West Virginia’s reliance on out-of-state group homes leaves some foster kids in unsafe, abusive situations

In early 2015, West Virginia state inspectors visited an all-boys group home in Grove City, Pennsylvania. There were West Virginia foster kids living at the facility about an hour north of Pittsburgh; they, along with hundreds of others, were sent to homes outside West Virginia because the overburdened foster care system couldn’t care for all its kids in-state.

A 10-page inspection report, summarizing what the inspectors saw over the course of six days in January and February, contained stark observations about the kind of care the kids were getting at George Junior Republic.

Kids were being improperly restrained, the inspectors wrote. They spent up to six hours a day isolated in their bedrooms and some reported not getting necessary therapy and education. The center used a “time out chair” as punishment liberally, and kids could be put in it for hours or for up to two weeks at a time.

Their conclusion, typed in red on the first page of the report, was clear: West Virginia should get its kids out of the center.

“Evidence obtained indicates that the facility conducts practices that jeopardize the health, safety and well being of youth at the facility,” the state’s inspectors wrote.

But seven months later, West Virginia kids were still at George Junior. Though the state Department of Health and Human Resources had told facility officials it would suspend the placement of children there, documents show in September an unspecified number of kids were still at the center.

A boy walks on the campus of George Junior Republic in Grove City, PA on Sept. 14, 2021. (Photo by Duncan Slade)

Every year, hundreds of West Virginia’s foster kids are sent to out-of-state facilities like George Junior Republic, far away from the officials charged with their care and family members who might otherwise check on them. Often, there are few other options for the children, who are typically older kids with mental or behavioral issues. But documents show the state’s reliance on these facilities has sometimes resulted in West Virginia children being sent to unsafe and abusive homes.

An investigation by Mountain State Spotlight in partnership with The GroundTruth Project has found 22 serious accounts of abuse and neglect at many of the out-of-state facilities West Virginia has paid to care for its foster kids. There have also been several reports of alleged sexual assault of kids at the facilities. West Virginia inspectors have many times flagged issues with employees using force to control kids improperly, including a situation that officials said posed an immediate threat to kids’ safety.  At one group home, children were forced to use sharp blades to cut down fields of weeds. And in several cases, West Virginia has continued or renewed the contracts with facilities despite media coverage and other states’ findings that children were being abused.

DHHR records show at times, the agency ended contracts or removed children from facilities facing serious allegations. But there are also records showing instances where the agency did not act, or where it took months to remove children from troubled facilities, like at George Junior. However, a comprehensive accounting of how state officials cared for out-of-state kids and handled each of these cases was impossible to compile because the agency repeatedly denied and delayed requests made under the Freedom of Information Act. In two instances, the requested documents were not provided by Sept. 20.

Publicly, DHHR leaders have defended the way they’ve managed the state’s system.

“This administration and the West Virginia Legislature have invested more resources into the child welfare system than any other administration,” Secretary Bill Crouch said in a 2019 statement in response to a lawsuit. “We have been consistent and deliberate in our commitment to the safety and well-being of West Virginia’s children.”

But throughout this investigation, DHHR leaders repeatedly dodged questions about the treatment of some of the most vulnerable kids in state custody. Agency spokeswoman Allison Adler denied multiple requests for interviews with Crouch and DHHR Bureau for Children and Families Commissioner Linda Watts (who retired in July), and declined to answer specific questions about this investigation’s findings.

GroundTruth/Mountain State Spotlight sent a summary of our findings and another interview request to DHHR. Spokeswoman Jessica Holstein said the agency could not comment on the specific cases of children due to state code protecting kids’ privacy.

“It is the mission of the West Virginia Department of Health and Human Resources to promote the health and well-being of West Virginia residents, especially for vulnerable residents such as children,” she wrote via email on Aug. 30.

She finished by including the agency’s 24/7 abuse and neglect hotline number.

Lack of foster homes factor in sending kids out of state 

West Virginia’s foster care system is bursting at the seams: There are 71% more children in state custody now than there were a decade ago. Of the approximately 10,500 kids who spend time in the West Virginia foster care system every year, some are placed in certified foster homes or with relatives, often called “kinship care.”

But despite efforts over the last few years to recruit and maintain foster families, there aren’t nearly enough homes. And in a system where about half of the children enter the state’s foster care system due to parental drug use, some have serious needs requiring specialized behavioral care or substance abuse treatment. Sometimes those services are available in kids’ communities, but often they aren’t.

