Fy 2010-11 report for milton girls juvenile residential facility

BUREAU OF QUALITY ASSURANCE
PROGRAM REPORT FOR
Milton Girls Juvenile Residential Facility
Gulf Coast Youth Services
(Contract Provider)
5570 E. Milton Road
Milton, FL 32583
Review Date(s): November 16-18, 2010
PROMOTING CONTINUOUS IMPROVEMENT AND ACCOUNTABILITY IN JUVENILE JUSTICE PROGRAMS AND SERVICES Florida Department of Juvenile Justice
Residential Quality Assurance Report
Office of Program Accountability
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Residential Performance Rating Profile
Program Name: Milton Girls Juvenile Residential Facility QA Program Code: 1022 Provider Name: Gulf Coast Youth Services Contract Number: R2045 County/Circuit #: Santa Rosa / Circuit 1 Number of Beds: 60 Review Date(s): November 16-18, 2010 Lead Reviewer Code: 110 Program Performance by Indicator/Standard
1. Management Accountability
4. Health Services
1.01 Background Screening of Employees/Vol.
01 Designated Health Authority 1.02 Provision of an Abuse Free Environment 02leHealthcare Admission Screening 1.03 Incident Reporting 03leComprehensive Physical Assessment 1.04 Protective Action Response (PAR) 04 Sexually Transmitted Diseases 1.05 Pre-Service/Certification Requirements 1.06 In-Service Training Requirements 1.07 Logbook Maintenance 07leMedication Control 1.08 Internal Alert System 08leInfection Control 09 Chronic Illness Treatment 78 4.10 Episodic and Emergency Care 90 4.11 Consent and Notification 2. Intervention and Case Management
4.12 Prenatal/Neonatal Care 2.01 Classification 2.03 Intervention and Treatment Team 5. Safety and Security
2.04 Performance Plan 01leSupervision of Youth 2.05 Performance Review and Reporting 2.06 Parent/Guardian Communication 03 Contraband and Searches 2.07 Transition Planning and Release 04 Transportation 2.08 Grievance Process 05 Tool Management 2.09 Gang Prevention and Intervention 06 Disaster/Continuity of Operations Planning 79 5.07 Flammable, Poisonous, and Toxic Items 90 5.08 Water Safety 3. Mental Health and Substance Abuse Services
5.09 Behavior Management System 3.01 Designated Mental Health Authority 10 Behavior Management Unit 3.02 MH and SA Admission Screening 3.03 MH and SA Assessment/Evaluation 3.04 Treatment Plan/Team and Service Delivery 3.05 Suicide Prevention 3.06 Mental Health Crisis Intervention 3.07 Emergency Services 3.08 Specialized Treatment Services Program Max.
Failed Minimal Acceptable Commendable Exceptional
1. Management Accountability 2. Intervention and Case Management 3. Mental Health and Substance Abuse Services 4. Health Services 5. Safety and Security Overall Program Performance
COMMENDABLE
Florida Department of Juvenile Justice
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Office of Program Accountability
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Methodology
This review was conducted in accordance with Florida Administrative Code 63L-2 (Quality Assurance, 6/10/10 Hearing Draft), and focused on the areas of (1) Management Accountability, (2) Intervention and Case Management, (3) Mental Health and Substance Abuse Services, (4) Health Services, and (5) Safety and Security, which are included in the Residential Standards (July 2010).
