Louisville Metro Youth Detention Services
Conditions Assessment Narrative Report

September 2017

EChildren?s

ELawand Policy

TABLE OF CONTENTS
Introduction __________________________________________________________________________________1
Methodology _________________________________________________________________________________1
Findings and Recommendations __________________________________________________________________4
General Strengths __________________________________________________________________________ 4
General Areas of Concern ____________________________________________________________________ 5
Classification and Intake _____________________________________________________________________ 8
Health and Mental Health Care_______________________________________________________________ 10
Admissions Screenings _________________________________________________________________ 10
Full Health Assessments ________________________________________________________________ 11
Medical Services ______________________________________________________________________ 13
Mental Health Services _________________________________________________________________ 16
Dental Services _______________________________________________________________________ 18
Suicide Prevention and Intervention _______________________________________________________ 18
Administration of Prescription Medication __________________________________________________ 20
Confidentiality ________________________________________________________________________ 21
Health and Mental Health Administration __________________________________________________ 22
Discharge Planning ____________________________________________________________________ 23
Access __________________________________________________________________________________ 24
Mail ________________________________________________________________________________ 24
Telephone ___________________________________________________________________________ 25
Visitation ____________________________________________________________________________ 25
Family Engagement ____________________________________________________________________ 27
Programming _____________________________________________________________________________ 28
Education ____________________________________________________________________________ 28
General Programming __________________________________________________________________ 32
Recreation ___________________________________________________________________________ 34
Religious Programming _________________________________________________________________ 34
Youth with Special Needs _______________________________________________________________ 35
Behavior Mangement __________________________________________________________________ 35
Training and Supervision of Employees ________________________________________________________ 40
Qualifications and Staffing ______________________________________________________________ 40
Training _____________________________________________________________________________ 41
Supervision __________________________________________________________________________ 44
Quality Assurance _____________________________________________________________________ 44
Environment _____________________________________________________________________________ 46
Positive Institutional Atmosphere _________________________________________________________ 46
Food Service and Nutrition ______________________________________________________________ 47
Emergency Preparedness and Fire Safety ___________________________________________________ 47
Physical Plant and Sanitation ____________________________________________________________ 48
Searches and Supervision _______________________________________________________________ 48
Accommodations for Youth with Physical Disabilities _________________________________________ 49
Restraints, Room Confinement, Due Process, and Grievances ______________________________________ 50
Mechanical Restraints __________________________________________________________________ 50
Room Confinement ____________________________________________________________________ 50
Due Process __________________________________________________________________________ 54
Grievances ___________________________________________________________________________ 54
Safety ___________________________________________________________________________________ 56

2

 INTRODUCTION

In May 2017, Louisville Metro Youth Detention Services (LMYDS) and the Kentucky
Department of Juvenile Justice (DJJ) jointly agreed to have the Center for Children’s Law and
Policy (CCLP) in Washington, DC, conduct an assessment of conditions at LMYDS’s secure
juvenile detention facility (for the remainder of the report, the team will use the acronym
“LMYDS” to refer to the secure detention component of LMYDS’s operations). CCLP’s staff
and a team of experts conducted the inspection of LMYDS following inspections of three
juvenile detention facilities operated by DJJ. This narrative report, along with the corresponding
assessment checklist, constitutes the team’s findings and recommendations from its assessment
of LMYDS.
METHODOLOGY

The assessment team consisted of the following:
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Mark Soler, Executive Director, Center for Children’s Law and Policy
Jason Szanyi, Deputy Director, Center for Children’s Law and Policy
Jennifer Lutz, Staff Attorney, Center for Children’s Law and Policy
Andrea Weisman, Ph.D., Consultant and Mental Health Expert
Michael Cohen, M.D., Consultant and Medical Expert
Peter Leone, Ph.D., Professor, Department of Counseling, Higher Education, and
Special Education at the University of Maryland, and Education Expert

The members of the team have significant experience conducting conditions of confinement
assessments. Mark Soler has worked on juvenile justice reform, with a special focus on
conditions of confinement, for nearly 40 years – 28 years at the Youth Law Center and the last
11 as founder and Executive Director of CCLP. Jason Szanyi has worked at CCLP since 2009,
where he has focused on improving conditions in juvenile justice facilities. He has particular
expertise in implementation of the Prison Rape Elimination Act (PREA) standards for juvenile
facilities. Jennifer Lutz has been a staff member at CCLP since 2015, where she manages the
Center’s campaign to end the solitary confinement of youth and trains individuals on conditions
in juvenile facilities. Dr. Andrea Weisman has experience directing health and behavioral health
services in juvenile and adult facilities in Washington, DC, and Maryland for two decades and
has served as a mental health consultant to the U.S. Department of Justice and the U.S. District
Court for the Southern District of Ohio. Dr. Michael D. Cohen is board certified pediatrician and
the former director of medical services for the New York State Office of Children and Family
Services. He has also served as a medical expert as part of litigation and investigations involving
medical services in juvenile facilities in several states. Dr. Peter Leone is a Professor in the
Department of Counseling, Higher Education, and Special Education at the University of
Maryland. Dr. Leone has evaluated education services, monitored educational programs, and
provided technical assistance in jails, detention centers, training schools, and prisons in a number
of states. He is the former Director of the National Center on Education, Disability, and Juvenile
Justice at the University of Maryland.

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 On August 17 and 18, 2017, team members conducted an on-site assessment of LMYDS.
Following a tour of the facility, the team engaged in interviews, observations, and review of
records at the facility. As part of the assessment, team members interviewed facility
administrators, medical staff, social workers, youth workers, maintenance and food service staff,
educational professionals, youth, and other staff. Prior to the on-site visits, team members
requested and received policies, incident reports, grievances, data reports, and a wide variety of
other records about LMYDS’s operations.
When conducting the assessment, the team used the most demanding set of standards for juvenile
detention facilities in this country, the Annie E. Casey Foundation’s Juvenile Detention Facility
Assessment Standards. The standards were co-authored by CCLP and the Youth Law Center for
the Foundation’s Juvenile Detention Alternatives Initiative (JDAI). The standards are used to
assess and improve conditions in over 300 JDAI sites in 39 states and the District of Columbia.
Jefferson County, Kentucky, is a JDAI site, although LMYDS had not yet conducted an
assessment of LMYDS using the JDAI standards.
The JDAI standards have been cited in investigations by the U.S. Department of Justice’s Civil
Rights Division. They have also served as the basis for federal and state legislation, as well as
many agencies’ policies. For example, CCLP staff worked with legislative task forces in
Louisiana and Mississippi in recent years to help those states develop comprehensive mandatory
statewide standards for their juvenile facilities following numerous lawsuits and concerns about
conditions in those states.
The Detention Facility Assessment Standards were initially released in 2006 and revised in 2014.
The standards were developed following an extensive review of applicable federal statutes;
federal and state court decisions; settlement agreements in conditions of confinement lawsuits
brought by the U.S. Department of Justice and public interest law offices; professional standards,
including those of the American Correctional Association, the National Commission on
Correctional Healthcare, and Performance-based Standards; best practices in jurisdictions
throughout the country; and consultation with over three dozen recognized subject matter
experts, including former facility administrators.
The standards are organized into eight categories that cover all major areas of a facility’s
operations and use the acronym CHAPTERS:
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Classification and intake;
Health and mental health services;
Access to family and counsel through mail, telephone, and visitation;
Programming, including education, special education, recreation, and religious services;
Training and supervision of staff;
Environment, including issues related to sanitation and the physical plant;
Restraints, room confinement, due process, and grievances; and
Safety of youth and staff in the facility.

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 The team used these standards to prepare this narrative report and a checklist of conformance or
non-conformance with each individual JDAI detention facility standard.
There are inherent limitations in this type of assessment. The team did not interview every staff
member at the facility, nor did it visit the facility over an extended period of time. Nevertheless,
the comprehensiveness of the assessment standards; the extensive interviews conducted with
administrators, staff, and youth; the experience of the members of the assessment team, the
review of available data and records; the observations made throughout the facility; and the
receipt of consistent information from multiple sources provided a strong foundation of
information for developing this report.
In addition, the assessment process inherently focuses attention on areas of concern, and may not
fully explore all of the strengths in the facility. The assessment team appreciates the effort that
LMYDS Director Dr. Ursula Mullins, Assistant Director Erica Day, Quality Assurance Director
and PREA Coordinator Toni Rice, Executive Administrator Stytisha Claycomb, their staff, and
others put into making the assessment process a success. We extend special thanks to Toni Rice
and Stytisha Claycomb, who spent significant time and energy preparing for and coordinating the
team’s assessment among their many other responsibilities.

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 FINDINGS AND RECOMMENDATIONS

GENERAL STRENGTHS
Several aspects of operations of LMYDS are excellent. We will discuss these in detail in the
body of this report. First, we want to point out some overall strengths of facility operations.
LMYDS has an energetic and highly motivated leadership team that is interested in raising
the level of practice at the facility. The team was very impressed with the leadership team at
LMYDS under Dr. Ursula Mullins and Erika Day. Although Dr. Mullins is relatively new to her
position and to the juvenile justice field, she and other senior staff, including Erika Day, Toni
Rice, and Stytisha Claycomb, are clearly motivated to tackle longstanding problems at LMYDS
and introduce new programs and resources that will improve conditions for youth and staff.
Additionally, Dr. Mullins brings a background in developmental psychology to the facility, a
significant asset that will help the leadership team shift toward implementation of policies and
practices that are consistent with adolescent development. We were encouraged to see
administrators taking advantage of existing networks of juvenile justice professionals, such as
the JDAI community and the American Correctional Association. We are committed to working
with facility leadership to identify peers and learning opportunities that can help the team
advance its mission and vision for the facility.
Many senior staff demonstrate high levels of skill and professionalism. LMYDS has senior
staff members who have a spent many years working at the facility, and it was obvious that many
staff members took great pride in their work with young people. The experience and dedication
of staff was apparent in our conversations with these senior staff members. As mentioned below,
these staff members have worked to operate the institution in the face of significant staffing
challenges and a shortage of mental health resources.
Administrators and staff have shown creativity in using limited resources to enhance
programming. The team was impressed with the recent efforts that administrators have made to
bring new programming and resources to the facility. The team learned about the introduction of
new programming for youth, as outlined in the Programming section below. The team also
observed the new murals in the courtyard, which were designed and completed with the help of
youth at the facility. The murals help convey a sense of positivity and hope in a building that is
structured to be a secure detention facility. Finally, the team also learned about administration’s
efforts to bring in supportive resources for staff members. For example, the team learned that the
facility had offered massages to staff during the week prior to our assessment.
LMYDS has good data collection capacity on a number of key indicators for the facility.
The team was impressed with the level and detail of data collection at LMYDS. Being able to
collect and analyze data on trends and problem areas at the facility is a significant strength. As
outlined in other points in this report, we believe there are areas where additional data collection
and analysis could further strengthen management and oversight of conditions at LMYDS.

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 LMYDS’s physicians and their connection with the medical program at the University of
Louisville are a significant asset in meeting the medical needs of detained youth. As
described greater detail below, the robust connection between the facility and the local university
hospital system in Louisville provides a greater degree of access to specialized evaluations and
medical services than most juvenile detention facilities can offer. We do have significant
concerns about particular aspects of LMYDS’s medical services, but the relationship between the
facility and the University of Louisville School of Medicine is a particular strength.
Other strengths of LMYDS’s operations are discussed below in the body of this report, which is
organized according to the CHAPTERS framework.

GENERAL AREAS OF CONCERN
During the assessment, the team identified a number of concerns that impact all aspects of
facility operations. We raise these issues here, as they provide significant context for the entire
report.
Staffing shortages and high staff turnover at LMYDS are hindering the ability to supervise
youth in a safe and humane manner. The team was very concerned with LMYDS’s ability to
recruit and retain qualified and dedicated youth workers. The demands of a very difficult job,
have meant that the facility has a high rate of staff turnover (38%), notwithstanding LMYDS’s
efforts to offer a higher rate of pay than comparable positions at other agencies and facilities. A
lack of adequate mental health resources, as outlined below, also contributes to a feeling of burnout among line staff, as line staff are expected to manage youth with complex mental and
behavioral health problems. High rates of staff turnover have meant that staff who do remain are
expected to work longer shifts or double-shifts on a regular basis, which contributes to levels of
stress, exhaustion, and low morale. Indeed, LMYDS anticipated spending over 12% of its budget
for fiscal year 2018 solely on unscheduled overtime. These staffing concerns are a serious
problem that jeopardize the safety of youth and staff at the facility. They also contribute to the
extensive and inappropriate use of room confinement, outlined below.
LMYDS houses many youth with significant mental health needs, but access to mental
health professionals is extremely limited. Staff and administrators at LMYDS were the first to
admit that the facility does not have access to adequate mental health services to address the
mental health needs of youth. As outlined below, the facility had just one designated on-site
mental health staff member at the time of our assessment, and that individual was not a qualified
mental health professional. The lack of adequate qualified on-site mental health professionals
jeopardizes the safety of young people with mental illness. It also places an unfair burden on
staff, who are required to manage the behavior of very troubled youth without guidance and
support from professionals with expertise in working with youth with mental health problems.
The use of room confinement jeopardizes the safety and well-being of youth. As mentioned
above, significant staffing challenges, when coupled with a lack of adequate on-site mental
health resources, have led to a significant over-use of room confinement at LMYDS. Minor
incidents often escalate into situations where staff end up applying room confinement as a
disciplinary sanction. Youth with mental health problems can see those problems worsen while
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 in room confinement, which raises the possibility of youth engaging in self-harming behaviors.
Additionally, youth in room confinement may not receive access to legally required services,
such as educational services and recreation. We were particularly concerned about the use of
room confinement on the girls’ unit, which we outline in greater detail below.
Youth at LMYDS are not receiving legally mandated general and special education
services. Educational services are often an area of weakness in juvenile detention facilities
because of the fluid and wide-ranging nature of the detained population and difficulties
coordinating with local school districts. However, the quality of education and special education
services at LMYDS, provided through the Jefferson County Public Schools, is lacking in many
different areas (with some exception for educators who are clearly doing their best to provide
meaningful instruction in a challenging environment). The lack of adequate educational services
for youth at LMYDS, such as the inability to provide in-person classroom instruction to more
than half of youth at any given time, violate federal and state law. Some of these problems stem
from operational issues at the facility, such as the need to manage multiple court orders requiring
separation of certain youth at the facility. However, these operational challenges must be
resolved in a way that ensures that all youth have access to legally required general and special
education services.
Several recent substantiated incidents involving reports of sexual misconduct or otherwise
inappropriate behavior by staff raise serious concerns about hiring practices and training
and supervision of staff. While the team was very impressed with the facility’s work to
implement and operationalize the Prison Rape Elimination Act (PREA) standards for juvenile
facilities, we were alarmed at the number of substantiated PREA incidents. From November
2016 to August 2017, LMYDS had 6 reported PREA incidents, 5 of which were sustained or
substantiated. LMYDS did a thorough and appropriate job of responding to these incidents, and
the fact that the incidents were detected in the first place speaks to the importance of the
facility’s PREA compliance work. Additionally, it is important to note that the incidents did not
involve allegations of alleged abusive physical contact by staff. However, the fact that some
incidents involved recent hires who crossed professional boundaries in their interactions with
youth (one of whom did so over an extended period of time) raises questions about screening
during the hiring process, training of staff on red flags and warning signs in their interactions
with youth, and supervision of newly hired staff. This was a particular area of concern given that
there may also be incidents that have gone unreported, notwithstanding the facility’s PREA
compliance efforts.
Staff and youth consistently complained about the quality, quantity, and timing of food
service at LMYDS. The team reviewed many grievances related to the quality and quantity of
food provided to youth prior to arriving on site. Interviews with staff and youth, coupled with the
team’s experience with the meal service while on site, provided additional information about
shortcomings within the food service and delivery system at LMYDS, which is contracted
through Trinity Services Group. The team recognized that the kitchen had implemented a new
menu recently with the goal of remedying long-standing areas of concern. The team also learned
about significant staffing shortages in the kitchen, coupled with the recent departure of the
facility’s food service manager. While the team acknowledges these challenges, we found that
there were serious concerns about the quality, quantity, and timing of meals at LMYDS. As any

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 juvenile facility administrator knows, problems with these areas of food service lead to hungry
and unhappy youth, who are more likely to engage in disruptive behavior.
The physical plant at LMYDS suffers from significant shortcomings, and the facility would
benefit from heightened attention to sanitation protocols. Administrators and staff at LMYDS
are all too familiar with the challenges presented by the facility, including chronic maintenance
problems, inconsistent air and water temperatures, lighting problems, and other problematic
conditions. There is, unfortunately, no easy remedy to these problems in a facility of this age, but
LMYDS could certainly benefit from additional resources directed at preventive and corrective
maintenance. Additionally, the facility relies upon youth for a significant amount of sanitation
services that would otherwise be provided by janitorial staff. The team observed parts of the
facility that were not adequately cleaned and sanitized under the current policies and protocols.

