Some fundamental shifts are happening in the state oversight of troubled youth programs in Montana, a result of new legislative measures lawmakers passed earlier this year.
The programs that were once licensed in a mostly self-regulating model beneath the state labor department will be moved under the oversight of the Montana Department of Public Health and Human Services and the scrutiny of the department's Quality Assurance Division.
The current Private Alternative Adolescent Outdoor or Residential Program (PAARP) oversight board met Tuesday in Helena, where program owners, public members and DPHHS staff got a chance to swap expectations of the transition process. They also aired concerns for new standards they felt could inflict harm on the programs' ability to operate as they have, some for more than 20 years.
Even with a number of questions, the move to switch over to the health department, a proposal made more than a decade ago, was lauded during both the legislative session and Tuesday's meeting.
"I do think there are some positive things that will happen from this," John Santa, founder of Montana Academy near Marion and chair of the PAARP board said of DPHHS. "You have better ability to enforce and investigate. We have had a lot of handicaps, it's very difficult, and they're (the Department of Labor and Industry) really not set up to do facility complaints. I think it will be an advantage that you're going to offer that kind of oversight and it will be a benefit of perception."
As part of the legislation passed earlier this year, the PAARP board — the majority of which is made up of program owners — will sunset July 1. The other part of that legislation set out the transition process, allowing current license holders to be grandfathered into the health department's licensure bureau and the current PAARP rules to remain in effect until DPHHS develops its own.
In the next six weeks, Quality Assurance Division Administrator Carter Anderson will visit each of the 18 programs that will migrate to DPHHS to learn more about each program so the upcoming rules can be developed in concert with the different types of programs, such as outdoor, therapeutic boarding schools, and others. After the new rules are set out, 11 programs scheduled for triennial inspections will undergo those by DPHHS inspectors.
Anderson said he hopes those rules will be drafted as soon as mid-August. After that, the department will hold a 30-day public comment period for input on the new rules, as well as a public meeting held by the department to hash out concerns and suggestions in an open forum.
Marshall Duval, a former resident at Spring Creek Lodge who phoned in to Tuesday's meeting, asked what role former program residents would have in the development of the new rules.
"The rule-making process is open to anyone who wants to participate in the rule-making process," Anderson vowed. "If you feel like you want input into the process, you can have input to the rule-making process."
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A number of program owners who have tentatively resisted the transition to DPHHS have described current health department standards as potentially fatal to their programs, although they voiced their concerns in vague terms. Santa offered one specific — that night staffing ratios for other programs under health department oversight require one staffer per eight attendees. Santa likened such measures to a prison or hospital setting, while the programs for troubled teens are not as intensive.
"We're just not that level of care," said Santa. "It's not the level that our parents are selecting. In our case we would have to hire 14 more night staff. What in the world would those people do?"
Anderson said these concerns are what the upcoming site visits are about. What may develop is the addition of new categories within the DPHHS oversight of troubled youth facilities to include more specific rules distinguishing larger programs from smaller ones, or outdoor treatment programs from residential ones.
"Our goal is not to come in and shut people down and say you're not going to do this," Anderson said. "Our goal, if you read everything in quality assurance, is health and safety — if we can show that the children are safe, and there's good, proper needs being met."
Anderson, responding to another question from Santa, also said the department has yet to determine how it handles complaints that are currently unresolved with the PAARP board.
"We are in the middle of some things right now," Santa said.
Complaints leveled against DPHHS-licensed programs will always be anonymous, Anderson said, but if the department finds issues that need to be addressed during inspections, those corrective actions are posted to the DPHHS Quality Assurance Division Licensure Bureau website.
The site shows, for example, that 48 complaints have been filed with DPHHS against Acadia Montana since November 2013, as well as the plan of corrections if deficiencies were found and the date those plans were accepted. Such information was not immediately available through the PAARP board site.
The opaque nature of PAARP's handling of complaints was one component of a yearlong investigation by the Missoulian into how the troubled industry regulates itself in Montana. Those stories examined 14 programs. The Department of Labor said Wednesday two additional programs have since been added to the list; one was inadvertently missing from the list while another's license is pending.
The "perception" issue to which Santa alluded during Tuesday's meeting led one parent to describe PAARP's oversight as the "fox guarding the henhouse." That series, published in January, spurred lawmakers to change the oversight.