Persons Interviewed
Program Director 2 # Case Managers
0 # Maintenance Personnel
2 # Clinical Staff
0 # Program Supervisors
DHA or designee 1 # Food Service Personnel
0 # Other (listed by title):
DMHA or designee 2 # Healthcare Staff
Documents Reviewed
Accreditation Reports Fire Prevention Plan Vehicle Inspection Reports Affidavit of Good Moral Character Grievance Process/Records Visitation Logs Key Control Log Confinement Reports 7 # Health Records
Continuity of Operation Plan Medical and Mental Health Alerts 7 # MH/SA Records
Contract Monitoring Reports 3 # Personnel Records
Contract Scope of Services Precautionary Observation Logs 7 # Training Records/CORE
Program Schedules 3 # Youth Records (Closed)
Escape Notification/Logs 7 # Youth Records (Open)
Exposure Control Plan Supplemental Contracts Table of Organization Fire Inspection Report 7 # Direct Care Staff
0 # Other:
Observations During Review
Posting of Abuse Hotline Staff Supervision of Youth Program Activities Tool Inventory and Storage Facility and Grounds Toxic Item Inventory and Storage First Aid Kit(s) Transition/Exit Conferences Security Video Tapes Treatment Team Meetings Use of Mechanical Restraints Social Skill Modeling by Staff Youth Movement and Counts Medication Administration Staff Interactions with Youth Comments
Items not marked were either not applicable or not available for review. The facility did not have a sick call or treatment team meetings occur while the team was on-site and therefore, sick call and treatment team meetings were not observed. Florida Department of Juvenile Justice
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Office of Program Accountability
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Performance Ratings
Performance ratings were assigned to each indicator by the review team using the following definitions and numerical values defined by F.A.C. 63L-2.002(10)(a) (6/10/10 Hearing Draft): The program consistently meets all requirements, and a majority Exceptional (10)
of the time exceeds most of the requirements, using either an innovative approach or exceptional performance that is efficient, effective, and readily apparent. The program consistently meets all requirements without exception, or the program has not performed the activity being Commendable (8)
rated during the review period and exceeds procedural requirements and demonstrates the capacity to fulfill those requirements. The program consistently meets requirements, although a limited number of exceptions occur that are unrelated to the safety, Acceptable (7)
security, or health of youth, or the program has not performed the activity being rated during the review period and meets all procedural requirements and demonstrates the capacity to fulfill those requirements. The program does not meet requirements, including at least one of the following: an exception that jeopardizes the safety, security, Minimal (5)
or health of youth; frequent exceptions unrelated to the safety, security, or health of youth; or ineffective completion of the items, documents, or actions necessary to meet requirements. The items, documentation, or actions necessary to accomplish Failed (0)
requirements are missing or are done so poorly that they do not constitute compliance with requirements, or there are frequent exceptions that jeopardize the safety, security, or health of youth. Review Team
The Bureau of Quality Assurance wishes to thank the following review team members for their participation in this review, and for promoting continuous improvement and accountability in juvenile justice programs and services in Florida: Daniel May, Lead Reviewer, DJJ, Bureau of Quality Assurance William Hardy, Review Specialist, DJJ, Bureau of Quality Assurance Bruce Morton, Review Specialist, DJJ, Bureau of Quality Assurance Linda Williams, Program Monitor, DJJ, Office of Residential Services—Northwest Region Karen Cox, LMHC, Clinical Services Supervisor, Camp E-Ma-Chamee Antigone Anderson, Case Manager, AMIKids—Tallahassee Florida Department of Juvenile Justice
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Office of Program Accountability
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Please note that this report refers to each indicator by number and title only. Please see the applicable
standards for the full text of each indicator. The standards are available on the Bureau of Quality Assurance
website, a

Standard 1: Management Accountability
Overview