“[There are] not enough services in communities to keep kids there … We need services in the communities to keep kids either in foster care or therapeutic foster care or in their home communities with relatives,” said Kathy Szafran, executive director of Mountain Health Promise at Aetna, which has managed health care for West Virginia foster kids since March 2020.

The shortage means every year, West Virginia ships hundreds of kids to group homes elsewhere. In August, 402 foster kids were living out of state. The state had contracts as of April 2021 with 49 out-of-state residential treatment centers and group homes as far away as Utah, Arkansas and Florida, according to DHHR.

These facilities should rarely be a first choice: Experts agree family settings — not group homes — give foster children the best opportunity for stability.

Mason Kendall poses outside of his home. When he finishes with school he plans to join the Army. When asked why the Army he responded that it was the branch of the service that his grandfather had served in and he wanted to do it to honor him. (Photo by Kristian Thacker)

Mason Kendall, 15, who grew up in Ripley, experienced the churn of moving from one out-of-state facility to another first-hand. He entered the state foster care system at 6 years old; by the time he was 8, his social worker was transporting him to group homes outside West Virginia.

“I was too messed up for foster programs,” Mason said.

By the time he was a teenager, he said, he’d been shuffled to facilities in states including Tennessee, North Carolina, Utah and Virginia.

His time out of state is difficult for him to talk about.
“There was a time a [facility employee] busted my nose and gave me a black eye, then he said I hit the wall. I just got smacked around a lot,” Mason, who now lives in Calhoun County, recalled.

Sometimes, West Virginia’s use of an out-of-state facility might be closer to the child’s community than one in the state; for example, a facility in Ohio could be the closest and best match for a child in Wheeling.

But no matter the distance, the fact that these facilities are over the state line means a difference in oversight because individual states vary in how they regulate the centers. While West Virginia has guidelines governing how often social workers check in and how these children should be treated, the day-to-day care takes place in facilities where DHHR doesn’t have as much control.

State social workers are required to visit foster kids living in out-of-state facilities in person every month, though Mason said he rarely saw his social worker once he moved out of state.

“They don’t come see you,” he said.

Originally from Ripley, Mason Kendall now lives in Calhoun County, West Virginia. He spent years in foster care, going from one out-of-state home to another. (Photo by Kristian Thacker)

These in-person visits to out-of-state facilities were temporarily halted during the COVID-19 pandemic, and the federal government allowed states to substitute videoconferencing during that time. Now, in-person visits have resumed except when there is a threat to health, according to DHHR spokeswoman Holstein.

But the agency would not provide a comprehensive accounting of these monthly visits. GroundTruth/Mountain State Spotlight began asking about these visits in October 2020. In January, reporters sought this information through a Freedom of Information Act request; the agency did not provide responsive records or a formal denial of the request by Sept. 20.

Besides the social worker visits, a team of employees from DHHR and the West Virginia Department of Education reviews just five out-of-state facilities a year. The state also uses health care management companies KEPRO and APS Healthcare to review health care aspects of the facilities.

DHHR only made one official available for an interview for this series, despite repeated requests: Foster Care Ombudsman Pamela Woodman-Kaehler, whose role is to review investigations and complaints brought by foster parents or foster children.

Woodman-Kaehler was unable in December 2020 to answer direct questions about the care of children in out-of-state facilities. In September, GroundTruth/Mountain State Spotlight reached out to her again with a summary of the investigative findings; Woodman-Kaehler replied that she would read the summary but did not return any other comment.

West Virginia continued to send kids to facilities accused of rape, abuse

Allegations of trouble in these out-of-state homes, and in the West Virginia foster care system, aren’t new. In September 2019, 12 West Virginia foster kids and their families sued the state, alleging among many things, West Virginia sent kids to unsafe homes and institutions that subjected the children to further abuse, neglect and trauma. The suit also alleged kids were institutionalized and forced to languish in the system, and that the state lost track of an alarming number of children.

The kids and their representatives wanted DHHR and Gov. Jim Justice to ensure foster kids in homes and facilities were adequately monitored and for the agency to try its best to place foster kids in family-like homes with access to appropriate behavioral and mental health services.

Almost immediately, West Virginia officials rejected the allegations; DHHR Secretary Crouch fired off a statement defending his foster care system and listing the reforms happening under Justice. He accused the attorneys behind the effort of seeking media attention and of being clueless about the state’s system.

“The company that filed this lawsuit against the State of West Virginia has not reached out to me or any member of our leadership team to ask questions regarding what we are doing in this state or to even engage in a conversation regarding these issues,” Crouch wrote.