7

 CLASSIFICATION AND INTAKE
Detention can be highly stressful and potentially traumatic event for a young person. From the
moment the youth arrives at the facility, staff need to gather information quickly, make critically
important decisions, and address the young person’s emotional, health, mental health, and
physical needs. The Classification and Intake section addresses these “front end”
considerations, including intake, criteria governing who comes into detention, housing and
programmatic assignments to keep youth safe, and mechanisms to reduce crowding and
unnecessary detention. This section also covers the orientation process necessary for youth to
understand what to expect in the facility, what rights they have, and how to ask for services or
help.
In the general observations above, this report notes the strengths that experienced staff bring to
this facility. In the Intake area, the team was particularly impressed with key senior staff, who
are clearly very knowledgeable and resourceful. The team appreciates the time they took to
answer questions and provide explanations.
Overall, the intake, orientation, and classification process seems to work well. The
accompanying checklist identifies some areas in which the facility does not meet the JDAI
standards. Some of these involve adding or re-writing sections of the Resident Handbook. The
absence of a qualified mental health professional is a concern with respect to asking youth about
sensitive information such as prior sexual victimization or abusiveness. In addition, the facility
should have written language access and ADA plans, in addition to facility policies, that outline
how accommodations would be made for youth with limited English proficiency and youth with
disabilities.
Recommendation: Hire a qualified mental health professional and give that person
responsibility for eliciting sensitive information from youth during intake.
Recommendation: Develop a written language access plan and ensure that staff are
familiar with the plan.
Recommendation: Develop a written Americans with Disabilities Act plan and ensure
that staff are familiar with the plan.
Some portions of the Resident Handbook use language that is vague or vocabulary that may be
difficult for youth to understand. For example, on page 3:
The Youth Detention Center is neither a punitive institution nor a treatment center. The
Youth Detention Center is a community, which encourages cooperation and mutual
respect between youth and staff.
As another example, on page 5:
You are expected to take advantage of programs and services offered upon
admission.
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 And on page 10:
Staff will not use physical confrontation, verbal harassment, degrading work, or
interference with sleep, eating, or bodily functions as consequences.
The team has no problem with the content of these sections, only with the vagueness or level of
language used. Other parts of the Resident Handbook are helpfully direct. For example, on page
4, under “Responsibilities While In The Youth Detention Center:”
o Treat others with respect and be courteous.
o Follow the rules, procedures, schedules, and directions of staff.
o Address staff as Mr. or Ms. at all times.
The Resident Handbook is twenty-seven pages of often dense text, which may present a
challenge for many youth in terms of maintaining focus and interest. The Resident Handbook
could be more interesting and accessible for youth if it contained pictures, graphics, and other
design elements such as variations in font size and style.
Recommendation: Review the Resident Handbook, add missing provisions identified in
the checklist, and revise language that is vague or vocabulary that may be difficult for
youth to understand. An example of revising language to make it more youth-friendly and
developmentally appropriate is the Washington Judicial Colloquies Project, A Guide for
Improving Communication and Understanding in Juvenile Court (Team Child 2012), in
which judicial colloquies with youth were revised to make the language more
understandable and accessible.
Recommendation: Make the Resident Handbook more interesting by addition of
pictures, graphics, and other design elements.

9

 HEALTH AND MENTAL HEALTH CARE
Youth often come into detention with medical and mental health conditions needing prompt
attention. Many youth have not received adequate health care in the community and have
unrecognized health needs. Other youth have chronic medical or mental health care needs. Still
others have care needs arising from the incident leading to detention. The Health and Mental
Health section highlights key elements in meeting the medical and mental health needs of youth,
including initial screening for medical and mental health problems, full health assessments,
ongoing health services, emergency services, and mental health services.
During the site visit, assistance was provided by the staff nurse manager and the medical
contractor’s regional health services administrator. Two staff LPNs on duty during the site visit
were also interviewed, as well as one of the medical doctors, the identified contract mental health
staff, and the psychiatrist. All of the staff provided valuable support and assistance to complete
the assessment of health and mental health services.
There are strengths of the medical program at LMYDS. The nurse manager has been in her
position for only a few months, but staff and consultants noted that significant improvements in
operations have occurred since she took over management of the clinic. Also, the contracted
physicians from the University of Louisville Department of Pediatrics are providing excellent
care for youth, including access to the health records of youth enrolled for care in the
University’s network of health providers, and to specialty services at the University’s affiliated
hospitals.
ADMISSIONS SCREENINGS

Admissions screening for youth admitted to secure detention is performed by intake staff. Staff
use a standard questionnaire that includes medical and mental health questions. They have been
trained on the health-related questions they are to ask. A nurse is available by telephone to
respond to questions from the intake staff or to come to the intake area to assess a newly
admitted youth with an active medical problem.
The JDAI standards require initial screening to be performed by a licensed health professional.
The logic behind this requirement is that a health professional will be better able to follow-up
immediately on positive responses to the questions. A licensed health professional will have
better judgment about how to respond to the information that is obtained.
Recommendation: Staffing with an additional RN or LPN on two shifts, 7 days a week
would allow for most admissions to be screened initially by a licensed health professional
on duty at the time of admission. In that case, only admissions between 11p.m. and 7a.m.
would have to have initial screening by youth worker staff.
In order to continue medicines in the facility, the nurse must contact a physician for orders.
Medicine brought in from home is examined and the pills are identified by the nurse to confirm it
is the correct drug stated on the bottle. If no medicine is brought in, a new prescription must be
ordered from the contract pharmacy, which takes from one to three days depending on weekday
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 or weekend orders. If the youth’s medicine is not on the health contractor’s formulary, prior
approval for off-formulary medicine must be obtained from the contractor’s pharmacy program.
This may take up to another 24 hours.
There is also a backup local pharmacy for same-day filling of prescriptions that are urgently
needed, but there are no established criteria for medicines that must not be discontinued abruptly
(such as antibiotics, some psychiatric medicines, and hormones). These must be ordered from the
backup pharmacy.
The facility physician interviewed at the site visit reported that it may take up to three days to
obtain a prescription needed to continue a youth’s medicine.
Recommendation: The agency quality improvement program should do a well-crafted
audit to determine what proportion of youth are getting their medicines continued without
interruption and the reasons why they do or do not. Analysis of the audit results should
help direct attention to the specific issues that need to be resolved to meet this standard.
For example, are medicines started promptly when parents bring in their child’s
prescription bottles? Are medicines delayed because there is no nurse on duty? Because a
physician cannot be reached to give an order? Because the pharmacy did not deliver the
medicine until the next day or later? Because of prior approval requirements? Other
reasons? This analysis will suggest solutions, such as greater use of the backup pharmacy
to get initial doses promptly while waiting for the full prescription to be filled by the
contract pharmacy.
More attention should be paid to defining which medicines must never be discontinued abruptly.
Some will have dangerous side effects if discontinued suddenly, such as reactive high blood
pressure when antihypertensive drugs are abruptly discontinued. Some youth may be at risk for a
dangerous mental health crisis if their medicine is discontinued at a critical time such as arrest
and detention. Effective advance planning to recognize such situations and obtain the needed
medicine is needed.
Recommendation: Determine which medications should never be discontinued. Create a
plan to ensure that such medications are available upon a youth’s admission and that
medical staff do not discontinue those medications.
FULL HEALTH ASSESSMENTS

Youth often have abnormal visual acuity, but do not have glasses to correct their vision.
Corrected vision is necessary to participate fully in school and other facility programs. The
standards require routine vision screening to identify youth in need of glasses. Those youth must
then be referred to optometry for a formal vision examination and prescription of corrective
lenses.
Recommendation: Nurses should provide routine screening of visual acuity on
admission. The facility already has a Titmus brand vision screening device. Alternatively,
a standard wall chart for vision screening can be used. Vision screening results must be
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 documented in the health record, noting whether the youth has previously been
prescribed glasses, and whether the test was done with glasses or without.
Youth admitted to juvenile justice programs are often medically neglected and may never have
been tested for hearing deficits. Hearing deficits can be inherited, or acquired due to ear trauma
or prolonged exposure to very loud music. Even a seemingly minor issue, such as reduced
hearing due to obstruction of the ear canal with wax, can have an impact on school performance
and response to instructions during programming at the facility.
No formal hearing screening is included in the admission medical assessment at LMYDS.
Formal hearing screening is necessary to recognize unilateral hearing deficits and high frequency
deficits that may result from high volume trauma. Simply observing that a youth appears to hear
speech during an interview is not adequate hearing screening. Formal hearing screening is
performed using pure tones at various frequencies and loudness, with established criteria for
determining when a youth has failed the test.
Recommendation: Formal hearing screening should be provided using a pure tone
generator such as the Audioscope from Welch-Allyn. This can be done by nurses as part
of the admission health assessment. They should be trained on the proper use of the
instrument and the criteria for a failed test. Youth who fail the test should have their ear
canals examined and cleaned when they are obstructed with wax. Those who still fail
retest after ear canal cleaning need to be referred to audiology for formal testing by a
hearing professional.
Immunizations are provided to prevent formerly epidemic childhood diseases, such as measles,
mumps, German measles, polio and chickenpox. They are also provided to prevent serious
illnesses of children and adults such as tetanus, diphtheria, meningitis, and certain cancers. Some
immunizations are required for entry into schools, but not all recommended immunizations are
school requirements. Public health authorities make annual recommendations for immunization
of children and adolescents, as well as catch-up schedules for those who did not receive their
immunizations at the recommended ages. Primary care health care providers are expected to
assess immunization status of their patients and bring them up to date for their age according to
the latest public health recommendations. Immunization for influenza is recommended annually
for all ages to prevent epidemics that cripple the economy and threaten the very young, the very
old, and the disabled.
The standards require review of each youth’s immunization history and provision of updates in
accordance with current public health recommendations. No immunizations are provided at
LMYDS at this time. No one interviewed at the facility seemed to know exactly why. It has
never been done was one reason given. Someone once thought they needed parental consent, but
the court order gives temporary guardianship to the facility director, so only her consent is
needed. Immunization records are obtained from school, but this is not a complete list of all
immunizations received, only those required for school entry. There is a statewide registry of
childhood immunizations, but the facility health staff do not have access to it.

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 Recommendation: Provide needed immunizations to youth based on review of readily
available records of their immunization history. The facility health program, like any
other primary care provider in Kentucky, should participate in the statewide
immunization registry to obtain records of prior immunization and to update the youth
records when immunizations are administered. Free vaccines are available for detained
youth from the federally supported Vaccines for Children program, administered by state
public health authorities. Any health care provider that treats children and adolescents
can participate. The program requirements include safe storage of vaccines in
refrigerators and freezers with temperature monitoring to ensure that vaccines are not
wasted.
Recommendation: While it does appear that parental consent is not needed to immunize
detained youth, parents should be informed of the need for immunizations and given the
opportunity to opt out if they so choose.
MEDICAL SERVICES

Juvenile detention facilities need a health program that is organized and administered with
attention to the needs of children and adolescents. In contrast to adult jails that often provide
only the bare minimum acceptable health care, juvenile detention centers have attempted to
provide comprehensive primary care to youth so they continue to grow, develop, and mature to
the best of their ability, while in care and after release.
Medical, dental, and psychiatric care at LMYDS is provided by Correct Care Solutions (CCS).
CCS is a large company with contracts to serve adult populations in jails, prisons, and
immigration detention centers. The company website states their contracts cover a variety of
medical, dental and mental health services for 250,000 prisoners. CCS is a for-profit corporation
that makes money by “controlling” the costs of health care for prisoners. LMYDS seems to have
been added onto an existing contract with CCS for services at the local jail.
The team heard that when CCS began operation of health services at LMYDS, all of the wellestablished adolescent forms were abandoned and the company’s standard electronic health
record (EHR) forms replaced them. The EHR forms are only cosmetically adapted to youth. The
team found that the health program appeared to be a program for an adult jail that had been
poorly adapted to the needs of a juvenile detention center. Some examples of problematic
practices observed during the brief on-site assessment include the following:
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Staffing was minimal and was dominated by the least qualified nursing titles (LPN) for
the advanced primary care role of a facility nurse. Some LPNs do a good job and have
excellent assessment skills based on experience and dedication to their profession. Some
do not.

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The respiratory illness assessment guideline was identical for both “Juvenile” and
“Adult” protocols on the EHR.

13

 •

A newly revised admission history and physical examination screen still does not include
basic sections, such as the Assessment where the examining medical provider sums up
the patient’s health needs and the Plan, where needed diagnostic tests, consultations,
treatments, follow-up and patient education are discussed.

•

The company pharmacy dispenses only in plastic screw top containers instead of unitdose blister cards.

•

The company formulary omits certain psychiatric drugs commonly used for children and
youth. The program requires off-formulary prior approval to continue a patient’s usual
medicine, with delays in re-starting treatment.

•

The sick call request form states to youth that there may be financial charges for seeking
health care, and the nurse response section of the form has check boxes for “charges” or
“no charges.”

•

Nurses write only minimal notes on the sick call request instead of progress notes
documenting the complaint, clinical observations, the nursing assessment, and the
management plan.
Recommendation: Take a close and critical look at the current contractor’s performance
as a juvenile detention facility health care provider. Explore whether the local children’s
hospital’s adolescent program would be interested in a broader role at the detention
center. At a minimum, consult the adolescent specialists who are currently the facility
physicians regarding improvements to the program that will make it more suited to the
needs of adolescents.