Milton Girls Residential Juvenile Facility is a sixty (60) bed, hardware secure program for female delinquent youth between the ages of fourteen (14) and eighteen (18). In order to be admitted into the program, the youth must display moderate to severe functional impairment as a result of mental health diagnosis. As such, the facility is designated as an intensive mental health program. A licensed mental health professional serves as the program director, and this individual has fulfil ed this role since the program's inception. An assistant program director also provides administrative support, and this individual's focus is primarily related to care, custody, and operational issues within the program. The center is operated by Gulf Coast Youth Services, a subsidiary of Psychiatric Solutions, Inc. The provider has a management team that offers additional support and oversight to the program. The program director participates on daily conference calls with other members of the provider's Management Team. Additionally, the Quality Assurance director compiles monthly trend analyses for the program, relating to incidents, use of force, escapes, abuse calls, etc. The provider also has a corporate Training Coordinator who is responsible for all staff and management training. 1.01: Background Screening of Employees/Volunteers
Exceptional (10) In addition to completing the required background checks, the provider agency has instituted a more comprehensive background screening process. Using E-quest, the provider is able to screen the following: county criminal search, fraud and abuse control information system, office of inspector general, driving record, name history, employment verification, sex offender registry database, and criminal wants and warrants. 1.02: Provision of an Abuse Free Environment
The program met all requirements for this indicator without exception. Florida Department of Juvenile Justice
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Office of Program Accountability
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1.03: Incident Reporting
The program met all requirements for this indicator without exception. 1.04: Protective Action Response (PAR)
Exceptional (10) The program has made a commitment to reducing the use of physical interventions. In the last year, the program's PAR incidents have been reduced by sixty-nine percent (69%). In addition to required administrative reviews of PAR incidents, the program has instituted a practice for the Program Director to also conduct a video review of incidents. Further, each youth is evaluated by a healthcare professional regardless of the need for a post-PAR medical review. 1.05: Pre-Service/Certification Requirements
The program consistently met all requirements for this indicator without exception. 1.06: In-Service Training Requirements
The program consistently met all requirements for this indicator without exception. 1.07: Logbook Maintenance
The program consistently met all requirements for this indicator without exception. 1.08: Internal Alert System
The program consistently met all requirements for this indicator without exception. 1.09: Escapes
Exceptional (10) The program has an agreement with the adjacent Santa Rosa Correctional Institute to participate in escape drills as well as in actual escape events. There are "escape kits" located in the master control area for disbursement to staff in the event of an escape. These kits contain items such as flex cuffs, binoculars, flagging material, compass, flashlight, etc. In the event of an escape, staff are also provided with an emergency response book that contains emergency contact numbers, copies of youth shoe prints, maps of the area, and "recapture do's and don't's". There has been no escape from the facility since its inception. Florida Department of Juvenile Justice
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Office of Program Accountability
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Standard 2: Intervention and Case Management
Overview
The case management process at Milton Girls is overseen by two (2) case managers. Each of these individuals maintain a caseload of approximately thirty (30) youth. The case managers are actively involved with youth, both through formal and informal meetings, on a daily basis. Since the last Quality Assurance review, the program has fully implemented the Residential Positive Achievement Change Tool (RPACT), RPACT Needs Assessment and performance planning processes. The Milton Girl's case management program is implemented through a multi-disciplinary treatment team which assesses each youth, identifies her needs, develops treatment goals, assesses the youth's progress on an ongoing basis, and assists in planning for the youth's transition back into the community. In addition to these processes, the program makes significant efforts to ensure that the youth have a voice in the program. There is a monthly community advisory board, composed of youth that meet to discuss issues, concerns, and recommend suggestions for program improvement. In addition to the advisory board, all youth participate in a monthly "Town Hall" meeting to address programming and concerns. There is also a disciplinary referral court that meets twice monthly to address behavioral issues of youth, and this "court" also allows youth an opportunity to express concerns with programming. 2.01: Classification
The program consistently met all requirements for this indicator without exception. 2.02: Assessment
The program consistently met all requirements for this indicator without exception. 2.03: Intervention and Treatment Team
