Working With A ‘Puzzle’ Of State Agencies, Youth Psychiatric Facilities May Fall Through The Cracks

It’s been nearly two years since Kingston Academy shut down, but Marie still struggles with guilt and says she feels like “a dirt of a mom” for sending her daughter to the 52-bed psychiatric center in the first place.

Marie’s daughter was diagnosed with an extreme mood disorder that, by age 9, was causing uncontrollable violence that Marie and her husband didn’t know how to de-escalate. After a particularly violent episode that prompted Marie to call 911 to intervene, Vanderbilt Children’s Hospital recommended Kingston.

“We looked it up online, and it looked beautiful,” says Marie.

More: This is the third story in a series about Kingston Academy and questions about youth psychiatric facilities. Read Left Without Care.

By the time Kingston Academy closed last year, the state of Tennessee had multiple reports of staff violence and at least two child-on-child sexual assaults. Yet it would take damning photos of squalid conditions, taken by the mother of four, to shut the children’s psychiatric facility down.

Marie says when her husband dropped off their daughter, he called it a little rundown but clean. (WPLN News is using only her middle name to protect the identities of her children, all of whom have special needs and are adopted.)

Sure, the buildings were glorified trailers. And it bothered her that he wasn’t allowed to see inside the dorms; parents were told by administrators that was to protect other kids’ privacy. But the property was nestled in rolling hills. It had basketball courts and a pool and promised equine therapy.

That was November of 2018. Soon the girl was complaining about going cold and hungry. And on the next family visit, “we pulled in and there was just garbage everywhere,” Marie says.

TN Department of Mental Health & Substance Abuse

Photos taken by Marie ended up in a state report in January 2019.

Inside the on-site school building, where family visits were held, Marie was even more disturbed. “There [was] garbage from one end of it to the other. Food debris, destruction. And it smelled so bad. … We ended up spending this whole time — and it was cold out — in the back of my car having pizza and reading books, trying to just make the best of it.”

On another visit, Marie says they saw staff chase and restrain a child face-down. She says kids ate stone-cold food, outdoors, from Styrofoam containers, and her 9-year-old daughter was housed with teenage girls. And when she acted out like them, Marie claims she was punished — for instance, by not being allowed a home pass or to call her family. At one point, Marie says, she had to try for two days before she got her daughter on the phone.

They wanted to move their daughter, but they felt it wasn’t safe for her to come home. Marie recalls thinking, “What do I do? I don’t know what to do.”

‘Different pieces to that puzzle’

Meanwhile, she says she left complaints and messages with Kingston’s executive director, who Marie says stopped returning her calls. The director did not respond to an interview request from WPLN News.

Marie and her husband also took pictures. Of wooden planks nailed across exit doors. Rooms littered with debris. Crumbling walls and floors. Toilets overflowing with feces.

“It was like a nightmare,” she says.

In January of 2019, Marie found their daughter a new facility, whose director sent their photos to a friend at the Tennessee Department of Children’s Services, or DCS. Within weeks, DCS removed all 18 kids it had placed there.

Department of Children's Services

In an unannounced visit in February 2019, the Department of Children’s Services noted that medications were not properly labeled and stored.

Kingston’s owner, Sequel Youth and Family Services, shut the place down a month later. The for-profit, Alabama-based company has since closed seven more facilities nationwide. Some closed amid allegations of medical neglect, sexual abuse and excessive — even deadly — use of restraints.

Sequel declined to comment specifically on Kingston, but said in a statement it’s dedicated to helping the nation’s most vulnerable children and committed to improvement.

More: Read APM Reports’ investigation into Sequel Youth and Family Services.

Every time a child is placed in a restraint, or hold, it should be documented in detail. But missing paperwork was another problem at Kingston, according to former employees and an independent investigator.

“There were just entirely incomplete records,” says Hunter Hancock of the advocacy group Disability Rights Tennessee. He examined Kingston’s files after the shutdown. “There was very little, if any, information about [a] hold, what caused it and what led up to it.”

That’s significant, because reports of kids being improperly restrained or hit by staff are crucial to assessing a facility’s safety.

There are 48 of these private psychiatric centers licensed by the state to house children, but making sure they’re safe isn’t always easy. They contract with multiple state agencies, including DCS, the Department of Education and the Department of Mental Health and Substance Abuse Services.

“They all have some oversight role, to different pieces of that puzzle, that they are required to monitor and report on,” Hancock says.

Many of the children at psychiatric facilities in Tennessee are among the 9,000 in custody with DCS: orphans, runaways, kids whose parents are incarcerated or struggling with addiction, many removed from homes where they were physically or sexually abused. DCS must find placements for all of them.

The agency tells WPLN News it chooses facilities like Kingston only for kids who need psychiatric care as determined by clinical guidelines and professionals.

But Hancock says he’s met children who have grown up in these facilities for reasons other than clinical, “because of red tape, backed-up court systems, custody battles.”

‘Profiting from these children’

Former DCS commissioner Jim Henry calls these facilities “a last resort for sending kids when you can’t do anything else with them.”

Henry led DCS as it was coming out of years of federal oversight for placing children in dangerous conditions. He says these centers are often used for kids who have been bounced around the system and have all experienced so-called Adverse Childhood Experiences, he says. Those are traumas such as emotional neglect and sexual or physical abuse, all of which increase the likelihood of mental illness, suicide and incarceration in adulthood.

Kids in DCS care need long-term stability that facilities with inexperienced staff just can’t offer, he says.

“The best hope,” he says, “is that they can get into a normalized setting and go to foster care.”

But Henry says there’s always a shortage of foster families. According to child advocates, that’s why Tennessee and other states keep contracting with companies like Sequel, even when safety and welfare issues are raised.

DCS denies that it places kids in these for-profit psychiatric facilities because it doesn’t have enough foster homes, and notes the agency says it has taken “immediate action” to remove children from unsafe conditions, just like it did at Kingston in 2019. A DCS report shows that it had cited some of Kingston’s issues the previous year, including the dilapidated conditions, but an agency spokeswoman notes that was under a different commissioner.

Department of Children's Services

DCS pulled children from Kingston shortly after it took these photos. But it noted similar issues in an inspection the previous year.

“The Department of Children’s Services holds treatment providers to a high standard and expects them to take every precaution to treat and care for our children in safe environments,” a spokeswoman says.

Meanwhile, the Department of Mental Health and Substance Abuse Services, which licenses youth psychiatric facilities, says it will shut sites down depending on their “aggravating and mitigating factors.” But it was Kingston’s owner, not the department, that decided to close the facility.

More: How we reported this story

Every case is unique with its own aggravating and mitigating factors for consideration.

All the while, says Hunter Hancock, the vulnerable kids at Kingston were a “revenue stream” for shareholders. Companies like Sequel, he says, “are profiting from these children being in these facilities, just like the for-profit prison system.”

In 2017, Sequel reported $200 million in revenue, $8.5 million of which came from Tennessee. About 90% of the revenue came from government sources: child welfare agencies across the country, like DCS, and Medicaid, for kids like Marie’s daughter.

Marie says her daughter is now thriving at the small, non-profit ministry home they found for her after Kingston. “She’s safe. … It’s a normal home.”

But Marie knows many of the kids she saw at Kingston Academy were not as fortunate.