Nursing care is required to administer medicines, respond to sick call requests, respond to urgent
requests from the units or intake, review initial screening information from new admissions,
follow-up with families and providers regarding youth medicines, schedule follow-up
appointments for new admissions, create a new health record on the EHR, prepare patients for
medical and dental clinics, order medicine refills, prepare for transfers and discharges, scan and
upload paper documents such as lab and x-ray reports to the EHR, and more.
On clinic days, which currently involve medical clinics two mornings a week and dental clinics
one morning a week, the one LPN and one Nurse Manager simply cannot keep up with the
demands for nursing care. At a minimum, the nurse manager needs to be able to manage the
clinic while a second registered nurse is on duty to provide nursing care to youth.
The physician time was recently reduced from three mornings to two mornings a week. Some
time ago, medical clinics were held five mornings a week. During the team’s assessment, the
physician asked what his priority should be between timely admission medical assessments
versus seeing youth with acute complaints referred by the nurses from sick call. He stated that
limited time was a problem even when the facility had three medical clinics a week.

14

 Recommendation: More nursing and physician time is necessary to provide adequate
services to youth. A careful review of the tasks nurses perform and the tasks that are left
uncompleted at the end of each day, week, month, and year will help to determine what
staffing is needed. Better control of movement to and from the doctor and dentist clinics
may help medical staff complete their tasks more efficiently. More time may not be
needed if medical staff have less down time waiting for youth to arrive.
Recommendation: Consider using mid-level providers such as nurse practitioners (NP)
to perform the admission health assessment, which would allow the physician’s time to
be devoted to clinical consultations on diagnostic or management problems referred by
the NP, as well as chronic illnesses.
Youth with a history or risk of a truly life-threatening allergic reaction need special attention.
Bee stings, certain foods such as peanuts or shellfish, and some medicines may cause life
threatening allergic reactions in susceptible individuals. A history of severe reactions to insects,
foods, or medicines must be sought and then confirmed, if possible, by family members who
observed the events. A blood test to confirm severe allergies may be done, but the history of
severe reaction alone should be sufficient to implement a prevention program for a youth.
Prevention includes total avoidance of the allergic substance and availability of an epinephrine
auto-injector (such as an Epi-Pen) to immediately treat a life-threatening reaction. This requires
the auto-injector to be immediately available wherever the youth may be in program at the time
the reaction occurs.
At LMYDS, an epinephrine auto-injector is available, but it is locked in the medicine cart in the
medical unit. In an emergency, a nurse with the keys would have to go to the cart, open it, find
the Epi-pen, and then go to the youth. The time delay inherent in this approach is a problem. It
was not clear what would happen if the Epi-pen were needed after hours when the clinic is
closed.
Recommendation: Have an Epi-pen assigned to each youth with history of severe
allergic reactions and have that Epi-pen travel with the staff supervising the youth
wherever he or she goes. Staff and the youth must be well informed about the allergy, his
or her reactions, and the need for prompt treatment with the Epi-pen. The youth should be
trained in how to use the Epi-pen and ready to administer it to himself or herself when
needed. Youth should also receive an Epi-pen to take home when released.
Movement of youth to and from the clinic in a juvenile detention center frequently presents
challenges. The less movement, the safer the facility and the easier the facility is to operate.
However, youth need to move about the facility to go to school, meals, recreation, visits, court,
the medical clinic, and elsewhere.
It was clear during the site visit that the dentist and the pediatrician had significant down time
waiting for youth to be brought to the clinic. The nurses try to assess and manage much of the
sick call requests on the units during medicine administration, in part to reduce the need for
movement of youth to the clinic for nursing assessments. The psychiatrist does his clinical
15

 assessments of youth in the hallway outside the unit in part so he can see more youth each Friday
morning, rather than waiting for them to be brought to the clinic for a confidential interview.
Recommendation: Have two youth workers posted to the clinic during the time that
youth are needed for medical, nursing, or dental care. Have one youth worker supervising
the clinic waiting area and the youth who are in the exam room. Have the other youth
worker moving treated youth back to their unit and bringing the next patient to the clinic
waiting area. If the youth workers stay one patient ahead of the doctor, dentist, or sick
call nurse, there will be no down time.
The team briefly reviewed documentation of sick call during the site visit. The nurse documented
only a single phrase or two on the sick call request form. There was no progress note. The paper
request form must be scanned and uploaded to the EHR to become part of the permanent health
record, which is then cumbersome to review if the pediatrician later wants to see how a problem
presented to the nurses previously and what they did for it. Also, the information recorded is too
minimal to be useful.
Recommendation: Document proper progress notes for every clinical encounter.
Progress notes should follow the standard format of Subjective (youth’s history and
description of the problem), Objective (clinical observations by the nurse), Assessment
(what the nurse thinks is going on), and Plan (what the nurse will do to manage the
problem.
MENTAL HEALTH SERVICES

The facility fails to meet most standards in this section. This is because LMYDS does not have
adequate on-site qualified mental health professionals dedicated to the facility, as required by the
JDAI standards. There is one staff with a B.S. degree that is contracted from CCS as the on-site
mental health provider. However, this person is not able to provide adequate qualified mental
health services to all of the youth who require them at LMYDS. In addition, there are three
“Social Workers” at LMYDS, all of whom have B.A. degrees and who function as case
managers. They are not qualified mental health professionals. Their responsibilities include
counting up the points youth receive and filling and delivering commissary orders, facilitating
phone calls, checking on youth who are on suicide watch every day, and developing Behavior
Improvement Contracts in conjunction with supervisory staff. There is a psychiatrist who comes
to the facility one day a week for around four to five hours. In addition, Centerstone, a
community service provider, comes to LMYDS several times a week to offer services to youth.
If concerns about a youth’s mental health arise during the admission intake process or at any
other point during their detention, the social workers and the mental health worker have limited
access to community based providers. These providers may come to the facility for a face-to-face
assessment of a youth presenting with some acuity. The facility also has access to the Brook
Hospital and Our Lady of Peace, which provide inpatient psychiatric care for juveniles.
Without adequate mental health professionals on-site, youth workers are given the responsibility
for critical functions mental health staff would otherwise assume. Youth workers administer the
16

 initial intake screening, which includes questions regarding past and current mental health issues
and requires careful observation of the youth in completing the assessment. While youth workers
receive training on conducting these initial assessments, the JDAI standards require that a
qualified mental health professional perform this function.
We were able to conduct in-depth interviews with four youth. One youth had recently returned
from a two-week inpatient psychiatric hospital stay. The problem behavior at the time was his
swallowing of staples and pencils. Upon interview, he spoke of his extreme depression
concerning his losses as he described having seen a friend of his shot and die in front of him. He
also spoke of a recent dissociative episode during which he was shaking and talking to himself.
The staff at the facility were so confused and overwhelmed by his presentation during this
incident that they called a Code 1, which is usually reserved for situations in which there is a
perceived imminent security threat to the institution. The youth did not present as a security
threat, and he described the rush of staff responding to the Code as terrifying at the time.
This show of force is a completely inappropriate response to a psychiatric emergency. It is
largely a product of there not being sufficient and adequately credentialed mental health staff on
site to appropriately respond to a youth in extreme distress.
The other three youth we interviewed also suffered one or more psychiatric diagnoses and spoke
of their trauma histories. All four youth were on psychotropic medication. There is no question
that the majority of youth at LMJDS suffer from both extensive psychiatric histories as well as
substantial trauma histories. Their behavior on the units can be extremely challenging. Absent
adequate numbers of on-site mental health professionals, youth workers are left to figure out how
to manage their behavior.
We were able to attend the annual refresher training for youth workers regarding the mental
health issues with which youth present at LMJDS. During the course of the training, most if not
all of the staff expressed their fear and fatigue at feeling “out of their league” in dealing with
youth who presented with such complex issues. They said they needed more training, more
mental health staff on site, and more ways to help them feel appreciated and decompress from
working in such a challenging environment with an “awesome” set of responsibilities.
Recommendation: Re-evaluate and re-negotiate the contract with CCS to ensure that
they have sufficient number of mental health staff who are appropriately credentialed to
make the clinical judgment calls required under the JDAI standards and to respond to
youth with mental health problems.
Recommendation: Given the reported levels of trauma that youth expressed, it is clear
that the introduction of a trauma-focused program designed for use in detention would be
to the advantage of youth. One such program is Trauma Affect Regulation: Guide for
Education and Therapy (TARGET). 1

1

Ford, J., Trauma Affect Regulation: Guide for Education and Therapy (TARGET), National Institute of Justice,
CrimeSOLUTIONS.gov, (2011).

17

 The team also had concerns about the Behavior Improvement Contracts that supervisory staff
and social work staff jointly develop, which are not adequate. One contract that we reviewed
listed the youth’s negative behavior (throwing bodily fluids) and then detailed the contractual
requirement. In this case, the youth was required to clean the hallway for some period of time
and accrue some number of points.
First, it was unclear what staff understood about the origins of the youth’s behavior. It was also
unclear what the relationship was between the underlying issue that led to the youth’s negative
behavior and the chosen consequence. Second, the Behavior Improvement Contracts focused on
having youth stop engaging in a particular behavior as opposed to focusing on a plan to help a
youth develop positive behaviors to replace the negative behavior. Behavior Improvement
Contracts should be constructed to reward youth for their production of specific measurable
behaviors, incentivizing youth for making incremental progress. The Behavior Improvement
Contracts did not reflect these features of effective behavior management plans. The lack of
qualified mental health professionals at the facility contributes to this fact.
Recommendation: As referenced above, obtain an adequate number of mental health
professionals who can assist with development of effective Behavior Improvement
Contracts.
Recommendation: Ensure that Behavior Improvement Contracts clearly outline the
replacement behavior or skill that the youth is expected to develop, the incremental and
measurable goals that are set as the youth develops the behavior or skill, and the
incentives that the youth will receive for making progress toward those goals.
DENTAL SERVICES

Experience in other states has shown that unfilled dental cavities are the most common physical
health needs of justice-involved youth. Although acute or urgent dental needs must be addressed
promptly, the standards allow detention centers to wait 30 days before initiating routine care. At
LMYDC, a dental assessment and development of a treatment plan is scheduled to occur when
the youth has been in care for 60 days.
Recommendation: Provide routine dental services to youth in care within 30 days of
admission.
SUICIDE PREVENTION AND INTERVENTION

With the exception of standards that expressly require the intervention of a qualified mental
health professional, LMYDS meets many standards outlined in this section. We did have a
number of concerns related to the practices around suicide watch, the facility’s physical plant,
and the ability of staff to intervene during a suicide attempt.
While anyone can place a youth on a suicide watch status, only a qualified mental health
professional can lower or remove a youth from such status. The process in place at LMYDS is to
keep youth on suicide watch status until the psychiatrist can assess their mental state. This means
18

 that if a youth requires being placed on suicide watch just after the psychiatrist leaves the
facility, he or she must wait at least a week before being lowered or removed from this status.
This is particularly problematic given the conditions for implementation of a suicide watch.
Youth are able to participate in programming during the day. However, at night, as one youth
noted, clothing and blankets may be removed. The facility does have suicide smocks and
blankets available, but one youth reported being locked in his cell with only his boxer shorts
during an incident in 2015. He described the cell as cold and uncomfortable, leading to his
further depression. Youth should never be housed in these conditions. Staff informed the team
that this youth had been offered a suicide smock and had refused to put it on, which was why he
was in his boxer shorts. Staff also informed the team that they had made changes to policy and
procedure following this incident to ensure that youth are always given a suicide smock and
blanket if clothing and bedding are removed.
In rare instances, youth who require constant monitoring are housed in the intake area. Youth are
placed in a cell that has a camera so that these youth can be monitored remotely in addition
checks completed by intake staff. While staff said that this arrangement rarely occurred, it is
unacceptable. Standards in the field dictate that youth who require constant monitoring be within
arm’s length from a staff member who is engaging in one-on-one observation. This means that
even during sleep hours, the observing staff sit at the open door of the youth’s cell.
Recommendation: Secure appropriate mental health staffing to respond to youth who
demonstrate suicide risk.
Recommendation: Ensure that any youth who has clothing and bedding removed have a
suicide smock and blanket in his or her room.
Recommendation: Discontinue video monitoring of youth on suicide watch.
Suicide prevention in residential programs requires attention to unit design and fixtures to
identify and mitigate potential suspension points for suicidal hanging. Particularly risky areas
include bedrooms, shower rooms, and toilets: places where youth are often left alone and
unsupervised.
The team encountered at least one shower room at LMYDS where one of two breakaway hooks
designed to give way in response to the weight of an attempted hanging was too stiff and likely
to support the weight of a suspended youth. Also, the shower head was not well designed to
prevent suspension and likely could be used for attempted hanging.
Recommendation: Critically examine shower rooms, youth rooms, and toilets for
fixtures and features that can be used as suspension points for attempted hanging. Among
many other fixtures to examine, ensure all breakaway hooks are lubricated and still
function as intended, and make sure all shower heads are properly designed to prevent
suspension.

19

 A special tool is needed to cut down youth who have attempted to hang themselves with bulky
pieces of sheets, towels, or long pants. It must be sharp enough and large enough to cut through a
thick bunch of cloth. It must also have a blunt tip and a curved shape to be able to slide safely
under a tight ligature next to the skin of the neck. Once in place, the knife is used to cut out,
away from the skin. The so-called Hoffman tool is properly designed for this purpose.
The standards require that a cut-down tool be available on every unit for immediate deployment
to cut down a youth in an attempted hanging. At LMYDS, the youth worker supervisor had a
cut-down knife on his belt on one floor of the facility, so there was one knife on that floor, not
one in every unit. Also, the knife was straight and did not have a blunt tip to facilitate passage of
the blade under the ligature to cut out away from the skin.
Recommendation: Obtain rescue tools properly designed for attempted hanging and
stock a rescue tool on every unit.
The most likely reason to perform CPR on a youth in juvenile detention is suicidal hanging.
Even apparently lifeless victims of hanging can be resuscitated if effective CPR is performed
within a few minutes of loss of consciousness. Staff at LMYDS have had CPR training and
certifications. There is an AED on site, and a most of the medical equipment needed for a
successful resuscitation is available in an emergency bag at the clinic. However, there is no hand
pump suction device for clearing secretions from the mouth.
Recommendation: Obtain a hand-pump suction device for the emergency bag and train
nurses and senior staff on how to use it, as well as the rest of the resuscitation equipment.
Finally, the standards require that parents or guardians be notified within 24 hours of a youth
being placed on constant observation. The team did not obtain documentation of this occurring.
Recommendation: Require in policy, procedure, and actual practice that staff notify
parents or guardians within 24 hours of a youth being placed on constant observation.
ADMINISTRATION OF PRESCRIPTION MEDICATION

Psychiatric medicines in particular have well-known and potentially serious side effects and
medical complications associated with them. For this reason, patients treated with psychiatric
medicine must be monitored clinically and with laboratory tests to identify side effects promptly.
Effective clinical monitoring requires training of nurses and mental health staff to recognize side
effects. Effective laboratory monitoring requires standard lab orders for patients prescribed
psychiatric medicines: initially before starting medicines, upon admission when they are already
taking medicines, and periodically thereafter (e.g., every three months).
CCS has developed no monitoring protocols for youth prescribed psychiatric medicine. At
LMYDS, it is up to the prescribing psychiatrist to order whatever clinical or laboratory
monitoring he feels is needed. The contract psychiatrist stated he did not order many labs or do
many tests for movement disorders. The doctor stated he ordered metabolic panels on admission
for youth prescribed psychiatric medicine, but none were found in the health records. Record
20

 review of youth in care at the time of the site visit showed that no labs or clinical monitoring for
side effects had been ordered or performed.
Recommendation: Implement clinical and laboratory monitoring protocols for
management of youth prescribed psychiatric medicine. Such protocols can be based on
the practice parameters promulgated by the American Academy of Child and Adolescent
Psychiatry. However, experience has shown that simpler is better when it comes to
monitoring protocols, and it is far simpler to implement a single battery of lab tests and
monitoring procedures for all youth treated with psychiatric medicines than to make 10 or
15 different protocols based on the drug or drug class that is prescribed.
CONFIDENTIALITY