Exceptional (10) The facility's case managers are designated as the treatment team leader. In the files reviewed, however, there was also clear evidence that both the psychiatrist and the DMHA play active roles in the treatment team process. For each meeting, the psychiatrist created a detailed entry in the progress notes section of the youth's medical/mental health file. Florida Department of Juvenile Justice
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2.04: Performance Plan
The program consistently met all requirements for this indicator without exception. 2.05: Performance Review and Reporting
The program consistently met all requirements for this indicator without exception. 2.06: Parent/Guardian Communication
Exceptional (10) Parents are sent a "Parent Goal Proposal" form upon the youth's arrival to make suggestions for areas of focus in the youth's performance planning process. A second parent survey is also completed by mental health staff during the assessment process. There was evidence of quarterly "Family Day" events at the program. These days include family activities, as well as counseling opportunities. Sign-in sheets provided by the program illustrated that these sessions are well attended. In May 2010, for example, there were twenty (20) visiting participants in a family relationships group. The program conducts an annual high school graduation for youth currently in the program, as well as those who were released and completed the graduation process. 2.07: Transition Planning and Release
Three (3) closed files were reviewed, and one contained a pre-release notification (PRN) that was sent less than forty-five (45) days from the date of release. 2.08: Grievance Process
Exceptional (10) In the past six (6) months, there were zero grievance's by the youth in the program. The grievance process is minimal due to the efforts taken by the program. The Program Director has put into place a system in which the youth can go directly to a supervisor, counselor or to the Program Director for a one-on-one discussion of any issue they wish to discuss. This has alleviated many of the grievances, due to the fact that the issue is resolved or explained before it becomes a grievance. Other issues that might become grievances, are addressed in the community meeting and/or through the disciplinary referral process. By utilizing these systems, the facility is able to be proactive in responding to situations and providing youth with input into programming. Interviews with youth supported that the facilities practices regarding grievances are well understood and highly effective. 2.09: Gang Prevention and Intervention
Exceptional (10) There was evidence of local law enforcement providing gang awareness training to youth and staff on a regular basis. The most recent training occurred on November 4, 2010. Florida Department of Juvenile Justice
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The provider has two (2) individuals who serve on the Okaloosa-Walton Gang Prevention/Intervention Committee as a part of the Florida Gang Reduction Task Force. This committee meets monthly. The facility maintained a notebook that included Santa Rosa County Sheriff's Office Offense Reports that identified youth who were known gang members or associates. It was apparent that the facility initiated these inquiries, as law enforcement notes indicated being called out to the program to address identification of potential gang members.
Standard 3: Mental Health and Substance Abuse Services
Overview
Milton Girls Juvenile Residential Facility is designated as an Intensive Mental Health treatment services provider. The Program Director is a Licensed Clinical Social Worker (LCSW) and also functions as the program's Designated Mental Health Authority (DHMA). In addition to these duties, this individual also manages a caseload of youth. In addition to the LCSW, the program has three (3) Master's Level Therapists, and a doctorate-level staff who provide therapeutic services for youth. The facility offers group services seven (7) days per week. Each youth receives a new comprehensive mental health and substance abuse evaluation at admission, and each youth participates in the development of an individualized treatment plan. Based on the files reviewed, however, the scope of these plans is limited and does not encompass all treatment services that are provided to each youth. It was evident that treatment services are the foundation of all programming at the facility. The services are comprehensive, and intervention is provided frequently to each youth, and yet the program is doing itself an injustice by not documenting a number of these approaches. Emergency and suicide prevention services are available. Due to the openness and approachability of staff, most potential crises are resolved without a formal intervention being necessary. Treatment teams meet often to monitor treatment and functional status of each youth. The facility's psychiatrist is an active participant in the treatment team process.
