CONCORD, N.H. (AP) - New Hampshire’s only residential treatment center for teens struggling with addiction operated with an apparent lack of oversight before it was shutdown earlier this month, the director of a state watchdog office said Tuesday.
Moira O’Neill, director of the Office of the Child Advocate, said the center operated by Granite Pathways was unusual in that it was licensed by the Department of Health and Human Services but was not certified by the division that oversees child welfare. While that’s not a requirement because the Division for Children, Youth and Families didn’t directly place children at the facility, without that certification, it is unclear who had oversight over quality and safety, O’Neill said.
“We have issues with the extent of oversight DCYF provides to certified agencies, but at a bare minimum, they know who’s there, they re-certify them every two years, they provide technical assistance. There’s some expectation that someone has an idea of what’s going on in the program,” she said in an interview.
Republican Gov. Chris Sununu and the health department announced on Nov. 27 the state was canceling its contract with Granite Pathways, which had been operating the 36-bed facility in Manchester for just over a year. A summary report released by the department Monday said that in a span of less than two weeks, four of the 10 residents were taken to hospitals after taking drugs one of them smuggled in, a fifth took multiple doses of prescription medication in an apparent suicide attempt and a sixth drank a bottle of hand sanitizer. The remaining residents have since been transferred, and the contract officially ends Dec. 27.
Some of the residents at the center were known to the child welfare agency, said O’Neill, who has been reviewing their records.
“In our preliminary review, we found that there were children who were placed there who have really complicated needs, and we don’t know if that program had the capacity to serve those needs,” she said.
O’Neill said she sent the Department of Health and Human Services a list of questions in late November about what the facility knew about the children, its capacity to meet their needs and how the program was supervised. As of Tuesday, she had not received answers.
“If we are going to understand the circumstances that prompted seven ambulance transports, we must understand how those children came to be at the facility and what transpired in assessing and treating them,” she said.
Jake Leon, spokesman for the Department of Health and Human Services, said the department agrees with O’Neill that it is important to ensure that children get the services they need. He said the department has addressed and continues to address similar questions, but responses must remain confidential to protect clients’ privacy.
“DHHS monitored Granite Pathways’ compliance with its contractual obligations and is still compiling information regarding the organization’s noncompliance. There is also an ongoing investigation by DCYF that must be kept confidential,” he said in an email.
Patrica Reed, state director at Granite Pathways, said the nonprofit’s leaders and board of directors were still reviewing the health department’s report.
“The end of this contract does not end Granite Pathways’ commitment to its mission of supporting individuals with substance use disorders and mental illness in achieving their life goals as valued members of their communities,” she said in a statement.
But the trouble at the youth treatment center has raised questions about the state’s approach to funding substance abuse treatment in general and Granite Pathways in particular. Since 2016, it has been a subsidiary of The Fedcap Group, a New York-based nonprofit that focuses on helping people overcome barriers to economic well-being through workforce development, education, occupational health and economic development. With close to $300 million in annual revenue, the parent organization has government contracts in 22 states, and its acquisitions include Easterseals programs New York, Rhode Island and parts of Texas.
In New Hampshire, Granite Pathways was a year into a four-year, $15.6 million contract for the youth treatment center. According to the state expenditure register, the organization has been paid $4.1 million since 2012, including just under $900,000 in the current fiscal year. Under the hub-and-spoke system the state launched this year to connect people to opioid addiction resources, Granite Pathways was awarded $5 million in federal funding over multiple years to run the two largest hubs, in Manchester and Nashua.
Contracts are approved by the five-member Executive Council, and at least one member has expressed concern about Granite Pathways in the past. In June, when the council approved a $345,000 contract related to treatment for adolescents, Councilor Andru Volinsky noted that the organization already was running the opioid response hubs and called for “continued vigilance” to ensure it could keep up with all its responsibilities.
“We’ve had, in particular when trying to quickly build out our substance abuse response, a number of instances where the financial management of private nonprofits was not strong. We haven’t really had strong capacity to oversee that at DHHS,” he said in a recent interview. “My concern at the time of this Granite Pathways contract was that we were again placing what I think are state responsibilities onto a private contractor, and we still haven’t built an infrastructure to oversee those private contractors.”
Volinsky, a Democrat, said he doesn’t know whether the state should build out its own capacity to respond to the substance abuse crisis, or whether it’s enough to rely on outside groups and closely monitor them.
“I could legitimately understand the arguments either way,” he said. “But to almost blithely continue to invest in outside agencies without oversight doesn’t make sense.”
In announcing the closing of the youth treatment center, officials said the state is taking 30 days to review all of its contracts with Granite Pathways and may take further action. The health department also has increased its oversight of substance use disorder treatment centers in the last year after one of the largest facilities closed. Those efforts have included financial audits and the appointment of a new director at the Office of Program Integrity.
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