Caring for some of Tennessee’s most vulnerable kids is challenging work, yet many who do so in residential psychiatric centers earn low wages, have no prior experience and get just a couple weeks training.
Which is why places like Kingston Academy near Knoxville, which closed last year, see such high staff turnover, burnout and violence.
Kingston’s owner — Sequel Youth and Family Services — shut the place down after filthy, unsafe conditions prompted the state to remove the kids it had placed there. Skyler Deloach was one of those kids.
“It was by far, I’d have to say, the worst facility I’ve been to,” said Deloach, now 18. “Kids went there to seek help and didn’t get what they needed at all.”
Fights broke out all the time, he says, and kids frequently tried to run away. Emergency 911 logs obtained through a public records request show more than 100 calls were made from the facility in the 12 months before the shutdown.
Many calls were about kids destroying property, which could be a sign that kids feel unsafe, according to the head of another facility. Others were about potential runaways.
Kingston Academy was at the end of a dead-end road in rural East Tennessee. Kids weren’t allowed cell phones; some didn’t even have a home or family to run to. That didn’t matter, says Deloach.
“Even if they knew they couldn’t make it, they would still run, just to have a few minutes to themselves away from the facility.”
Deloach says he himself spent much of his childhood running away from the grandmother who raised him. He ended up in state care — including at a juvenile detention center, which he says was better than Kingston, a behavioral treatment center.
They needed to know ‘that somebody cared’
At Kingston, kids slept on thin mattresses. Deloach says he didn’t get enough to eat, and contact with family was not guaranteed.
“They wouldn’t use home passes and phone calls as a way to help you in your treatment,” he says. “They would just use it as a reward if you was good for that week.”
According to the state of Tennessee, withholding phone calls or visits with family as a behavior modification tool infringes on a child’s civil rights. Yet multiple former employees say it happened at Kingston.
In interviews with WPLN News and APM Reports, they describe a dilapidated, understaffed place that paid a little better than the local Walmart — and where kids removed from abusive homes, or sent there by families looking for help, often didn’t get the care they needed.
“All of these kids, all that they needed and wanted was just to know that somebody cared,” said Brittaney Cantrell, a shift supervisor at Kingston when it shut down in March 2019.
Cantrell still cries thinking about the teenage girl who she says lived at Kingston for years while dreaming of being adopted and a younger boy who would climb up on the buildings and throw rocks at staff cars. Cantrell says he even busted a few windshields, before “we realized that he was kind of embarrassed when he’d go to school and he didn’t know how to read.”
Multiple grades are often combined at these schools, which makes learning difficult. But Cantrell says they taught the boy to read at night, “and he stopped climbing up on the buildings.”
Strained staff ‘react very poorly’
Yet finding the time and energy for that kind of individual attention is rare if staff are stretched thin.
“I was working five to seven days a week, upwards of 90 hours,” said Jeremy Roach, a former residential counselor who mostly worked nights.
Double shifts were common, he says, and he once even worked 24 hours straight. And while he was supposed to oversee at most eight kids, he was typically assigned a dozen. That was a difficult task even at night, when staff were supposed to clean, do laundry, and monitor kids on suicide or sexual aggression watch, who at Kingston often had to sleep on the common room floor so that staff could see them.
“And we were also expected to check all the kids in their rooms,” said Roach, to make sure they weren’t physically or sexually assaulting each other, or running away.
Yet despite staffing issues and decrepit conditions, Kingston Academy kept taking kids from child welfare agencies in Tennessee and other states. Kingston’s owner, Sequel, prides itself on taking the nation’s most difficult-to-treat kids, some of whom require two employees to watch over them.
This only adds to the strain of inexperienced and overworked staff, says Hunter Hancock of the advocacy group Disability Rights Tennessee. He monitors some of these for-profit children’s treatment facilities and investigates reports of abuse by staff.
“Emotionally, it’s traumatizing for them as well,” says Hancock.
He says he sees the same problem that’s also common to prisons, nursing homes and adult mental health facilities: a staff of well-intentioned, low-wage workers pushed to the brink.
For some, he says, “this is the only job they can get with their education levels. They have a sincere desire to help children, and they have an idea that they can go [to a facility] and do that. They’re working 12-hour days and then they’re showing up to do it again tomorrow. And throughout that day, they’re being kicked and beaten and punched and cursed out.
“They’ve been slapped in the face 150 times,” he says. “And on the 151st time, they react very poorly.”
Like hitting a kid back. Or abusing restraints. Those should be a last resort when kids are hurting themselves or others, but Hancock says over-stressed employees tend to use restraints incorrectly or unnecessarily. State inspection and incident reports cite concerns with staff restraints at Kingston.
At another Sequel facility in Michigan, a boy died this spring after staff members held him down for throwing food. It became the eighth facility that Sequel closed nationwide since last year, some amid investigations into abuse and neglect.
Working toward a model of ‘trauma-informed care’
Hancock says he is working with companies to improve training. That includes using videos of bad restraints to teach staff what not to do. He’s also helped facilities add more surveillance cameras, for accountability purposes.
But what really needs to change, says Hancock, is a facility model “based on reward and punishment. They don’t like to use the term ‘punishment,’ but loss of privileges and things like that, that are not trauma-informed.”
Trauma-informed care means treating the root of an emotional problem, not punishing the behavior that results from it.
In a lengthy statement to APM Reports, Sequel says it intends to adopt “evidence-based, trauma-informed” care at all its facilities. But it has to anyway, according to a new federal law.
Sequel also says it will phase out using restraints at facilities and improve hiring practices. But the company did not respond to WPLN News’ questions about whether it intends to hire more medical professionals or ensure facilities are adequately staffed.
When there’s enough staff, it’s “night and day,” says Jeremy Roach. The former Kingston employee also spent a few months at Norris Academy, Sequel’s other Tennessee facility, also near Knoxville.
“At Norris, you could see people act more like actual people,” he says, “and think a situation through, versus just responding off of whatever their base instinct was.”
Although Sequel did settle two child-on-child rape lawsuits at Norris Academy in 2013, the state did have fewer reports of staff violence than at Kingston in the years right before that facility’s shutdown.
Roach knows it’s easy to forget that behind all these reports and statistics are marginalized, lonely kids who may have no other “family” than the adults and children at these facilities.
He recalls the toughest, most disruptive kids at Kingston crying the hardest at the end — and apologizing, as if the facility’s closure was their fault.
“They were going around promising everyone they could that they would act better,” said Roach, “saying they would do everything they possibly could, just to not get ripped from everyone they knew. All they have is the people that show up every day.”
This is the first in a three-part series by WPLN News contributor Natasha Senjanovic and part of APM Reports’ national, yearlong investigation into Sequel Youth & Family Services.