Confidentiality of protected personal health information is a basic principle of health care. When
health services are provided in a public place rather than a clinic or examination room,
confidentiality may be compromised. Special attention to privacy is necessary if any services are
provided in a public place.
At LMYDS, medicines are administered on the unit. Youth sit in front of their rooms, and those
due for their medicine are called up to the medicine cart to be given their medicine. A youth
worker is present at the cart to supervise youth. In this case, other youth know who is getting
medicine, and the supervising staff may have an opportunity to observe what the medicine is.
Also, during medicine administration the nurse may inquire of youth about a sick call request.
Her goal is to address simple, common, self-limited complaints with over-the-counter medicines
without having to move the youth to the clinic for a nursing assessment. Unless the supervising
staff steps away from the cart, out of hearing of quiet conversation, this interview is not
confidential.
Recommendation: At a minimum, remind staff that they are not to disclose any
protected health information they obtain while performing their duties at the cart. Ask
staff to step back out of hearing when the nurse is interviewing youth about their sick call
requests until development of a system for efficient movement of youth to and from the
clinic.
Finally, the psychiatrist interviews youth in the hall outside the unit due to staffing shortages and
the difficulty of moving youth from one to another location within the facility. When the team
raised concerns about the lack of confidentiality given the traffic in the hallway, the team was
told that they stop talking during the time someone is walking by. This is a completely
inappropriate practice. Psychiatric assessments, like other medical assessments, should not be
done in the hallway. These confidential evaluations should be done in an office, and in the case
of psychiatric examinations, with both parties sitting.
Recommendation: Ensure that the psychiatrist interviews youth in a private setting. Staff
may be within sight or be able to hear a loud call for help, but should not be able to
overhear the general content interview. If the psychiatrist and the facility managers agree
21

 that these interviews should take place at the units rather than at the clinic, make an
empty room available for private interviews on every unit.
HEALTH AND MENTAL HEALTH ADMINISTRATION

The standards state that medical and mental health services must be provided to youth free of
charge. At LMYDS, the sick call request form states to youth that they may be charged for
requesting health care, and the nurses’ section has a checkbox to indicate whether youth will be
charged for their care. The health staff stated that this form was a mistake and there was no
intention to charge youth for care. Nevertheless, the threat of charging youth for care may be
intimidating to the residents and prevent them from requesting needed care.
The facility pediatrician inquired about charges to families when youth are sent out for specialty
consultations, tests, or procedures. In those situations, the parents are required to attend, sign
consent, and take responsibility for the costs of services, and provide the office with their health
insurance information. This is not an appropriate practice. If the facility director has temporary
guardianship by virtue of the court order placing the youth in secure detention, then the facility,
not the parents, should be responsible for the costs of health care while youth are in care.
Medicaid and sometimes other health insurance is suspended whenever a patient is placed in
secure detention. For this reason, many families may incur substantial bills for health services
provided while their child is in detention. LMYDS does incur costs for off-site medical care for
youth who have been in custody for longer than 30 days.
Recommendation: Use a different sick call request form that does not threaten to charge
youth for requesting health services.
Recommendation: Re-examine the practice that requires parents to be responsible for
the costs of outside consultations, procedures, and diagnostic tests. These should be paid
for by the authority that operates the secure detention facility.
The standards require a quality improvement program that assesses both process and outcome
measures related to health services. CCS has a system-wide quality improvement plan and
schedule of audits. These audits are largely based on process indicators (e.g., was the intended
service carried out or not?) and may result in some improvements in care (e.g., creation of a new
or improved screen to guide the nursing practice).
This is adequate to measure process indicators, but not sufficient for outcomes. Outcome
measures must be used to determine if the health program is successful in meeting its goals. For
example, a process measure related to immunizations would be whether or not records of the
youth’s prior immunizations were obtained. The outcome measure would be whether or not
youth’s immunizations were brought up to date for age in accordance with current public health
recommendations for adolescents.
Recommendation: Develop and implement a quality improvement program for health
services that assesses outcome measures as well as process measures and results in
improvements in health outcomes.

22

 DISCHARGE PLANNING

Youth must have health insurance to continue to receive health care after they are released from
detention. The standards require efforts to assist families to obtain health insurance for their
children. At LMYDS, there is no program to obtain re-authorization of Medicaid that was
suspended when a youth was placed in secure detention. Also, there is no program to assist
families to enroll their children in a health insurance plan.
Recommendation: Learn from Kentucky DJJ staff how they support re-authorization of
Medicaid when youth are released from state operated secure detention. Implement a
similar program at LMYDS.
Recommendation: Provide assistance to families for youth without health insurance to
become insured. Currently “health navigators” funded under the federal Affordable Care
Act are assisting families to obtain health insurance. Health navigators based in LMYDS
or in family court could specifically assist youth and their families with enrollment in
Medicaid, the Child Health Insurance Program (CHIP), or another health insurance
program for low income children subsidized under the Affordable Care Act.

23

 ACCESS
Success in the community is often linked to supportive relationships that youth have with family
and others. This section addresses the rights of detained youth to have access to the outside
community through visitation, correspondence, and access to the telephone. It also addresses the
need for youth to be able to visit with and communicate with their attorneys and other advocates
about their cases, problems in the facility, or other issues requiring legal assistance. Standards
also ensure that administrators and staff value the input and participation of families.
In general, youth at LMYDS reported being satisfied with their level of contact with family
members and other important individuals outside of the facility. However, we were concerned
with limits on certain types of contact in policy and practice, as well as with the lack of
confidentiality with attorney mail and telephone calls.
MAIL

In general, youth reported being happy with mail service at the facility and understood the rules
around delivery and receipt of mail. There were two main areas of departure from the JDAI
standards, however. First, the facility provides postage for only two letters per week (excluding
legal correspondence), although youth can earn additional stamps for good behavior or have their
parents bring extra postage. The team recommends that the facility provide youth with additional
postage if they choose to write more than two letters per week. It is worth encouraging youth to
express their feelings in writing if they choose to do so. Moreover, given the limitations on
phone and visitation contact, letters may be the only avenue to stay connected to certain
individuals while youth are detained.
Recommendation: Do not limit youth to two stamps per week for non-legal mail.
Second, staff and youth reported that staff routinely “scan” incoming and outgoing mail,
including legal mail in some situations. The resident handbook provides that mail can be opened
if there is “clear and convincing” evidence to do so, but it appeared that mail was routinely
opened, albeit in front of youth. Staff should only read non-legal mail upon reasonable suspicion
that the content of the mail contains a specific threat to the safety or security of the institution.
Staff should never read mail marked as legal mail under any circumstances, as such
correspondence is protected by the attorney-client privilege.
Recommendation: Clarify in written policy, procedure, and actual practice that staff
should not read incoming or outgoing non-legal mail unless there is reasonable suspicion
that the letter contains a specific threat to the safety or security of the institution.
Recommendation: Clarify in written policy, procedure, and actual practice that staff are
never to open or read incoming or outgoing legal mail.
Third, we received inconsistent information about where youth were allowed to store their mail,
including legal mail. Some staff said that youth were allowed to keep mail on their units, but
others said that mail had to be stored in the youth’s property boxes. The resident handbook states
24

 that youth are not allowed to keep mail on unit with no exception stated for legal mail, which
may be the source of the inconsistency.
Recommendation: Allow youth to store legal and personal mail in their individual
rooms.
TELEPHONE

LMYDS has a general rule of giving youth two ten-minute phone calls per week. Youth can earn
additional phone calls, and calls beyond the standard list of approved contacts, through the
facility’s behavior management system. As with mail service, there were two major areas of
departure from the JDAI standards.
First, youth in room confinement are not allowed to make or receive calls, except to or from their
case worker and attorney. While the team agrees that access to additional phone time can serve
as an incentive for good behavior, all youth should receive a minimum amount of phone time
regardless of disciplinary status. A phone call with a family member can be particularly valuable
for youth who may be struggling at the facility.
Recommendation: Allow all youth, including youth in room confinement, to have a
minimum amount of phone time.
Second, although staff reported that they do not routinely listen in on youth’s conversations, calls
from social workers’ offices – including legal calls – are made with staff present in the room. As
mentioned above with mail service, staff should only listen to non-legal phone calls if they have
a reasonable suspicion that the call constitutes a threat to the safety or security of the facility.
Staff should never listen to calls with attorneys, which are protected by attorney-client privilege.
Many facilities have found ways to make accommodations that allow staff to maintain
supervision of youth without listening in on phone calls.
Recommendation: Clarify in written policy, procedure, and actual practice that staff
should not routinely listen in to non-legal calls unless there is reasonable suspicion that
the call contains a specific threat to the safety or security of the institution.
Recommendation: Clarify in written policy, procedure, and actual practice that staff are
never to listen in on legal calls, and identify accommodations to allow youth to make
calls confidentially.
VISITATION

The team had an opportunity to visit four scheduled shifts of visitation during the on-site visit.
We were impressed with how well the social workers managed the process, as well as how
professional and respectful staff’s interactions were with parents and legal guardians.
Additionally, youth generally expressed being happy with the visitation process, with three
exceptions.

25

 First, youth on room confinement, youth who appeared in court on the day of scheduled
visitation, youth in the maximum security unit (which was not operational at the time of our onsite assessment), youth who have engaged in an altercation in the visitation area during the
previous 30 days, and youth who have engaged in more than one fight in the visitation area are
not allowed visits (except from their DJJ worker or attorney). As stated above, additional or
expanded visitation opportunities are acceptable as an incentive for positive behavior, but all
youth should receive access to a baseline level of visitation privileges. Indeed, visits may be
most important for those youth who are struggling at the facility.
Recommendation: Afford all youth a minimum of two visitation opportunities per week,
regardless of placement on room confinement or other status.
Second, the team understood that routine weekly visitation was generally restricted to parents,
grandparents, and legal guardians. The team understood that siblings were not routinely allowed
to visit outside of one-time special visits for youth who are being placed at another facility,
special holiday or graduation events at the facility, or upon permission by the court. This seems
to occur very rarely. For example, in the period between April 15 and April 30, just 3% of visits
were made by those other than individuals listed as parents, grandparents, or legal guardians (just
8 of 209 visitors). Given that many youth are detained for extended periods of time, we
encourage LMYDS to expand the list of permitted visitors. Many facilities accommodate a
broader range of visitors without jeopardizing the safety and security of the facility.
Recommendation: Expand the list of visitors to include siblings and other important
adults in a youth’s life.
Third, the visitation periods during weekdays are just 20 minutes in length, and the visitation
periods during weekends are only 30 minutes in length. The JDAI standards provide for a
minimum of one hour of visitation multiple times per week, recognizing that many family
members spend significant time traveling to the facility (often at expense via public
transportation). Additionally, many family members must secure child care for their other
children given the restrictions on approved visitors. The short visitation windows offered by
LMYDS may discourage parents from visiting their children.
Recommendation: Extend visitation periods to one hour in length.
Fourth, weekday visitation periods occur prior to the end of regular business hours (e.g., before 5
p.m.). While many parents or guardians work non-standard schedules, those parents and
guardians who do have jobs with hours from 9 a.m. to 5 p.m. would not be able to make it to the
facility in time for weekday visits. We recommend pushing weekday visitation later in the
evening to accommodate a larger group of individuals.
Recommendation: Move weekday visitation later in the evening to accommodate the
schedules of parents and legal guardians who work standard business hours.
Fifth, the team noted that while the social workers were intended to be family members’ point of
contact at the facility, facility staff did not always operate with that understanding. For example,
26

 while we were on-site, the team observed social workers responding to a family member who
had arrived at the facility at the incorrect time for her child’s visitation period because she had
received incorrect information from a youth worker. We understood that this was a recurring
problem at the facility. While social work staff managed to respond to an understandably upset
parent, clearer understanding among staff about the need for social workers to serve as the
contact point for parents and legal guardians would help avoid this situation in the future.
Recommendation: Ensure that policy, procedure, and actual practice provide that social
workers are to be the point of contact for information about the facility.
FAMILY ENGAGEMENT

We understood that telephone introductions are done with family members of youth detained at
the facility, but that there is no formal orientation program for parents or legal guardians. We
recommend expanding upon the written visitation guidelines to incorporate additional
information that may be helpful to family members.
Additionally, the visitation rules that were posted at the facility were comprised of a standard
sheet of printer paper with a lengthy bulleted list of rules and information in 12-point font taped
to the front desk and walls of the visitation area. As designed, the sheet is difficult to read and
understand. A larger poster or set of posters with key pieces of information presented in a
visually appealing way would do a much better job of conveying essential information.
Recommendation: Consider developing a more formal family education orientation,
through a combination of written and video presentation of information.
Recommendation: Develop larger and more visually appealing posters for parents and
legal guardians that contain essential information about the facility.