The state asked the judge to dismiss the lawsuit in November 2019.

But two months later, during a visit to The Children’s Center of Ohio, DHHR inspectors verified some of the suit’s allegations with their own eyes. There, they reported children were tasked with more than two hours daily of cleaning and yard work. While work programs are sometimes allowed at these facilities, child labor can’t be used in lieu of employing housekeepers and maintenance workers. At The Children’s Center, kids were responsible for all of the cleaning and were also tasked with “weed whipping,” where they used sharp tools to clear grass in nearby fields to maintain the 200-acre campus.

The buildings also had numerous hazards, including exposed electrical wiring above a bed and a “deplorable” boys’ bathroom with visibly rotting floorboards. Staff with The Children’s Center of Ohio did not respond to questions for this story.

In February 2020, DHHR quietly suspended placements at the facility. But in July of that year, documents show there were still two West Virginia kids enrolled there.

DHHR didn’t respond to questions about when they removed West Virginia kids from the center;  the state no longer contracts with the facility as of October 2020.

The Children’s Center of Ohio wasn’t the only facility facing serious issues as West Virginia paid them to care for vulnerable kids.

Because DHHR officials would not answer questions about the agency’s use of troubled out-of-state facilities, GroundTruth/Mountain State Spotlight used public records to create a timeline of some of the state’s contracts and responses to abuse and neglect allegations. Reporters filed 45 Freedom of Information Act requests with DHHR beginning in September 2020.

At George Junior Republic, the Pennsylvania all-boys institution where in 2015 inspectors warned kids weren’t safe, DHHR’s own review from April of that year showed the agency was aware of other problems. In a letter sent on April 2, 2015 explaining that West Virginia wouldn’t send any new kids to the facility, the agency noted that for months, Pennsylvania had been investigating abuse incidents involving at least four West Virginia youths who lived at the center. One youth was sexually abused by a staff member while on a home visit, though DHHR officials declined to say whether the victim was a West Virginia child. Another inspection provided to the agency around the same time noted that when restraints were used on children, often to force compliance, documents or video footage of the incidents were sometimes missing or incomplete.

George Junior Republic in Grove City, Pennsylvania. (Photo by Duncan Slade)

“Students consistently report experiencing, witnessing or being aware of questionable treatment of residents,” a West Virginia Department of Education employee wrote in a separate letter in April 2015 to George Junior administrators.

Though the state officially ended its contract with George Junior in September of that year, West Virginia kids were still living there at that point, according to a DHHR document. Agency officials declined to answer when they pulled West Virginia kids from the facility.

But as of April 2021, West Virginia foster kids could again be sent to the facility, which was included in a 2019 Philadelphia Inquirer investigation about dangerous Pennsylvania juvenile homes. DHHR officials did not respond to multiple questions about whether there are currently kids living at the Grove City location or when the facility reinstated its contract with the facility, and DHHR attorney Daron Light said the agency did not have any documents related to the contract reinstatement, which could have shown the facility had resolved the issues that led to the 2015 contract termination.

Nate Gressel, executive director of the facility since January 2019, did not respond to specific questions about the treatment of West Virginia children at the facility. He said the Philadelphia Inquirer article “did not represent all of the facts and was steered in [a] direction to support negative provider dialog,” and that while he couldn’t speak to events that happened before his time as director, since then the facility has “gone through a significant transformation.”

In at least two cases at centers in Georgia and Michigan, West Virginia officials continued or renewed the state’s contract despite media coverage and other states’ findings that children were being abused.

In August 2020, DHHR renewed its contract with Devereux Georgia, a center for children with intellectual and developmental disabilities, one month after a Philadelphia Inquirer investigation detailed ongoing abuse at facilities around the country run by the company.

“At least 41 children as young as 12, and with IQs as low as 50, have been raped or sexually assaulted by Devereux staff members in the last 25 years,” the Inquirer investigation found, noting that 10 of them said they were assaulted at Devereux campuses near Philadelphia; the others were abused at facilities around the country, including the Georgia home where West Virginia contracts. Devereux Georgia employees did not respond to a request for comment for this story.