3.01: Designated Mental Health Authority (DJJ Program)
Exceptional (10) The program has a process in place for youth to complete a special request form so that they may meet with the Program Director/DMHA. This practice allows youth to have unimpeded access to the DHMA at any time. The DMHA carries a caseload of youth, and, thus she is highly knowledgeable of the youth and their current issues. There was evidence that the DMHA authority also provides clinical supervision to case management staff to ensure that they are aware of potential issues with youth. Florida Department of Juvenile Justice
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Office of Program Accountability
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3.02: Mental Health and Substance Abuse Admission Screening
The program consistently met all requirements for this indicator without exception. 3.03: Mental Health and Substance Abuse Assessment/Evaluation
The program consistently met all requirements for this indicator without exception. 3.04: Treatment Plan, Treatment Team, and Service Delivery
Treatment objectives were not individualized based on the outcomes of the assessments. Though youth had similar diagnoses, such as conduct disorder versus disruptive behavior disorder, the treatment objectives were the same. None of the seven files reviewed contained treatment plan revisions or addenda. The program has a specific form for amendments, but it was blank in all cases. 3.05: Suicide Prevention
The program consistently met all requirements for this indicator without exception. 3.06: Mental Health Crisis Intervention
The program consistently met all requirements for this indicator without exception. 3.07: Emergency Services
The program consistently met all requirements for this indicator without exception. 3.08: Specialized Treatment Services
The program met all requirements for this indicator without exception. Standard 4: Health Services
Overview
Milton Girls Juvenile Residential Facility has three (3) nursing staff to provide healthcare services to the youth in the facility's care. There are two (2) full-time Licensed Practical Nurses (LPNs) and one (1) part-time Registered Nurse (RN). Further oversight is provided by the agency's Director of Nurses, who is also an RN. Nursing coverage is provided seven (7) days Florida Department of Juvenile Justice
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per week, and, based on schedules; there is at least one nurse on-site from 7 AM until 7 PM each day. The Designated Health Authority (DHA) is a Florida-licensed Medical Doctor (MD). This individual is on-site once a week, and there was evidence in the files of the doctor providing required services, such as: completing health assessments and periodic evaluations, reviewing off-site care orders, monitoring medications prescribed for health concerns, and referring youth for testing (as necessary). Of the seven (7) files reviewed, each had a completed Facility Entry Physical Health Screening (FEPHS), Health Related History (HRH), and Comprehensive Physical Assessment (CPA). All reviewed youth met at least one of the criteria for a chronic condition, and, as such, each youth was receiving periodic evaluations as required. Youth were also clinically screened for Sexually Transmitted Diseases (STDs) and when indicated a referral was provided for further evaluation. Youth were referred either to the Okaloosa AIDS Support and Information Services (OASIS) for Human Immunodeficiency Virus (HIV) counseling and/or testing, or to the obstetrician/gynecologist for other STD testing. There was evidence that youth are tested and, when necessary, treated for STDs, however, there were some issues with the length of time from the referral until being evaluated by the physician. Youth are oriented to the health services available at admission, and there was evidence that nursing staff complete weekly health care education with the youth. Topics include disease prevention, infection control, female health issues, reproductive health, etc. In addition to education services, sick call is conducted daily at 2:30 PM. Due to the population served by the facility, there are a number of youth on psychotropic medication. The facility has a clearly written medication administration protocol, and all medications are provided by licensed healthcare professionals. In an effort to minimize risk, only a limited amount of over-the-counter (OTC) medication is stored at the facility. There were current, accurate inventories for OTC medications. Also, there was evidence of routine shift-to-shift inventories for controlled medications. Finally, the facility had accurate inventories for sharps. The Medication Administration Record (MAR) book maintained by the facility includes a variety of helpful information about medications, such as lists of medications that cannot be crushed, medications that interact with particular foods, protocols to prevent "cheeking", etc. When reviewing MARs, however, there were some discrepancies noted, and these are addressed in the indicator below. The facility also makes significant efforts to minimize potential infectious exposures. The Director of Nurses is a member of the Association of Professional in Infection Control, and she has developed an exposure control manual that identifies over twenty potential workplace exposures. This manual provides guidelines for reporting exposure and actions to take when a potential exposure is encountered. The Director of Nurses also compiles data on exposures and infectious illnesses, and this data is used for agency-wide trend analyses. Despite these efforts, however, there was no evidence that staff had received annual training on the facility's exposure control plan, as required. Florida Department of Juvenile Justice