27

 PROGRAMMING
Youth in detention are, first and foremost, adolescents. They need to be involved, to the extent
possible, in the same kinds of age appropriate, healthy, educational activities youth would
experience in the community. This section outlines the requirement that detained youth receive a
full academic education, with special services for youth with disabilities or limited English
proficient youth. Youth are also entitled to go outdoors regularly, engage in physical exercise,
participate in a range of recreational activities, and have the opportunity to practice their
religion. This section also covers the ways youth are encouraged and motivated through positive
reinforcement and incentives for good behavior.
EDUCATION

Education services at the Louisville Metro Youth Detention Services (LMYDS) facility are
provided by the Jefferson County Public Schools (JCPS). Funds to support the school program
come from the Kentucky Education Collaborative for State Agency Children (KECSAC), the
Kentucky Department of Education, the Federal Title 1 Neglected and Delinquent program, as
well as Federal special education funds. Several Kentucky Department of Juvenile Justice (DJJ)
policies address education services of youth in detention. KECSAC and DJJ conduct annual
audits to ensure that the school at the detention center meets state standards.
The school at LMYDS is part of the alternative education program in the JCPS. However, the
program at the detention center is seriously inadequate. JCPS devotes insufficient personal and
administrative support to the education program at the LMYDS. Currently at LMYDS, students
only attend school in designated classrooms every other day. Students who do not attend school
in a classroom remain on their units to complete instructional packets. Students on room
restriction do not attend school. The lack of adequate programming for youth during intake as
well as those on room restriction and the adequacy of special education services are serious
shortcomings. The narrative below addresses two broad areas: educational access and special
education.
Educational Access
The team visited LMYDS during the first week of school during the Fall 2017 semester. The
school at LMYDS is part of Jefferson County High School. Five general education teachers, a
special education teacher, an instructional assistant who manages school records, and a transition
specialist serve youth at the facility. An assistant principal and a school counselor are on site one
day each week. According to staff, the principal is at the facility about once each quarter.
Instruction at LMYDS appeared to be primarily workbook and worksheet-based following
curricula developed by JCPS. Although web-based instruction was available at the detention
center, it has not been used in the past few months following a security breach earlier in the year.
All students attend class with other students from their living units. Each unit goes to the
facility’s designated classrooms every other day. On the days when youth are not in school,
instructional packets are sent to the units. If students need assistance, unit staff notify a teacher
who comes to the unit if available. When teachers travel to the units to answer questions, they
28

 leave their regularly scheduled class to do so. There are no substitute teachers available when
teachers are absent.
The disciplinary system at LMYDS is a “response cost” system in which students lose points and
incur fines for rule violations. When students accumulate three minor infractions and receive a
150 point fine, they are placed on 8-12 hours of room confinement. When on room confinement
they receive no education services. At the time of our visits, the girls unit was on a “1 in 1 out”
restriction. That is, no more than one girl was allowed out of her room at a time. As a result of
this restriction, the girls did not attend school and received no more than 1 hour of one-on-one
instruction from a teacher on the living unit. Facility administrators noted that at the time of the
assessment, several girls were ordered to be on non-contact by the court because they were codefendants in an open matter. The team understands that the challenges of keeping those girls
separated contributed to the use of “1 in 1 out,” but there are other arrangements that should be
explored to house female youth, including speaking with the court about the problems that those
orders create.
LMYDS conforms to some of the JDAI standards for education but also has serious
shortcomings. The school schedule in which students attend school every other day is a
significant problem. Special education staffing is also a concern. The one special education
teacher on staff does not have sufficient time to provide services as specified on students’ IEPs.
The practice of denying students services while being disciplined at the facility and the lack of
dedicated special education staff contribute to the current status of education. Several of the
teachers appear to be well-qualified, and they have access to curriculum and materials provided
by JCPS. However, teachers appeared to be resigned to the inadequate support provided by JCPS
and the restrictions placed on the school by LMYDS.
The team reviewed the current contract and a proposed new contract between the LMYDS and
the Jefferson County Board of Education. While it is beyond the scope of our review to provide a
detailed analysis of the contracts, a number of elements in the current contract are not being
implemented as intended. Responsibility for these shortcomings rests clearly on both parties. For
example, the current and proposed new contract both call for 6 hours of academic instruction per
day on school days. Because the detention center allows only half of the units to attend school
each day, students only receive half of the instructional time specified in the contract and
mandated under state law. The adequacy of special education services, transition support, and
resources for the extended year summer school are also significant problems.
Lack of meaningful instructional activities for student groups kept on the living units during
class time and teachers providing instruction outside of their content areas – because assignment
of students to teachers is by unit - are significant problems. The short-term stay of many students
in juvenile detention presents challenges for education programming. However, at the time of
our visit to LMYDS, one quarter of the students had been at the facility an average of 8 months.
For these youth, the absence of career and technical education programming is a significant
problem. The recommendations below address broad issues in the design, delivery, and
management of general education services.

29

 •

Recommendation: Hire additional certified teachers. Create a school schedule that
enables teachers to provide instruction in their content areas.

•

Recommendation: Designate a full-time assistant principal or lead teacher who
spends more than one day each week at the detention center.

•

Recommendation: Consider developing an intake classroom where students spend
the first week at the facility. Conduct initial screening and assessments, review
students’ records, and provide instruction in numeracy, literacy, and current events.
An intake classroom can help socialize students who may have been out of school for
an extended period of time, as well as provide basic instruction for students who may
be at the detention center for just a few days.

•

Recommendation: Assign students to classes and teachers according to their
academic needs. While it is impossible to provide homogeneous classes in which all
students are enrolled in the same course, teachers should be teaching in their certified
areas.

•

Recommendation: Develop a career and technical education (CTE) program.
Courses and certifications in areas such as culinary arts, digital literacy, and OSHA
10 safety fit well into short-term placements and should be added to the curriculum.

•

Recommendation: Discontinue keeping students on room restriction and denying
them access to a full day of education. If students’ behavior is disruptive or out of
control, develop plans to remove students from the classroom no longer than
necessary for the student to regain composure.

•

Recommendation: Do not restrict students’ access to school as a punishment.

•

Recommendation: Review the intake protocol that includes screening for students
who may be English language learners (ELLs). Ensure that the current intake protocol
includes asking students about intensive services or supports they may have
previously received in school. For example, ask students about 1:1 tutoring,
counseling, or therapeutic groups that they may have been part of their school
program.

•

Recommendation: Develop a system of positive behavioral interventions and
supports (PBIS). PBIS, widely used in the public schools, is also used in a number of
juvenile correctional facilities. Discontinue punitive, unproductive discipline systems.

•

Recommendation: Under current state law, high school students may not take the
GED exam until they are 18. Petition the KDE, KECSAC, or appropriate legislative
authorities for a waiver for of this requirement.

30

 Special Education
Students eligible for special education services at LMYDS do not receive services specified on
their IEPs. The detention center school complies with parental notification for IEP meetings, but
fails to implement IEPs as written. The current staffing at LMYDS is inadequate to meet the
needs of residents. A retired contract special educator assists the special education program but
does not provide on-site support.
The school is not involved in discussions about discipline involving students with disabilities.
There was no indication that the facility conducts manifestation determinations and Functional
Behavior Assessments (FBAs) or implements Behavior Intervention Plans (BIPs). The majority
of students eligible for special education services had a history of emotional or behavioral
problems associated with their disability.
According to the special education teacher, more than 50% of the students at LMYDS are
eligible for special education. The CCLP team reviewed IEPs for seven students and discussed
service delivery with the special education teacher. Six of the seven students whose files we
reviewed had been identified as students with an “emotional and behavioral disability,” and one
student was identified as having a “mild mental disability.” Five of the seven students whose
files we reviewed received intensive services prior to their incarceration. That is to say, these
students received instruction in general education classrooms less than 40% of the time. In spite
of differences in students’ needs and a history of intensive supports in previous schools, all
students receiving special education services at LMYDS received the same level of support.
Discussions with staff and file review revealed that if students’ IEPs had been developed during
the past 12 months prior to their incarceration, staff at LMYDS do not meet to review and revise
the IEPs.
Some education staff suggested that staffing was governed by state law and a contract between
the detention center and the JCPS, which would prevent it from being changed easily. Some
education staff noted, when asked about the availability of related services, that there was a
counselor on the school staff at LMYDS. However, this staff member – on site one day each
week – managed students’ records and did not provide the psychological counseling associated
with related services on students’ IEPs.
The one special education teacher at the facility is not able to meet the needs or provide services
as specified on students’ IEPs. There was no evidence that students received related services
such as individual counseling. There was some evidence that the JCPS communicated with the
parents of the youth and sent out notices about IEP meetings and students’ progress.
•

Recommendation: Conduct a comprehensive review of special education services
and ensure that JCPS has the capacity to provide services as indicated on students’
IEPs.

•

Recommendation: Hire or contract with specialists to provide related services such
as counseling and group therapy as specified on students’ IEPs.

31

 •

Recommendation: Discontinue the practice of changing the intensity of services or
supports for students in the absence of new information or assessments that would
justify changes in services.

•

Recommendation: Hire two additional special teachers and an instructional assistant
to ensure that students receive services as specified on their IEPs.

•

Recommendation: Develop a behavior management system based on the principles
of positive youth development. A collaborative effort between LMYDS and JCPS has
the potential to significantly reduce youth disruption, promote positive behaviors, and
most importantly, teach youth new skills.

The education program at LMYDS has the potential to provide high quality services to students.
However, JCPS provides inadequate administrative support for the program, and LMYDS
behavior management system restricts students’ access to school. The current operation leaves
LMYDS and JCPS vulnerable to legal challenges for failure to provide an adequate education
program for students in general and for the more than 50% of the students eligible for special
education services.
GENERAL PROGRAMMING

LMYDS has recently added a notable number of programming activities. The University of
Louisville offers group sessions with residents through two programs: the Catch Grant discussed
STDs and is offered only once to each resident; Cardinal Success helps youth learn to control
their anger and emotions. A volunteer delivers art therapy to youth on Saturdays and a local
mural artist worked with residents on several projects at the facility. 2Not1 is a multi-week
program designed to develop skills for young fathers. Staff select 10-15 youth who are likely to
be at the facility for at least five weeks, whether or not they are fathers. A volunteer from the
SPAVA program speaks to one unit each week during school hours about the importance of
character. LMYDS also offers two programs for girls. My Life My Choice is a 10 week
workshop for girls who are at risk of being trafficked. Uncaged is a summer-only program
designed to “reduce stress and trauma symptoms and increase self-esteem.” Administrators told
the team about other programming opportunities that do not appear on the
programming/volunteer calendar. These include resume building from the Office of Safety and
Healthy Neighborhoods and an annual art program through “ARCA.”
While LMYDS has offered a variety of programming activities, there is significant room for
improvement in two areas. First, many youth do not have regular access to programming.
Residents consistently reported boredom and a lack of enjoyable and consistent programming.
For instance, youth on one housing unit have not participated in any arts programs during the
past month. Most programs are offered to only one housing unit at a time. Volunteers and outside
programs usually rotate housing units, meaning that each unit will be able to participate in the
program only once or twice per month. Other programs like 2Not1, My Life My Choice, and
Uncaged are only available to a small number of youth at a time. LMYDS offers special
programming opportunities only a handful of times per year, based on the schedules of the
volunteer organizations.
32

 Recommendation: Expand programming to multiple housing units or arrange for
additional volunteers to provide programming to youth. Use close supervision and
desirable activities to prevent disruptions between particular youth or groups.
Second, there is no systematic effort to seek out and cultivate programs that meet the specific
needs and interests of youth at LMYDS. While the facility responds to available programming, it
does not appear that staff actively seek out or create programs to benefit justice-involved youth.
For instance, LMYDS does not offer consistent art, career, vocational, or life skills
programming. Residents consistently indicated the desire for increased educational programming
that they can apply to their lives. Most LMYDS programs seem to provide generalized “group”
discussions. Because LMYDS does not provide group sessions through social workers or mental
health staff, these programs are certainly helpful. Current programs do not, however, use
structured approaches to help youth build skills or work on specific activities. Some youth
described the programming as “just listening to people talking at you.”
Recommendation: Conduct on-going outreach to local and regional organizations and
individuals to create more robust programming based on needs of the youth population.
Offer activities that will provide youth with marketable skills. This could include
vocational programming (CTEC, Serve Safe, OSHA), job-seeking skills, yoga, cooking,
music, creative writing, photography, painting, sculpture, or drama. Supervised “handson” engagement is likely to lead to more positive attitudes within the facility and a better
overall environment.
Recommendation: Create a process to encourage youth, families, and staff to think about
and express recommendations for programming. Build upon the LMYDS resident
subcommittee to create a channel for feedback and input from all youth and staff. This
could be done through regular surveys, focus groups, or suggestion boxes.
Another major concern is that youth spend a large amount of time in their rooms. Unit schedules
include several hours per day of time when the most youth on a unit are in their rooms, e.g.
shower time, phone calls. Even staff told the team that it was not uncommon for an entire unit to
be on lock-down due to short staffing. With few exceptions, youth eat lunch and dinner on their
units. Residents also expressed frustration that they did not always report to the day’s scheduled
activities, such as outdoor recreation time or the library. This variability also limits the
effectiveness of the facility’s behavioral management program, as youth are not guaranteed to
participate in activities that they have earned by following the rules.
Recommendation: Involve youth in as much off-unit programming and recreation as
possible. Allow youth to eat meals in the cafeteria. Create an additional recreation or
multipurpose room with activities and supplies to keep youth busy. LMYDS’s ability to
do this is directly related to staffing resources.
While the LMYDS library has an impressive number of books, books are stored in tall cabinets
with closed doors. Televisions, chairs, and boxes block access to many of the cabinets. As a
result, youth reported having to pick a book without being able to browse through a range of
33

 options. There is no librarian or staff person to guide reading selection based on youth’s interests
or reading levels.
Recommendation: Clear the library room of other items and display reading materials so
that youth may look through possible options. Consider training a staff member to be
available when youth visit the library to help spark their interest and make
recommendations.
RECREATION

Recreation opportunities at LMYDS are limited. On Fridays, youth watch a movie on their units.
Most recreation activities and supplies are kept in the program worker’s office. We observed a
small number of puzzles, games, and cards inside offices, but almost nothing available on the
housing units. Televisions, DVDs, and video games are located in the library. The team observed
one group of youth go to the library to play video games only to find the Xbox broken. Residents
said that the television carts are sometimes located on their housing units and staff permit them
to watch television. Many youth requested more interesting recreational options. They suggested
access to approved music on an IPod, newer games and video games, and more structured art
activities e.g. painting, knitting, and sketching. Several youth expressed interest in journaling.
Recommendation: Invest in additional recreational activities for youth. Update
recreation supplies and purchase video games, movies, and iPods. The facility could
create a youth focus group to determine what activities are most meaningful to youth.
Some of these activities could also be used as incentives.
LMYDS has an impressive outdoor area with inspiring and colorful artwork by a local mural
artist. Youth stated that staff generally take them outside unless youth request to use the indoor
area for recreation. There is a basketball court, foosball tables, and picnic tables in the outdoor
recreation area. LMYDS also has a large indoor gym and basketball court. The Recreation
Director was not present during either day of the team’s visit. We did observe a storage area with
additional basketballs, volleyball nets, and badminton racquets. The team spoke to youth on
several units who said were not allowed to go outside or to the gym every day. We spoke to staff
who confirmed this, stating that units alternate going to the gym for afternoon recreation.
Recommendation: Enforce oversight and monitoring to ensure that all youth have one
full hour of large muscle exercise in either the indoor or outdoor recreation space.
RELIGIOUS PROGRAMMING

Religious programming at LMYDS generally complies with the JDAI Standards. The facility has
several volunteers who bring Christian religious services to the facility each week. If youth want
to speak to a representative from their own religious community, they must make a specific
request to a social worker. Staff indicated that they would respond appropriately to accommodate
the requests of youth to practice other faiths by asking a resident’s family for religious literature
or supplies. While we have no doubt that the current staff and administrators would do this, there
is no clear policy describing the process and who would be responsible.
34

 Recommendation: Establish and maintain connections with a broader range of religious
resources in the community.
Recommendation: Modify youth education materials and the Resident Handbook to
include information about how residents can request to meet with religious leaders of
their choice.
YOUTH WITH SPECIAL NEEDS

There is a written policy for youth with disabilities. Senior and administrative staff told us that
medical staff and social workers would probably be responsible for identifying a physical
disability and determining how to meet the youth’s needs. Social workers do not receive
adequate training to do this. Staff indicated that they would make auxiliary aids and services
available for youth who are deaf or hard of hearing, but the facility does not have these resources
or a plan to access them.
Recommendation: Create a detailed written plan for youth with disabilities. The policy
should address how the facility will provide programming, medical and mental health
services, recreational activities and reading materials, and educational services for youth
with disabilities. The plan should include details of how the facility’s designated staff
would obtain any needed auxiliary aids.
LMYDS has taken important steps to accommodate limited English proficient youth. The
Resident Handbook is available in Spanish and LMYDS has access to two interpreter service
providers during the admissions process. During Orientation, staff members or “other qualified
individuals” are tasked with assisting residents who have difficulty understanding the rules due
to language or literacy problems. The Kentucky Department of Juvenile Justice is available to
provide long-term translation services, and LMYDS maintains contracts for interpretations
services.
However, facility staff have not documented how they would provide long-term programming,
services, and education to youth who do not speak English in a written language access plan.
LMYDS policy only addresses the use of interpreters to assist at intake and admissions. Also,
despite existing policy that staff will not use youth as interpreters, several juvenile program
workers stated that they have allowed one resident to translate for another if they spoke a less
common language or dialect.
Recommendation: Develop a written language access plan outlining how staff will
provide meaningful programming, services, and education for limited English proficient
youth.
Recommendation: Remind staff of the policy prohibiting the practice of youth
interpreting for other youth.
BEHAVIOR MANGEMENT