DHHR also contracted to send a West Virginia child to Lakeside Academy in Michigan in 2018, though the state of Michigan started investigating the facility that same year for reasons including overuse of child restraints. DHHR officials did not provide requested records that showed agency inspectors visited the site before or during a child’s stay. In May 2020, just five months after the state arranged to send another West Virginia child to Lakeside, DHHR officials suspended placements at the facility after a staff member killed a 16-year-old boy while restraining him. Carla Harper, director of Children and Adult Services for DHHR, said in an internal memo on May 14, 2020 that there were no West Virginia children staying at the facility as of that date.

Lakeside Academy has since closed; Sequel Youth and Family Services, which operated the facility, declined to comment through a public relations firm. “Sequel Youth & Family Services is unable to speak to your questions regarding Lakeside Academy due to the ongoing criminal investigation and civil litigation,” wrote Darby Dame in an email. “Due to privacy concerns, we do not comment on specific placements of clients.”

DHHR officials did not answer questions about the extent to which they were aware of substantiated or unsubstantiated allegations against facilities they use, though many of the allegations were available via a Google search. Occasionally the agency’s own documents cite other states’ certification or inspection results as justification for an agency decision.

Another consistent problem noted in out-of-state inspections was the improper use of physical restraints, which occur when a facility employee physically holds a child. Sometimes this can involve medication, or equipment like a straightjacket. Under state policy, restraints of any kind are mostly limited to emergencies when children are a danger to themselves or others.

GroundTruth/Mountain State Spotlight requested inspections for the 47 out-of-state facilities where West Virginia had contracts between 2011 and 2020. DHHR provided reviews for 32 facilities, and state employees flagged restraint issues — including young children being restrained too long and staff failing to notify parents of use of restraints — at 24 of those centers.

Documents show DHHR suspended state contracts over restraint issues in at least three cases. At Northern Illinois Academy, West Virginia officials noted the restraint issues flagged by federal inspectors were “so serious they constituted an immediate threat to patient health and safety.”  The agency also cited misuse of restraints in its contract suspensions with Fairfield Academy in Ohio in 2014 and with George Junior Republic in 2015.

Better oversight of out-of-state facilities like these was one of the outcomes sought in the lawsuit filed by former West Virginia foster kids. It would have required DHHR to place children in safe facilities that were adequately monitored under federal standards.

But in July 2021, U.S. District Judge Thomas Johnston dismissed the lawsuit, saying that the suit belonged in state court rather than federal court.

The agency ultimately rejected the plaintiff’s proposed settlement terms of a third-party monitor of its state’s foster care system.
DHHR spokeswoman Holstein said in an email the judge’s decision “reinforces the efforts of the many federal, state and community partners who are working tirelessly to transform and improve our system.” But in his 30-page dismissal, Johnston did not refute any specific claims made by the foster children about their alleged harm under DHHR care. Attorneys for the kids are appealing Johnston’s decision.

“The bad thing is that the kids in West Virginia are going to have to wait longer to get any relief,” said Marcia Lowry, the executive director of nonprofit A Better Childhood, who is representing the foster kids.

Lawmakers didn’t follow up on mandate to reduce out-of-state placements

As West Virginia lawmakers have attempted foster care reforms in the wake of the state’s growing foster care population, they’ve rarely focused on the kids sent out-of-state.

Scott Boileau, a former social worker turned lobbyist for West Virginia children’s issues, brought concerns about out-of-state placements in front of state legislators in the early 2000s. But the issue never got the attention it needed, he said.

“There have been individual leaders in the Legislature who have been interested in this area, but as a sustained concern … I’ve never seen that,” said Boileau, who led the West Virginia nonprofit Alliance for Children Inc.

“I’ve never seen it from a governor either,” he added.

The campus of George Junior Republic in Grove City, Pennsylvania on Sept. 14, 2021. (Photo by Duncan Slade)

In 2004, more than 11% of kids in state custody were living out of state. That year, DHHR officials told lawmakers they would reduce the number of out-of-state placements to 3% of all foster kids by 2006, according to The Charleston Gazette.

The agency didn’t hit that mark, though at some point they moved the goalposts. Now, the agency refers to a goal of having no more than 10% of foster kids living out-of state, though DHHR spokeswoman Holstein didn’t answer a question about when the new goal was implemented.

Since 2012, there have never been fewer than 5% of the state’s foster kids in facilities outside West Virginia, according to available public data.

This care is expensive: The price tag last year for lodging, education, therapy and medications for out-of-state foster kids was $33 million. The facilities can cost the state from $300 to $1,500 a day per kid.

For comparison, in 2020, the state paid $31 a day to West Virginia foster families housing and caring for foster teens and young adults.

