New Jersey Office of the Child Advocate Final Monitoring Report: Oversight of the 2005 Bancroft NeuroHealth Settlement Agreement Executive Summary August 22, 2007
In 2004, the Office of the Child Advocate (OCA) became concerned about the safety and care of children residing and receiving care at Bancroft’s pediatric programs, including its Campus Residential and Lindens programs. These concerns were raised by correspondence and other communications between the OCA and parents of children who were receiving or had formerly received treatment at Bancroft NeuroHealth (Bancroft), as well as through monitoring allegations of abuse and neglect that were reported and investigated by the Department of Human Services (DHS) Institutional Abuse Investigation Unit (IAIU). As a result, the OCA began an inquiry into conditions at the programs pursuant to its statutory mandate at N.J.S.A. 52:27EE-66 et seq., specifically focusing on the following areas; Staffing, Reporting and Investigations, Supervision of Psychological and Behavioral Services, and Coordination of Medical Care. On June 30, 2005, the OCA and Bancroft NeuroHealth entered into a Settlement Agreement.
The Settlement Agreement called for the appointment of an Independent Expert, and Steven M. Eidelman, MSW, MBA, was selected to provide technical assistance and monitor compliance with the terms of the agreement. On November 15, 2006, the Independent Expert’s report was released. He found Bancroft in substantial compliance but recommended that the OCA continue oversight of the pediatric programs for a period of time to ensure both that gains were sustained and that areas still in need of improvement were addressed. Based on this recommendation, the parties agreed to extend the monitoring period for six months.
The OCA monitoring period extended from January 2007 to June 2007. On-site monitoring of the Bancroft Campus Residential and Lindens Programs was performed by OCA staff and included the following: • •
Monthly site visits, both announced and unannounced; Review of policies and records;
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Facility tours, including meetings with program and executive staff; Demonstrations of the Time and Attendance System, the emergency restraint database, and the reporting and investigation database; Attendance at an Individualized Habilitation Plan and Individual Education Plan meeting; Attendance at a quarterly meeting for families; and Review of Office of Licensing findings from their site visits and the resulting corrective action plans developed by Bancroft.
This report, captioned, “The New Jersey Office of the Child Advocate Final Monitoring Report: Oversight of the 2005 Bancroft NeuroHealth Settlement Agreement” (Final Monitoring Report) outlines the OCA’s findings in the broad areas of Staffing, Reporting and Investigations, Supervision of Psychological and Behavioral Services, and Coordination of Medical Care with particular concentration focused on areas that the Independent Expert reported were in need of continued improvement. In addition, the OCA examined efforts by Bancroft to improve its
relationship with family members of children served in its pediatric programs. Among its key findings: • • • • •
The required level of supervision was maintained for all persons served across shifts. Direct care, clinical and nursing staff received ongoing training to enhance the quality of services being provided. The organization maintained a commitment to report all incidents of possible abuse and neglect to the appropriate state agencies. A database system tracked allegations of abuse and neglect in order to analyze trends and develop corrective action plans. Based on an individual’s needs and treatment goals, the facility implemented the least restrictive behavioral management intervention. Behavioral management interventions
were implemented under the supervision of appropriately credentialed staff. • • Qualified medical staff maintained oversight to ensure coordination of medical care consistent with best practices in the field of pediatrics. Improved quality assurance measures were instituted for increased family involvement including development of a family handbook, continuation of quarterly meetings for family
members, implementation of an annual family satisfaction survey, and maintenance of a family advocate position on staff.
This report also addresses the one area of the original Settlement Agreement where compliance is still an active issue, and where OCA involvement will continue, namely, implementation of video recording. Bancroft's good faith negotiations and earnest contributions to three-way discussions with the OCA and the Office of Licensing have been extremely important in developing a video recording policy. This policy balances many competing, legitimate interests including, but not limited to: concerns about the safety of persons served; concerns about protecting the privacy rights of persons served and their families; the organization’s or a family’s desire for video recording of their child to further evaluate unexplained physical or behavioral findings; and the limitations, utility, and practical application challenges of a video recording system. The OCA will continue to assess these issues with Bancroft through a new Limited Settlement Agreement entered into on August 20, 2007, which focuses on the implementation of video recording at Bancroft. The OCA has looked closely at Bancroft’s operations, has assessed it carefully and has made the considered judgment that continued OCA monitoring is no longer required. While the OCA will no longer be specifically monitoring Bancroft, as part of its statutory mandate the OCA will continue to monitor all systems of care serving children throughout the state, including Bancroft. From a legal standpoint, Bancroft has met the obligations that it entered into as part of the Settlement Agreement. In some instances, it has exceeded those standards by a significant extent. The OCA's analysis also includes the judgment that Bancroft has quality assurance processes in place to sustain those gains. While there is no certainty with respect to long-term outcomes, the present situation does not justify continued monitoring. Should change occur at the facility and should significant problems emerge in the future, the OCA would undertake any appropriate action consistent with its statutory mandate.