35

 We observed many positive and constructive interactions between LMYDS staff and residents. It
is evident that many staff have experience working with young people.
Each resident is assigned a social worker to help facilitate connections to the outside world
(court, phone calls, etc.). They are not expected to provide treatment or counseling. Social
workers must visit each unit once per day, but there is no requirement that social workers hold
regular sessions with individual youth. In order to speak with social workers, youth submit a
request form each evening. Several youth stated that social workers were not always accessible
to them. Staff stated that social workers do not always communicate and interact with program
workers and youth on a regular basis.
Recommendation: Require social workers to communicate regularly with program
workers about individual youth and meet with each youth individually at least once per
week. Require social workers to review all uses of time outs, fines, and verbal deescalation. Allow youth to request to speak with social worker at any time during the day.
Require social workers to make daily unscheduled rounds to each unit.
The LMYDS behavior management program relies on point values, token economy purchases
and fines, minor and major violations, and a level system. The point system is based on a number
of points that youth may earn during the day for “categories” of positive behavior (Self Care,
Respect for Property, Academic Skills, Social Skills, Self Control, Peer Relations, and Staff
Relations). Youth may earn a certain number of points in each category during each period on
the daily schedule. Residents may spend points at the Token Economy Store on hygiene items,
snacks, permission to mail extra letters, hair care, and access to their cell to retrieve items like
books or sweatshirts. In addition to not earning points, youth receive additional fines for
behavioral violations. Fines consist of 50 points for minor violation and 150 points for major
violations. A fine also results in a drop in one behavioral level. Major fines are accompanied by a
period of room confinement based on staff discretion.
In addition to the point system, residents must advance through a series of behavior levels:
Orientation, Level 1, Honors, and Super Honors. To advance to each level, youth must achieve a
certain number of points, spend a certain amount of time on the previous level, or pass tests
based on the Resident Handbook. A set of privileges is associated with each level. Privileges
include extra books or posters in youth’s cells, later bedtime, permission to buy playing cards or
sodas with behavior points, extra phone calls, and honors hour.
Staff have a range of sanctions available to respond to youth behavior: verbal intervention,
failure to award points, time outs, fines, room confinement, and behavior improvement contracts.
Staff have broad discretion to give residents 20-minute time outs for minor rule violations. After
three time outs in one shift, youth receive a 50 point fine and level drop. Staff can also assign
room confinement for minor and major violations. For major violations, staff can place a youth
in room confinement without attempting less restrictive interventions. Although a disciplinary
hearing is required to place a youth in room confinement for longer than one hour, records
showed that room confinement was almost always used for periods of six hours or more.

36

 The effectiveness of LMYDS’s behavior management program is limited by three factors. First,
the behavior management program relies primarily on the use of sanctions and point deductions
rather than recognizing positive behavior. Both youth and staff told us that, because the system
of possible points per time period for each behavior category was complicated, staff
automatically give each youth the maximum number of points at the start of each shift.
Throughout the shift, the team observed staff deduct points when youth demonstrated noncompliance or negative behavior.
The combination of deducting points, issuing fines, and using room confinement also means that
youth are penalized multiple times for the same behavior. Certain items and privileges should be
available to youth independent of their behavior: regular access to their rooms, playing cards,
participation in reward activities, envelopes, paper, or postage. Youth who exhibit negative
behavior often receive the most benefit from communication with family.
Recommendation: Create a behavior management structure that focuses on rewarding
positive behavior. Simplify the system so points and verbal recognition are awarded for
clearly defined positive behavior. Do not require youth to earn access to books and mail.
Require staff to document the use of positive incentives, verbal de-escalation, and time
outs.
Second, LMYDS relies heavily on room confinement despite a behavior management policy that
provides a series of alternatives. Records showed that youth regularly receive room confinement
in response to normal adolescent behavior, e.g. leaving the unit with extra food, refusing to
participate in a program, being talkative during medication pass, and pushing an intercom button
(all 12 hours of room confinement). One of the team’s most serious concerns is the use of room
confinement for manifestations of mental illness or trauma history such as a resident banging his
head on the wall or smearing and eating feces. There is no doubt that room confinement is linked
to suicide and self-harm. Allowing line staff to use room confinement for residents exhibiting
symptoms of mental illness and trauma is extremely dangerous.
Recommendations: Limit room confinement to situations where a resident’s immediate
behavior poses a risk of physical harm. Require and monitor staff reliance on the removal
of privileges or other behavioral interventions. Require continuous observation and
assessment of youth in room confinement. Remove youth from room confinement as
soon as youth are calm.
Third, staff have a great deal of discretion to determine what sanction(s) to administer, which can
lead to perceived unfairness and a loss of integrity of the behavior management program among
youth. Facility policy provides that staff must secure approval from a supervisor before
administering a sanction. Notwithstanding this requirement, youth receive minor violations for
loosely defined behavior such as complaining to staff, wasting of supplies, talking without
permission, “self abuse,” or disruptive behavior. Many youth told team members that the
duration of room confinement decided by staff is often completely unpredictable for the resident.
Some categories of behavior that require mandatory room confinement are subject to staff
interpretation. For instance, youth reported that rapping, regardless of the content, can result in
24 hours of room confinement for gang activity. It is certainly important to hold youth
37

 accountable for violent and truly gang-related behavior. However, it is also important that staff
investigate and document this behavior properly rather than generalizing behavior.
Almost all residents we spoke to felt that the behavior management program was unfair and that
disciplinary hearings were meaningless. Several youth said they were not present during the
hearing or they were simply told by the program worker how long they would be in room
confinement. Staff told the team that staff would wait to inform the youth that he or she had
received room confinement until youth were already locked in their room for other reasons. This
might be hours after the underlying behavior occurred. Understandably, youth felt tricked,
reducing the likelihood that they will comply with the behavior management program. We
acknowledge strengths of the facility’s due process protections for youth later in this report,
including relatively quick scheduling of hearings following incidents and the provision of
assistance to youth who request it. Nevertheless, the perceptions of the behavior management
system by youth require attention, as youth are less likely to engage with a system that they feel
to be unfair.
Recommendation: Limit behavior violations to conduct that jeopardizes the safety of
youth, staff, or the facility. For all other misconduct or rule violations, require staff to use
behavioral interventions and removal of privileges. Require staff to inform youth as soon
as possible about sanctions or the loss of privileges.
Fourth, the facility does not provide a sufficiently wide range of incentives to encourage youth to
demonstrate positive behaviors throughout their time at the facility. Current privileges include
additional books, posters, visits, phone calls, and biweekly ice cream socials. Items in the Token
Economy Store are either brand name hygiene supplies, playing cards, letter-writing supplies, or
snacks and sodas. While LMYDS administrators clearly understand the positive value of
incentives, the diversity and quality of privileges available is insufficient, especially due to the
extended length of stay for many residents. Given the community resources in Louisville,
administrators and staff could incorporate a much more creative and meaningful range of
privileges. A more extensive range of incentives would encourage residents to maintain positive
behavior over a longer period of time. In turn, this would reinforce the benefits of good behavior
by showing all youth what they could receive.
Recommendation: Develop more incentives for positive behavior, such as extra free
phone calls, improved commissary items, access to video games, listening to an iPod,
extra photos in their cells, special clothing, food items (e.g. donuts, soda, or pizza).
Expand the list of items available in the Token Economy store. Allow youth to earn
incentives regardless of their behavior level.
Recommendation: Explore community resources to create rewards, such as donated
items from restaurants, business, and sports teams. The team learned that two
professional athletes recently visited the facility. This is an excellent example of
incentives that LMYDS can offer. Include a list of possible incentives in the Resident
Handbook. Contact other detention facilities to discuss ideas for incentives and
programming.

38

 Fifth, LMYDS does not use individualized behavior management plans for youth. Staff may
place youth who require frequent disciplinary intervention on a Behavior Improvement Contract
(BIC). While BICs must be approved by the Deputy Superintendent, there is no guiding criteria
for effective BICs or a process for determining what a youth must do to return to regular
programming. A BIC may require a youth to write a letter, complete a cleaning project, or
transcribe certain pages from the Resident Handbook. These plans do not address the underlying
causes of youth behavior or include individualized strategies for program workers to help youth
succeed. There is no way to ensure that program workers understand or apply this information.
Also, staff and social workers explained that BICs were only used for a small number of youth.
This is particularly troubling given the high number of youth at LMYDS with serious mental
illness.
Recommendation: Use individualized behavior plans designed to target the underlying
causes of each youth’s behavior. Implement a method for mental health staff, social
workers, and program workers to collaborate and identify a broader range of youth who
can benefit from individual plans. Individual behavior plans should include incentives,
examples of positive and negative behavior, time frames, and clear expectations for what
the resident must do to complete the plan.

39

 TRAINING AND SUPERVISION OF EMPLOYEES
The quality of any facility rests heavily upon the people who work in it. This section requires that
the facility hire properly qualified staff and provide the necessary pre-service and continuing
training they need to work with troubled youth. Staff should also perform their work in an
operational setting that enables them to do their work well – through appropriate staffing ratios
and proper administrative supervision. The section further requires that facility staff engage in
ongoing quality assurance and self-improvement through documentation of serious incidents,
citizen complaints, and child abuse reports.
The team recognizes that LMYDS staff are committed to serving young people. Residents
mentioned several LMYDS staff members who helped them and cared about them.
Unfortunately, staff shortages and hiring concerns have created a constellation of issues that
undermine facility operations and jeopardize the safety of residents and staff. One troubling
example of the impact these issues is the disturbingly high number substantiated incidents of
sexual misconduct involving new staff.
LMYDS has an organized system designed to ensure that all staff receive new employee training
and annual refresher trainings. New staff receive at least two weeks of supervision from another
program worker. The facility maintains excellent training records. Despite these strengths, the
training program omits several key topics required by the JDAI Standards.
Finally, LMYDS should enhance the level of supervision and oversight in the use of discipline
and incentives.
QUALIFICATIONS AND STAFFING

LMYDS follows Louisville Metro’s rules and regulations concerning selection, retention, and
promotion. After LMYDS staff interview and select a candidate, the Louisville Metro Human
Resources Department conducts a criminal background check and child abuse and neglect
registry check. Louisville Metro Human Resources Department does child abuse and neglect
checks annually, but there are no periodic criminal background checks for current employees.
As discussed, the team was concerned with LMYDS’s ability to recruit and retain qualified and
dedicated program workers. The education and experience qualifications for program workers
are minimal. Neither Louisville Metro nor LMYDS require that staff have at least two years of
college or a high school diploma or the equivalent and two years’ experience working with
youth. LMYDS cannot offer competitive salaries for entry-level positions in a difficult line of
work and does not provide promotions or salary increases based on performance. As a result,
there are staff at LMYDS who have no experience working with teenagers, and who are not
interested in working with troubled youth at a juvenile detention facility or learning how to be
effective in their positions. This results in high turnover rates (37% in May 2017) and a large
number of inexperienced staff.

40

 Recommendation: Require staff who have direct contact with residents to have at least
two years of college or a high school diploma or the equivalent and two years’ experience
working with youth.
Recommendation: Explore options to increase the salaries of staff to improve hiring and
retention. Work with Louisville Metro to attract and recruit applicants interested in
working with justice-involved youth. Implement a more rigorous screening process to
exclude staff who may have a greater likelihood of engaging in inappropriate conduct
with youth at the facility.
LMYDS is also significantly understaffed. The facility requires a staff to youth ratio of 1:10
during waking hours and 1:16 during sleeping hours, but this ratio includes staff inside the
Control Room who cannot directly hear and speak with youth. In July, there were 76 authorized
program worker positions and 16 vacancies (a number that had fallen to 8 vacancies by midAugust). Staff are routinely required to work overtime. For instance, LMYDS spent over
$97,000 on overtime in July 2017. While policy caps overtime at 16 hours per week, staff
reported that, in practice, overtime often exceeds that amount. When staff report to work, they do
not know whether they will have to work twelve hours or sixteen hours. To add to complications
caused by overtime, administrators assign overtime beginning with the newest staff. While this
allows staff to plan ahead, it also increases the percentage of inexperienced staff on each shift.
Regardless of how seasoned program workers are, no one can expect staff to be effective in the
very demanding jobs at the LMYDS for sixteen hours at a time. Along with inadequate mental
health resources and training, this results in unsafe conditions for youth and staff.
Recommendation: Hire enough program workers to increase LMYDS’s staff to youth
ratio to 1:8 or less during waking hours, as required by the PREA standards and the JDAI
standards.
TRAINING

LMYDS provides an organized and inclusive training program that meets many of the JDAI
Standards. The Training Specialist is knowledgeable and invested in providing quality training
for staff. He is interested in exploring new training opportunities that can benefit youth and staff.
All new staff receive eight hours of Louisville Metro Orientation on professional values, ethics,
and benefits. LMYDS provides additional training. The Training Specialist is responsible for
developing and implementing training programs at the facility. Supervisors are responsible for
coordinating on the job training and making recommendations for the training needs of
individual staff.
The LMYDS training program includes a pre-service orientation (PSO), on the job training
(OJT), basic skills training, and program in-service training. Once staff have completed 56 hours
of PSO on a range of topics related to working with youth, they are assigned a staff mentor
(program worker) for an additional 72 hours of on the job training. OJT supervisors complete an
OJT Checklist to certify that new staff have mastered key program worker tasks. Supervisors
must review this documentation. Within the first year of employment, program workers and
professional specialists receive 32 hours of basic skills training.
41