By 2014, West Virginia’s over-reliance on group homes had prompted a U.S. Department of Justice investigation, which resulted in the state promising that it would offer more home- and community-based services to children in an effort to reduce the number of kids going into residential mental health treatment facilities. But despite the federal probe and troubling allegations in the lawsuit filed by former foster kids five years later, lawmakers haven’t pressed the issue, though they have passed several pieces of legislation aimed at addressing holes in the larger foster care system.

Delegate Barbara Fleischauer, D-Monongalia, has been a member of the House of Delegates Health and Human Resources Committee for 25 years; during her time in office, there have been major changes to the state’s foster care system.

Lawmakers mandated that the state hire an outside company to oversee the health care of foster children and created Woodman-Kaehler’s ombudsman position in an effort to provide neutral oversight over DHHR’s programs. But out-of-state placements have not been included in attempted reforms.

“I think there’s been a lot of attempts to fix this problem, and a part of it is just that it’s really hard,” Fleischauer said. “And, if you don’t keep your eye on the ball, it gets worse.”

Lack of in-state youth mental health care a problem

The path to reducing the number of foster kids leaving the state isn’t clear, especially as West Virginia continues to experience waves of children affected by poverty, the COVID-19 pandemic and the drug crisis.

DHHR officials are hoping to reduce the number of kids going to facilities outside of West Virginia with more agency scrutiny on the decision to send a kid out-of-state in the first place. In a memo sent to staff in December 2020, Linda Watts, then commissioner of the state Bureau for Children and Families inside DHHR, reiterated to staff that sending a kid out of West Virginia was a last resort. The agency’s policy now requires the commissioner or a top-level DHHR official to personally sign off on every foster child leaving the state, in addition to the team of DHHR employees, social workers, education employees and judges that also have input. The number of kids leaving the state has not decreased significantly since the policy was implemented, according to DHHR monthly foster care placement reports.

However, this strategy has worked before: West Virginia saw success in reducing the number of out-of-state placements in the late 1990s with the same requirement.

Betty Rivard, who retired in 1999 from DHHR as an executive assistant to the Office of Social Services, worked on initiatives in the state’s southern coalfields.

During that time, Rivard said the focused efforts and personal attention from then-DHHR Secretary Joan Ohl resulted in whittling the coalfields’ out-of-state placement to just four kids.

“In my mind, that proves that the state has the capacity to get kids what they need in most situations if they have the political will and resources to do it,” Rivard said.

While in-state care could keep a child close to biological family and community, many who work in child welfare say the state needs more adolescent mental and behavioral health treatment options.

But Marcia Lowry of A Better Childhood emphasized that building more in-state facilities isn’t necessarily the answer to addressing the crisis.

For some kids, the need is a family, though there aren’t enough foster families in West Virginia to care for all of the kids who have entered the system in recent years.

“A lot of these kids do not have to be institutionalized,” Lowry said. “It’s not like the state has to build big buildings for these kids and lock them up. The kids need families.”

After being shuttled from one out-of-state group home to another, when he was 12 Mason Kendall did find a family, much to his surprise, in Calhoun County. He hadn’t been in a home setting since a social worker removed him from his mom’s home at age 6.

In 2020, Crystal Kendall and her husband adopted Mason.

“My parents have had a lot of patience with me,” he said. “I learned to control my emotions and not get mad about every little thing.”

Mason Kendall with his mom, Crystal Kendall, in the living room at their home in Calhoun County, West Virginia. (Photo by Kristian Thacker)

The transition from institutional living to a family setting was anything but easy, said Crystal Kendall, a former social worker who has fostered and adopted other teen boys.

“When [Mason] came here … he just hated everything and everybody. He was so disconnected from the world and was on so many medications,” she said. “His learning had stopped at about 8 years old. He was at about a second-grade level.” Now, she said Mason is excelling in his vocational classes as he works toward finishing high school.

Kendall hoped sharing her story would bring change to the system, including more West Virginians being willing to foster teenagers.

“The change in him has been so dramatic,” she said. “It’s just all from not being yanked around. He has that solid foundation under him.”

“He needed a mom,” she added.

This story was produced in collaboration with Mountain State Spotlight, a nonprofit news organization that aims to hold the powerful accountable and tell the stories of West Virginians and the issues facing their communities. Amelia Ferrell Knisely is a Report for America corps member, and Molly Born’s reporting was supported by a grant from GroundTruth.

A version of this story appeared on MOUNTAIN STATE SPOTLIGHT on September 21, 2021