State of New Hampshire, Office of the Child Advocate – 2020
Through the lens of child welfare there are layers of safety nets employed to ensure parents are doing what they need to do to keep children safe. At school, recreation programs, churches, and all the community intersections a child encounters, people are watching after the children and, when needed, will step in to offer assistance or prompt protective action. When children are removed from their home and community for whatever reason, it falls to the State child welfare system to ensure safety and wellbeing at an even higher standard than parents would be expected to provide, because just leaving home sets a child back in the trajectory of development. Children placed in institutional settings are hidden from community view. Children who are institutionalized have the highest risk of being restrained,1 and yet the restraint and seclusion of children placed in institutional settings is a hidden practice. The incidence of restraint and seclusion in New Hampshire may therefore come as a surprise. In a five year period between 2014 and 2018 there were more than 20,000 incidents of children being restrained or secluded in New Hampshire residential facilities, most of them, 15,544, were restraints.2 Acknowledging the dangers of restraint and seclusion to both children and staff, New Hampshire put a law in place, RSA chapter 126-U, to ensure limited use of these practices, careful collection of information about each incident, periodic review of facility practices, and transparent reporting to state decision makers. However, the Department of Health and Human Services (department) declined to adopt statutorily mandated rules to guide its oversight of facility practice and reporting. An annual report to the legislature is only an aggregate sum of restraints and seclusions in a year. The reports lack the informing details that give meaning to what happened, to whom, by whom, why and what came next. There has been no examination of the reports to determine effectiveness of the law or assess the risks and benefits of the practice of restraining or secluding children behind closed doors. Children arrive in residential treatment facilities with a significant history for adverse childhood experiences (ACE), placement out of home being one of them. Children in these facilities have been exposed to substance use, mental illness, domestic violence and abuse and neglect. They experience trauma or diagnosed post-traumatic stress disorder at a rate more than twice that of combat veterans.3