 All staff must receive in-service training. Program workers and professional specialists must
attend the full 40 hour program offered during three separate times, while support staff and
program supervisors receive selected topics. In order to complete 40 hours annually, the latter
two categories of staff attend additional specialized training or workshops. In-service training
topics may vary based on the issues and needs in detention. Annual topics include PREA,
CPR/First Aid, policy updates, and use of force techniques.
Our interviews revealed that staff members were generally well-informed about the institution’s
policies and procedures. We did note, however, that there were serious inconsistencies in how
staff use the behavior management system. Staff also rely heavily on the use of fines, room
confinement, and other punitive measures, often in response to normal adolescent behavior.
Expanding and improving staff training is one way that LMYDS can address these concerns.
Despite notably strengths, LMYDS’s training program is inadequate in several areas based on
content or duration. We identified four areas of concern.
First, LMYDS should provide additional training on trauma responsiveness. It appeared, based
on the team’s file review, that staff may view youth who have experienced trauma as defensive
and non-compliant. LMYDS did provide documentation that some staff members (approximately
25) received training on trauma-informed care in March of 2017. The team applauds this effort,
but also believes that all staff must receive more practical skills training on how to respond to
behavior of youth with trauma histories within a secure facility, and how to help traumatized
youth develop new behaviors. This training should be a substantial part of pre-service and inservice training for all staff who have direct contact with youth.
Recommendation: Enhance training to better prepare staff to deal with the causes,
nature, and symptoms of trauma that they will encounter in justice-involved adolescents.
Staff should receive pre-service and annual in-service training on trauma.
Second, LMYDS’s does not offer sufficient training on crisis intervention and verbal deescalation. The HWC curriculum includes some content on these topics, but in-service training
does not. Staff receive some training from LMYDS on how to respond to negative youth
behavior, but the fact that sanctions are used inconsistently by different staff may reflect the
inadequate content and frequency of this training. Given the significant trauma and mental health
histories of residents as well as the high rate of room confinement, additional de-escalation
training is essential. The facility clearly places a premium on training to help staff protect
themselves with physical control techniques. All LMYDS staff who have direct contact with
youth receive 14 hours of initial training on the Handle With Care Physical Management System
(HWC) as well as 6 additional hours each year. Verbal de-escalation and conflict management
skills are equally necessary to keep staff and youth safe.
Recommendation: Provide pre-service and regular in-service training on the use of
conflict management and verbal de-escalation. The facility should research and adopt a
training model that prioritizes prevention, with physical intervention as a last resort, such
as Safe Crisis Management.
42

 Third, LMYDS does not adequately train staff on how to work effectively with youth of various
racial and ethnic backgrounds in a culturally responsive manner. Pre-service training contains a
section on “cultural lifestyles,” but this is only a fraction of a training half-day. Residents stated
that some staff interpret innocuous behavior as gang-related or threatening based on a lack of
understanding about residents’ communities and backgrounds. Several staff actually requested
training on how to communicate with youth from urban areas and youth with different racial,
ethnic, and cultural backgrounds.
Recommendation: Deliver pre-service and refresher training on the racial and ethnic
backgrounds of youth in custody and how to work with youth in a culturally responsive
manner. Include material on historic and institutional racism and strategies to address
implicit bias. Clearly distinguish cultural responsiveness from gang-awareness.
Fourth, staff at LMYDS do not have sufficient guidance regarding the management of lesbian,
gay, bisexual, transgender, and questioning (LGBTQ) youth. The team spoke with several
program workers who did not have a consistent view of how to appropriately provide
programming for LGBTQ youth. The LMYDS training program should include much more
training on working with LGBTQ youth beyond that which is required by PREA.
Recommendation: Adopt a dedicated policy on the treatment of LGBTQ youth
independent of the facility’s PREA policy. Provide additional training on working
effectively with LGBTQ youth, and consider partnering with community-based resources
to deliver that additional training.
LMYDS’s training program omits several important subjects in the JDAI Standards. Youth
program workers need additional training, especially training on how to identify and respond to
youth with mental illness in detention settings.
Recommendation: Develop training in the following areas for all staff:
1. Signs of physical, intellectual, and developmental disabilities, the needs of youth
with such disabilities, and the ways to work and communicate effectively with
youth with those disabilities;
2. Signs of mental illness and the needs of and ways of working with youth with
mental illness, including working effectively with mental health staff;
3. Gender-specific needs of youth in custody, including special considerations for
boys and girls who have experienced trauma, pregnant girls, and health protocols
for both boys and girls;
4. Effectively communicating with LGBTQI youth;
5. Signs and symptoms of medical emergencies, including acute manifestations of
chronic illnesses (e.g., asthma, seizures) and adverse reactions to medication;
6. Signs and symptoms of mental illness and emotional disturbance;
7. Access to mental health and crisis intervention services for youth;
8. Signs and symptoms of chemical dependency, including withdrawal from drugs
and alcohol;
43

 9. Procedures for appropriate referrals of health and mental health needs, including
transportation to medical or mental health facilities;
10. Signs and symptoms of child abuse and neglect; and
11. Handling disclosures of victimization in a sensitive manner.
SUPERVISION

LMDYS has created several important channels for supervision of staff. The Training Specialist
and Quality Assurance coordinator have worked at the facility for years and are familiar with
almost all staff and most residents. Program workers receive regular reviews from Supervisors.
All staff attend training and shift meetings on Thursdays with supervisors. Social workers hold
monthly meetings on the third Thursday of each month. The facility holds weekly meetings for
program workers with supervisors and quarterly meetings for all staff members.
Program workers complete daily behavior sheets for each youth to document their points. They
also maintain a three-ring binder for each resident and a Unit Behavior Report for each shift.
Staff must complete a Fine Sheet if a youth receives a minor violation as well as an Incident
Report if a youth receives a major violation. Unfortunately, supervisors are not able to easily
view data from resident binders, daily behavior sheets, incident reports, fines, and BICs all in
one place. Supervisors do review Shift Reports and weekly Shift Reports, but these reports lack
detail on the use of fines, hours of room confinement, and details found in resident binders.
While the Director and Assistant Director are clearly dedicated to serving youth, they did not
appear to be familiar with individual youth and staff. Program workers consistently requested
that the Director and Assistant Director work more closely with direct care staff, observe staff on
duty, and provide positive and constructive feedback to staff and supervisors. This is particularly
important because many of the administrative staff at LMYDS are relatively new.
Recommendation: Administrators should spend time on living units daily and interact
directly with staff and youth. Administrators should consider joining a number of shifts
each month.
Recommendation: Create a system to review log books, video, and resident binders
regularly.
QUALITY ASSURANCE

LMYDS has several ways of tracking information about youth and staff. One obvious strength is
that the facility has a process to document almost all incidents of discipline and current
administrative staff understand the importance of data. Several administrators have extensive
experience in program improvement and quality assurance. The new leadership at LMYDS
understands how data-driven strategies can improve the quality of services. The facility uses
several different programs to track and review data, including LouieStat and XJAIL, and
administrators are familiar with the capacity and limitations of these programs. Program
Improvement staff have reviewed existing data and completed reports on room confinement and
recidivism.
44

 Administrators review Shift Reports and Cumulative Behavior Reports for the entire facility,
which capture important daily information. These reports do not track the number of room
confinement hours. Through LouieStat, the facility can track department metrics like overtime,
sick time, and staff turnover. Although LMDYS has the ability to capture an impressive amount
of information, staff are not able to track and store all of this data in one place. This makes it
difficult for facility leaders to translate information from various sources into strategic corrective
action plans. This is especially problematic given concerns about inconsistency in the use of the
behavior management system.
Recommendation: Work with Louisville Metro to develop a synchronized way to track
and review information about the use of discipline and incentives, fines, and room
confinement.
Recommendation: Establish collaboration between direct care staff and quality
improvement staff so the facility can better translate existing information (e.g. reports on
room confinement and recidivism) into corrective action plans endorsed by line staff.

45

 ENVIRONMENT
Juvenile detention facilities should not look like or be operated as jails. This section encourages
facilities to provide a non-penal environment appropriate for youth who need to be held in a
secure setting. It requires that the facility is clean, meets fire and safety codes, has properly
functioning temperature controls, light, and ventilation, and offers youth appropriate living
conditions. This section also encompasses quality of life issues – assuring that youth will have
clean, properly-fitting clothing; pleasant, healthy eating experiences; permission to retain
appropriate personal items; and some measure of privacy.
LMYDS has an impressive and current comprehensive set of emergency preparedness plans. We
have identified a handful of additions that we think would strengthen the plans and their
effectiveness if they are ever needed. As described below, an aging and problematic physical
plant contributed to findings of non-conformance with many standards in this area. The facility’s
leadership has taken notable steps to try to remedy these longstanding challenges.
POSITIVE INSTITUTIONAL ATMOSPHERE

A positive institutional atmosphere in a juvenile detention facility depends on two factors: the
physical environment and the interpersonal atmosphere created by the way staff work with and
supervise youth. As mentioned in the introduction, the team appreciated the recent work that had
been undertaken to introduce positive messages and artwork through large and colorful murals in
the courtyard. There are many more areas that could benefit from such attention, and we
encourage the administration to forge ahead with plans to introduce other artwork and
developmentally appropriate imagery throughout the facility.
Recommendation: Continue with plans to introduce murals and other positive artwork
and imagery in other parts of the facility and on the living units.
Many of the systemic problems mentioned in the introduction – staffing shortages, forced
overtime, low pay, a lack of mental health resources, and an overuse of room confinement – limit
the facility’s ability to achieve a staff-created positive institutional atmosphere. With the
exception of some exemplary front-line staff and supervisors, the atmosphere at LMYDS is
generally not one that conveys a sense of high expectations of youth. This includes the fact that
youth at LMYDS wear prison-style jumpsuits, and some staff wore law-enforcement style shirts
with prominent embroidered shields (as opposed to other staff who wore polo shirts). While the
overarching challenges are likely to take time and resources to address, the clothing may be one
area that administration can address on a more rapid timeframe.
Recommendation: Develop and implement an action plan to address the systemic
challenges facing the facility that limit the ability to create a positive institutional
atmosphere.
Recommendation: Change the clothing offered to youth to polo shirts and khakis instead
of prison-style jumpsuits.

46

 FOOD SERVICE AND NUTRITION

Consistent, high-quality food service can help maintain a positive institutional atmosphere and
reduce the number of incidents involving physical aggression and violence. As mentioned in the
introduction, the team reviewed many grievances related to the quality and quantity of food
provided to youth prior to arriving on site. Interviews with staff and youth, coupled with the
team’s observation of meal service while on site, provided additional information about
shortcomings within the food service and delivery system at LMYDS.
The team recognized that the kitchen had implemented a new menu recently with the goal of
remedying long-standing areas of concern. The team also learned about significant staffing
shortages in the kitchen, coupled with the recent departure of the facility’s food service manager.
While the team acknowledges these challenges, we found that there were serious concerns about
the quality, quantity, and timing of meals at LMYDS. As any juvenile facility administrator
knows, problems with these areas of food service and delivery lead to unhappy youth who are
more likely to engage in disruptive behavior.
First, the meals that the team observed delivered to youth (and that some team members
consumed) were not visually appealing or particularly appetizing. The team also questioned
whether the portion sizes matched what was prescribed via the menu. We understood that the
facility had adopted a 3,000 calorie diet recently to acknowledge the growing adolescent
population at the facility, but the servings did not seem large enough to meet that target.
Additionally, many youth reported that the meals left them hungry later in the day.
Recommendation: Verify whether portion sizes are in line with menus approved by the
food service provider’s dietician.
Recommendation: Ensure that meals are both visually appealing and appetizing to
youth.
Second, many youth and staff reported concerns about the timing of lunch and dinner. Some
youth at the facility eat lunch as early as 10:45am, and they may not receive dinner until 5:30pm
or later. Youth and staff reported that youth often became hungry during this time period in the
absence of a snack.
Recommendation: Align the facility’s food service delivery with a more standard
schedule that includes a later lunch.
Recommendation: Provide an afternoon snack in between lunch and dinner.
EMERGENCY PREPAREDNESS AND FIRE SAFETY

As mentioned above, the facility has an impressive and comprehensive set of emergency
preparedness plans that account for many different types of emergencies and natural disasters.
We applaud the facility for thinking through how it would manage those situations. We did have
47

 several additions that we believe would strengthen the plans. The plans do not explicitly address
the process for transporting essential medications off-site, notifying family members (including
designating staff who would be responsible for making the notifications), and addressing how to
meet the needs of youth with disabilities and limited English proficiency. The team encourages
administrators to think through how they would manage those aspects of the facility’s response
to emergencies and integrate them into the existing plans.
Recommendation: Include additions to existing emergency preparedness plans that
address the process for transporting essential medications off-site, outline the process for
notification of family members (including designating staff who would be responsible for
making the notifications), and address how to meet the needs of youth with disabilities
and limited English proficiency.
The facility conducts regular fire drills on shifts and has good documentation of the outcomes of
drills. We understood that drills did not include practice clearing youth from the secure area of
the building. We recommend conducting a drill that includes clearing youth from the building at
least annually.
Recommendation: Conduct a fire drill that requires staff to clear youth from the building
at least annually.
PHYSICAL PLANT AND SANITATION

As mentioned in the introduction, the physical plant at LMYDS suffers from significant
shortcomings, and the facility would benefit from heightened attention to sanitation protocols.
Administrators and staff at LMYDS are all too familiar with the challenges presented by the
facility, including chronic maintenance problems, inconsistent air and water temperatures,
lighting problems, and other problematic conditions. There is, unfortunately, no easy remedy to
these problems in a facility of this age, but LMYDS could certainly benefit from additional
resources directed at preventive and corrective maintenance. Additionally, the facility relies upon
youth for a significant amount of services that would otherwise be provided by janitorial staff.
The team observed many parts of the facility that were not adequately cleaned and sanitized
under the current protocols.
Recommendation: Secure additional resources for preventive and corrective
maintenance and develop a prioritized list of chronic maintenance issues to be addressed
in order of their relation to the life, health, and safety of youth and staff at the facility.
Recommendation: Develop policies and procedures that ensure a thorough and
appropriate cleaning and sanitization of areas where youth and staff are present.
SEARCHES AND SUPERVISION

First, we did not observe staff consistently announcing themselves when entering housing units
where youth of the opposite gender were present. We understand that the facility has units that
house both males and females. However, the PREA standards do not provide exceptions for co48

 ed units. We recommend reinforcing the need to make such an announcement by posting a
reminder on housing unit doors or through some other means.
Recommendation: Develop signage or some other technique to ensure that staff of the
opposite gender of youth on a housing unit announce their presence.
ACCOMMODATIONS FOR YOUTH WITH PHYSICAL DISABILITIES

Although the facility had designated rooms and bathrooms that were intended to accommodate
youth with physical disabilities, the rooms and bathrooms lacked all of the fixtures necessary to
comply with the Americans with Disabilities Act (ADA) standards for secure detention facilities
and the JDAI standards in this area (e.g., grab bars). Additionally, the restrooms available to the
public during visitation were not ADA complaint, potentially limiting the access of family
members and legal guardians with disabilities.
Recommendation: Install grab bars and shower fixtures that would meet the needs of
youth with physical disabilities. Suicide-resistant grab bars with welded steel between the
wall and the bar are available from corrections supply outlets. Modify the public
restrooms to ensure compliance with the ADA.

