A troubling report released today by DisAbility Rights Idaho presents an inaccurate and incomplete picture of our operations at the Southwest Idaho Treatment Center (SWITC) in Nampa.
The report makes some serious allegations about our staff and our ability to provide a safe home for the residents of SWITC. None of the issues raised in the report are new or recent. In fact, all of the issues have been and continue to be addressed. While we appreciate and respect the work done by DisAbility Rights Idaho, we have serious issues with a report that contains numerous factual inaccuracies. Information gained during our own investigations and licensure surveys has led to increased emphasis on ensuring the safety of our residents and our employees. We have done our best to be transparent. But we are also bound by privacy and confidentiality laws that limit what we can say. We are not able to provide the additional context necessary to tell the entire story.
Contrary to what the report says, we first notified media and the public in August 2017 when we identified inappropriate and abusive employee behavior that was not meeting our standards. We launched an extensive internal investigation into the allegations. As a result, six employees were terminated. However, the Canyon County Prosecuting Attorney’s Office declined to file criminal charges based on the Nampa Police Department investigation.
A licensure survey last summer and follow-up surveys resulted in several findings that we are continuing to address. SWITC has implemented plans of correction that also must be approved and checked as part of the licensure surveys.
SWITC annual licensure survey ended this past week. It was a full survey that looked at SWITC’s compliance with more than 470 federal regulations. The surveyors also conducted a complaint investigation, addressing some of the same allegations DRI makes in its report. The survey team reviewed many of the abuse investigation reports from 2017 and 2018 and interviewed clients, staff, parents, guardians, and agencies, including Adult Protection Services.
What they found was that SWITC’s abuse investigations were both “very thorough” and “complete” and that the facility’s response and corrective actions were “appropriate.” No citations were warranted. Surveyors also said they were pleased to see SWITC’s focus on Applied Behavioral Analysis and its use in the development of treatment plans, along with a strong focus on Trauma Informed Care.
We walk a fine line in making sure residents have a safe place to live and employees have a safe place to work. That is why we are working to create an environment that provides protection and safety for our clients, our staff, and the public.
The actions of a few former employees do not represent the commitment, compassion, and professionalism demonstrated by the majority of our staff at SWITC who daily turn extremely challenging situations into potentially life-changing moments for residents. As we continue to improve our treatment and care for individuals with intellectual disabilities, we also are working to rebuild the community trust so that SWITC is a good neighbor and a model treatment center.
Russ Barron is the director of the Idaho Department of Health and Welfare.
Background and relevant context
- SWITC treats and houses people with intellectual disabilities who also have extreme and oftentimes criminal behaviors that prevent them from being served safely in their communities. Residents also come to SWITC from homelessness or from jail. SWITC then provides assessment, treatment, and stabilization so residents can safely transition back to their families and community.
- Transition to the community has not always been a priority at the facility. SWITC’s purpose and mission changed when its name changed in 2011 from the Idaho State School and Hospital to the Southwest Idaho Treatment Center. It is no longer a long-term residential facility for people with intellectual disabilities. It supports the idea that people with intellectual disabilities have better outcomes when they live and work in the community rather than an institution.
- Functioning as a short-term treatment center creates a uniquely challenging environment for residents and employees. Several residents live at SWITC because their guardians cannot find a community provider who is able or willing to serve them, and their guardians are unable to care for them in their homes. Some residents have been declared incompetent to stand trial for one or more criminal acts, such as assault with a deadly weapon, malicious injury to property, or sex offenses. Some residents have been committed by the courts to the Department of Health and Welfare because they have been deemed a danger to themselves or others. SWITC frequently receives residents who county jails cannot safely house.
- Most residents at SWITC have secondary diagnoses of mental illness in addition to their developmental and intellectual disabilities. All of our residents at SWITC live at SWITC because they have exhausted the services available in their communities. If they could live someplace else, they would not be at SWITC.
- Regardless of how they came to be in our care, almost all the residents at SWITC have demonstrated extreme behaviors that are challenging and even dangerous to manage, both for themselves and for the staff who care for them. Most of our clients have a history of assaultive behavior. Our challenge is to provide appropriate, individualized treatment in a safe environment.
- Employee injuries are not uncommon – 30 percent of staff have had at least one medical claim. In 2017, an average of over 70 assaults on staff per month occurred at SWITC from clients. Client-to-client assaults averaged a little over 26 per month. This means we regularly have staff out on medical leave and high turnover in our direct care staff.
- Despite these challenges and the difficulty of the work, residents at SWITC stabilize and move safely out of the facility back to their communities. Since 2011, 104 residents have been discharged from SWITC and most now live in communities throughout Idaho. Only eight of these residents have returned to SWITC, and all eight have since been discharged from SWITC again to their communities. Two of these eight have experienced significant difficulties and returned to SWITC yet again. All 17 current residents at SWITC know it is a treatment center, not a long-term home, and nearly everyone living at SWITC hopes to be discharged to their families and communities.
- The allegation that SWITC investigators told residents they could not discuss investigations with anyone, including their guardians or advocates is only partially true. Residents were asked to not discuss the investigation with others involved in the incident and were then given a memo about maintaining confidential information. That practice has been stopped since staff discovered it was confusing for residents. It was intended to protect the integrity of the investigation, not to keep residents from discussing their experiences with their guardians and advocates. In fact, guardians were and are notified within 24 hours whenever there is an allegation of abuse or neglect.
- Instances of abuse or neglect in the report lack the context needed for an accurate judgement of what happened. For example:
- In the head-butting incident, a resident had attacked and was on top of a staff member and was holding him down. In the struggle for the staff member to disentangle himself from the resident and get up, the staff member was scared for his safety and headbutted the resident. The staff member was terminated.
- For the incident where a resident experiencing seizure-like activity did not receive required prescription medication: The resident and SWITC staff were on an outing away from SWITC, and the needed medication required a nurse to dispense it in the event of a seizure. So it was not available when they were away from the facility and the resident had a seizure. SWITC has changed its practice on outings to consider whether a nurse should attend, and if not, have a medical plan in place in case something happens.
- The primary delay in reporting allegations of abuse or neglect to Adult Protection Services is caused by the fact that it is closed on evenings and weekends. They only take referrals by phone, so our staff would wait until they were open to call them.
Niki Forbing-Orr, Public Information manager