007 settlement with the U.S. Department of Labor for
failing to even pay workers the minimum wage -- could afflict an
institution with such a profitable corporate parent.

"There is clearly a responsibility, moral if not legal, on the part of
the parent company," said Blumenthal, referring to UHS.

The company, based outside Philadelphia, which bills itself as the
third-largest hospital management chain, has experienced a boom in
business in recent years, despite a revenue loss tied to damage from
Hurricane Katrina. The company reported record revenues of $4.2
billion in 2006, according to a report to shareholders, a 7 percent
increase over the previous year.

Among the company's directors is former U.S. Sen. Rick Santorum of
Pennsylvania, who was the third-ranking Republican in the Senate
before his defeat in 2006.

UHS, said Blumenthal, "certainly has resources to assure compliance
with standards of quality care as well as legal mandates. There's no
excuse for delay or substandard staff or care. So the answer is, most
definitely the parent should be held accountable."

That's the same thing some more up-close observers were saying this
week, including Trooper Victor Lenda Jr., a resident trooper in North
Stonington who has complained to Stonington Institute executives in
the past about the time and energy police have spent responding to
calls generated by the facility.

"We get comments from staff all the time," Lenda said. "'Oh, Trooper,
thanks for coming up. Our management won't give us this, they won't
give us that, we can't get a hold of management sometimes.' Those are
the things they are telling us."

Lately, Lenda said, "the staff has been doing fine. I think management
could be doing better."
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MAP posted-by: Derek