49

 RESTRAINTS, ROOM CONFINEMENT, DUE PROCESS, AND GRIEVANCES
Security and good order in a facility are best achieved when expectations are clear; the facility
encourages compliance with rules through positive behavior interventions; staff are well-trained
to help prevent and de-escalate crises; and there are positive relationships between youth and
staff. This section addresses what happens when those protective factors are insufficient. This
section includes the facility’s rules for restraint, use of physical force, room confinement,
discipline, provisions for due process, and disciplinary sanctions. This section also addresses the
facility response to concerns and complaints by youth through an effective grievance process.
MECHANICAL RESTRAINTS

Staff appear to be adequately trained to use force and handcuffs when necessary for youth who
are out of control, and to cease using PRT and handcuffs as soon as the youth is under control or
in their room.
Shackles are routinely used for transporting youth outside of the facility. Leg shackles are
physically very uncomfortable and psychologically humiliating. Leg shackles may be necessary
for security and safety in transporting some youth, but certainly not all youth. For this reason, the
JDAI standards require that staff “provide particularized reasons for their use and obtain
approval by the facility administrator” before using shackles. The team was told that a previous
superintendent did not support the routine use of leg shackles during transportation.
Recommendation: Require particularized reasons and approval by the facility
administrator before using shackles for transportation outside the facility.
There is a restraint chair in the facility. The team received varying recollections of how often it
has been used in the past, but there was agreement that it has been used rarely. Restraint chairs
constitute an unnecessary and degrading level of restraint in a juvenile facility, particularly when
staff are well-trained on physical control of disruptive youth. For that reason, when it has
investigated juvenile facilities that use a restraint chair, the U.S. Department of Justice has
consistently found that use of the chair violates a youth’s constitutional rights and should be
ended. The restraint chair in this facility obviously is not an important element in staff efforts to
control disruptive youth. It should be removed from the facility so that future staff or
administrators do not decide to begin using it again.
Recommendation: Remove the restraint chair from the facility.
ROOM CONFINEMENT

The usual stated purpose of room confinement is as a temporary response to youth behavior that
threatens immediate harm to the youth or others. When the youth ceases to threaten immediate
harm to self or others, staff should release the youth from room confinement. This principle is
embodied in the JDAI Juvenile Detention Facility Standards and has been approved by the
American Correctional Association, National Partnership for Juvenile Services (composed of
administrators and staffs of juvenile detention facilities), Council of Juvenile Correctional
50

 Administrators (composed of administrators of the state juvenile correctional agencies), National
Commission on Correctional Health Care, American Academy of Child and Adolescent
Psychiatry, American Academy of Pediatrics, American Probation and Parole Association,
American Psychological Association, and the National Council of Juvenile and Family Court
Judges. Room confinement can have long-lasting and devastating effects on youth, including
trauma, psychosis, depression, anxiety, and increased risk of suicide and self-harm. The
American Correctional Association is adopting a new standard that explicitly requires these
limitations on the use of room confinement in juvenile facilities.
In this facility, room confinement is used primarily as punishment for violating facility rules.
Youth are held in rooms for set periods of time (e.g., 6 hours, 12 hours, 24 hours, 48 hours). This
is inconsistent with the guiding principle described in the previous paragraph. While in the
rooms, youth may not have phone calls or visits with parents or guardians, and may not have
books. The Resident Handbook incorrectly states that youth will receive 30 minutes off of their
confinement time for each hour they cooperate and followed expected behavior in their rooms:
the team was told that does not actually happen.
A review of Behavior Reports and Incident Reports revealed that some youth are held in room
confinement for long periods for nonviolent behavior, including passing candy (8 hours),
refusing to go into their room (12 hours), failing to comply with a rule after receiving bad news
(12 hours), grabbing a phone without permission (6 hours). Any reference to gangs results in 24
hours of room confinement.
The “1 in 1 out” program in 2D, the girls unit, is particularly harsh and unfair. As mentioned
earlier in this report, the team recognized that non-contact orders issued by the court contributed
to this arrangement. However, the team also learned that acting out behavior also contributed to
“1 in 1 out.” For example, because some girls acted out, all girls were in lockdown in their rooms
for two weeks as of the dates of the on-site assessment. This is group punishment for the
misbehavior of some girls, which is inherently unfair. It is unnecessary and excessive. It is also
discriminatory on the basis of gender, since units in which boys were disruptive were not
subjected to lockdowns at the time of our visit. The team learned that “1 in 1 out” had been used
on male units in the past, but the fact that it was only being used for female youth undercuts
perceptions of fairness among youth at the facility. Interviews with girls in their unit indicated
that one or two girls have especially high needs and are prone to quick anger. The solution to that
is to bring in a qualified mental health professional to develop truly individualized behavior
plans, not the current “Behavior Improvement Contracts” which essentially offer youth
reductions in punishment for doing chores or assignments but do not get to the underlying
emotional problems.
The assessment team is well aware of the dangers posed by disruptive youth in a juvenile
facility, the critical importance of maintaining safety and security, and the difficulty in
transitioning away from a facility culture that uses room confinement routinely. But several
jurisdictions have done so. Massachusetts and Maine have largely done away with room
confinement as a punishment for violating rules in detention and commitment facilities and only
use it during brief periods (usually no more than one hour). Ohio reduced its use of room
confinement by 90% by providing individualized behavior plans and changing the culture of its
51

 state facilities. Mississippi does not rely on room confinement as a disciplinary sanction in its
state facility for youth transferred to adult criminal court.
This facility has several levels of response to youth misbehavior, including verbal intervention,
failure to earn points, time out, fines, room confinement, and behavior improvement contracts.
This system may be useful, since it allows staff to gradually increase the level of sanction if a
youth does not cease misbehavior or continues with additional misbehavior. However, in
practice, many youth go quickly to room confinement, so the gradations in the sanctions are not
effective. “Failure to earn points” and “fines” do not seem to be sufficient sanctions to deter
youth from being disruptive.
Part of the problem may be that the rewards offered to youth who attain higher levels do not
seem to provide sufficient motivation to youth. Many of the articles youth can purchase at the
Token Economy Store are for hygiene such as soap, deodorant, and toothpaste, i.e., basic needs.
Snacks such as chips, candy, cookies and sodas are available, but the rewards are not so desirable
that youth think twice before acting out and making those rewards unavailable. Other juvenile
detention facilities in Kentucky use much stronger rewards, like meals from McDonalds or
Chinese food, more frequently and for a broader range of youth than LMYDS currently does.
The assessment team was told that a National Basketball Association player donated athletic
shoes to the facility, but the shoes have not yet been distributed. These are examples of rewards
that would be highly prized by youth in the facility. Facility administrators should solicit
suggestions from staff and youth about more desirable rewards.
In addition, the Token Economy program should be revised so that more youth can achieve
Honors and Super Honors and can achieve those levels more quickly. At the present time, very
few youth can get to the top level, even if they do not violate any rules.
The facility wisely recognizes that youth may get upset during incidents in the facility. The
Resident Handbook states:
A resident placed on time out is allowed to verbalize anger during the calming or cooling
off process. Staff shall not discipline the resident for ventilating during a time out unless
the resident uses abusive language directed toward another person, or violates major rule
offenses.
This is a developmentally appropriate policy to allow youth to verbalize anger after an incident.
In practice, however, it appears that many youth call out specific individuals when they
verbalize, and they then receive room confinement. A considerable number of youth receive
room confinement in such circumstances.
Needless to say, youth cannot be allowed to threaten staff or other youth. Yet it may not be
realistic to expect upset youth to avoid directing their anger toward a specific person. Their anger
may be an expression of their emotional upset, rather than an actual threat to a staff member or
youth.
The use of room confinement also demonstrates the critical need for a qualified mental health
52

 professional on site. As discussed earlier in this report, there are youth with serious mental health
disorders in this facility, and they act out. Punishing them by locking them up in a bare room
with nothing to do is not going to help them. They need professional intervention. The qualified
mental health professional should be involved in intervening in or soon after confrontations in
the facility, working with the most disruptive youth and youth who spend the most time in room
confinement, developing individualized behavior plans that reward successive approximations of
measurable behavior change, conducting debriefings after all incidents that result in room
confinement, and training staff on adolescent development and behavior.
Dr. Mullins and Ms. Day are to be commended for their interest in reducing room confinement
and their openness to new ideas. Team members suggested a number of resources that may be
helpful, including reports, toolkits, and administrators of juvenile facilities who have made
significant reductions in the use of room confinement. A particularly helpful resource is the
Toolkit for Reducing the Use of Isolation prepared by the Council of Juvenile Correctional
Administrators (March 2015).
Recommendation: Limit room confinement in the facility to a temporary response to
youth behavior that immediately threatens the safety of the youth, other youth, or staff,
and release youth from room confinement when they regain control.
Recommendation: Review relevant materials such as the CJCA Toolkit and talk with
facility administrators in jurisdictions that have reduced room confinement in order to
plan a transition away from the frequent use of room confinement that now occurs.
Recommendation: Do not use room confinement for fixed periods of time or as a
punishment or disciplinary sanction.
Recommendation: Do not use group punishment or the “1 in 1 out” program.
Recommendation: Conduct focus groups with staff and with youth to elicit ideas for
more desirable rewards for the Token Economy. Contact local businesses, including
sports teams, for donations to the Token Economy program. Streamline the process for
youth to advance to higher levels in the program so that rewards are both desirable and
attainable.
Recommendation: Review policy and staff training to determine how to allow youth to
verbalize their emotional upset without using room confinement if they direct their upset
toward a particular youth or staff.
Recommendation: Hire a qualified mental health professional for on-site work at
the facility.
Recommendation: With the qualified mental health professional, revise the “Behavior
Improvement Contracts” to make them more individualized and structured so that they
provide rewards for youth who achieve successive approximations of measurable desired
behavior, rather than only providing youth with an opportunity to erase part of their
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 overwhelming point deficits.
DUE PROCESS

The checklist lists some JDAI standards that are not met. However, several positive aspects of
the discipline and due process system are noteworthy. Hearings are scheduled soon after
disruption incidents, usually within a few hours. Assistance to the youth in the hearing is
routinely offered and provided. The assessment team notes that youth should receive “credit for
time served” for the time they are in confinement until their disciplinary review hearing.
Recommendation: Give youth credit for time served for the time they spend in their
room after the incident until the disciplinary room confinement.
GRIEVANCES

The grievance process has several important strengths. There are grievance boxes in every unit.
Youth understand the grievance process and most do not fear retaliation for filing a grievance.
The grievances are investigated expeditiously and youth are given meaningful responses. Many
of the grievances are valid, and administrators often take action to remedy the identified
problems.
There are some challenges for the grievance process. In unit 2C, the grievance box is behind the
water cooler and is not readily visible and easily accessible. Some youth told the team that they
don’t believe the grievance process is very effective.
The Resident Handbook states that, before a youth requests a Resident Grievance Form, the
youth must “Maturely explain your side of the conflict to the worker to see if the issue can be
resolved without using a Resident Grievance Form.” There are two concerns about this. First, a
youth should not have to request a grievance form from staff. The forms should be available near
the grievance box or in some other easily-accessible location. If youth have to request a form,
they may be deterred from filing a grievance. Second, a youth may interpret the requirement in
the Resident Handbook to mean that the youth must go to the staff member whom they want to
file a grievance about (i.e., “the worker”) to try to resolve the issue. That is not appropriate and
is a bad practice. Many youth may be deterred from filing a grievance if they have to talk to the
same staff member first. The language in the Resident Handbook should be revised to make it
clear that a youth should talk with a youth worker about their issue, but they do not have to talk
with a staff member about whom they intend to file a complaint.
The language on the Resident Grievance Form is also ambiguous. It says, “It is your
responsibility to attempt to resolve issues before filing a grievance by calmly discussing the
issues with staff.” It doesn’t say “the staff” but it could still be interpreted that way by youth. The
language should also be clarified.
The grievance process does serve as a valid indicator of youth concerns at the facility. The team
reviewed all grievances since the beginning of the year. Two major categories of grievances
were food and problems with the building, which is consistent with what the team was told by
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 youth and staff. The largest category of grievances, however – more than the total for food and
building problems combined --were about unfairness in imposition of consequences, fines, and
room confinement. Another major category, with about as many grievances as about food, were
those about staff behavior. The team recognizes that many youth grievances are unsubstantiated.
But the sheer number of grievances about the discipline system, as well as those about staff
behavior, should raise red flags with facility administrators. The research literature in juvenile
justice, as well as common experience, make it clear that youth do not effectively engage in a
process that they consider unfair.
Recommendation: Ensure that all grievance boxes are in locations that are fully visible
and easily accessible by youth.
Recommendation: Clarify the language in the Resident Handbook and the Resident
Grievance Form so that youth understand they do not have to talk to the worker they
intend to complain about before filing a Resident Grievance.
Recommendation: Regularly review youth grievances and talk to youth to determine if
there are patterns in their concerns about the fairness of the consequences, fines, and
room confinement. Determine whether there is a pattern of concerns with individual staff,
or in specific units, or whether the concerns are spread over many staff. That may
indicate a need for reviewing staff training, or for clarifying policy about the imposition
of sanctions for misbehavior and misconduct.

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 SAFETY
Although safety is the last section of this assessment tool, physical and emotional safety for youth
and staff is the overarching principle underlying all of the other sections. This section identifies
the facility’s responsibilities to protect youth and staff, respond quickly and appropriately when
incidents occur, provide support to alleged victims, and investigate allegations of misconduct.
As we described in the introduction and other parts of this report, the combination of a lack of
mental health resources, staffing shortages and turnover, and the excessive use of room
confinement have created a dangerous situation in parts of the facility. However, we did want to
recognize two areas of strength in this area of the standards.
First, the facility, and the Quality Assurance Coordinator in particular, have done an exemplary
job of prioritizing thoughtful implementation of the Prison Rape Elimination Act standards for
juvenile facilities. The team was very impressed with how knowledgeable the Quality Assurance
Coordinator was about the standards, and how thoroughly she investigated and documented any
allegations of sexual misconduct. We were also pleased to hear that the facility was in the
process of securing $1 million in upgrades to its video monitoring system to address blind spots
within the facility.
Second, the team was pleased to hear that a Resident Council of youth at the facility meets on a
monthly basis to advise administrators about safety concerns and other operational issues at the
facility.
In addition to addressing the overarching areas of concerned mentioned above, we had one major
area of concern: the number of substantiated PREA incidents over the course of the last year. As
mentioned in the introduction, from November 2016 to August 2017, LMYDS had 6 reported
PREA incidents, 5 of which were sustained or substantiated. There was also one reported
incident of retaliation by a staff member against a youth who had made a PREA report, which
was also sustained.
LMYDS did a thorough and appropriate job of responding to these incidents, and the fact that the
incidents were detected in the first place speaks to the importance of the facility’s PREA
compliance work. Additionally, it is important to note that the incidents did not involve
allegations of alleged abusive physical contact by staff. However, the fact that some incidents
involved recent hires who crossed professional boundaries in their interactions with youth (one
of whom did so over an extended period of time) raises questions about screening during the
hiring process, training of staff on red flags and warning signs in their interactions with youth,
and supervision of newly hired staff. This was a particular area of concern given that there may
also be incidents that have gone unreported, notwithstanding the facility’s PREA compliance
efforts.
We recommend considering whether additional or enhanced screening of staff would better
prevent staff with inappropriate motives from applying to work at LMYDS. For example, DJJ
uses a screening instrument known as the Diana Screen to identify staff who may be more likely
to engage in sexual abuse or harassment of young people.
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 Recommendation: Consider whether additional screening questions or tools, such as the
Diana Screen, could identify staff who may have a greater likelihood of engaging in
inappropriate conduct with youth at the facility.
Second, we recommend clarifying the appropriate boundaries of staff and youth interaction in
policy and procedure and through training. While the Code of Conduct and Code of Ethics speak
generally to boundaries, there is a clear need for a social media and undue familiarity policy and
training on maintaining appropriate boundaries.
Recommendation: Develop and add guidance to the undue familiarity policies and
procedures to address appropriate boundaries between youth and staff, contact outside of
the facility (including through social media), and admissions to detention of relatives and
family friends.
Recommendation: Train staff on appropriate boundaries between staff and youth,
including warning signs and red flags that such contact is inappropriate. CCLP has
developed trainings for several agencies on this topic and would be happy to share
training materials and provide such training in partnership with LMYDS.

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