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4.01: Designated Health Authority
The program consistently met all requirements for this indicator without exception. 4.02: Healthcare Admission Screening
The program consistently met all requirements for this indicator without exception. 4.03: Comprehensive Physical Assessment
One youth had a current comprehensive physical assessment upon arrival. This form, however, did not document if the genital exam was conducted or refused by the youth. The program did not update the physical to address this omission. 4.04: Sexually Transmitted Diseases
Despite the fact that all youth were screened for STDs, two (2) youth, identified in need of further evaluation, were not evaluated or tested until sixty (60) and ninety (90) days after the clinical screening occurred. 4.05: Sick Call
A total of twenty-five (25) sick call encounters were reviewed. Of these, twelve (12) related to complaints that reasonably required an assessment of vital signs. In four (4) instances, vital signs were not documented. 4.06: Medication Administration
One youth was prescribed Zovirax three times daily for five days. A review of the MAR found that only eleven (11) of the fifteen (15) doses had been administered. Another youth had her prescription for Abilify discontinued on August 16, 2010, but documentation showed that the medication was administered through August 18, 2010. One youth was prescribed two (2) antibiotics (Septra and Vibramycin). She refused these medications a total of twenty-five (25) times and none of the refusals were documented on the back of the MAR as required. 4.07: Medication Control
Exceptional (10) The facility has a pharmacist on-site monthly to review the medication storage and audit medications. This individual also collaborates with nurses to destroy controlled medications. There was documented evidence that the pharmacist conducts an in-depth review of the clinic area. The facility maintains controlled medications behind three locks (a locked box inside a locked medication cart inside a locked room of the clinic). Florida Department of Juvenile Justice
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4.08: Infection Control
Of the three (3) staff training files reviewed for annual training requirements, none had completed required training on the site-specific exposure control plan. 4.09: Chronic Illness Treatment
The program consistently met all requirements for this indicator without exception. 4.10: Episodic and Emergency Care
The program consistently met all requirements for this indicator without exception. 4.11: Consent and Notification
Exceptional (10) There was evidence that the facility sends parental notifications for all encounters with the medical doctor, psychiatrist, or outside providers. These notifications are sent even if there are no changes that require parental notification. There was evidence that all changes to psychotropic medications are sent via regular and certified mail. This practice includes initiation, change, and discontinuation from psychotropic medication. 4.12: Prenatal/Neonatal Care
The program consistently met all requirements for this indicator without exception. Standard 5: Safety and Security
Overview
The facility has a total of thirty-four (34) direct care staff, with an additional six (6) staff designated as supervisors. There is a supervisor and assistant supervisor for each shift. The program operates on three (3) eight-hour shifts. Observations conducted during the review showed that staff maintained appropriate order and control of youth. There were also enough staff on each shift to meet the contractually required staffing ratio. The Assistant Program Director is responsible for the oversight of safety and security provided at the program, such as tool management and flammable, poisonous and toxic items due to a vacancy in maintenance. The program has video surveillance to record the daily activities preformed by youth and staff at all times. Florida Department of Juvenile Justice
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Staff communication is accomplished by two-way radios, logbooks and shift reports maintained by direct care staff. The programs behavior management system is based on the company's strategic model, called Adolescent Behavioral/ Development Incentive Program. It is a multi-stage point system with privileges available to the youth at each succeeding level. The program does utilize room restriction and controlled observation, however, does not maintain a behavior management unit. 5.01: Supervision of Youth
Exceptional (10) The program provides at least a one (1) staff to seven (7) youth ratio at all times exceeding the staff to youth ratio of one (1) staff to ten (10) youth. All staff, not just direct care staff are PAR certified and assist with supervision and respond to disturbances. Monitoring of supervision is conducted daily by management using surveillance cameras and personal observations. Additional training is provided to all staff annually regarding appropriate supervision Awards or incentives are built into the Methods Oriented Safety Thinking (MOST) 5.02: Key Control
Review of key inventory and key accountability logs found discrepancies when keys were signed-in and out. Cross-reference of the master key inventory sheet and the key box found that the inventory sheet indicated sixteen (16) keys on the maintenance key ring, however that ring itself contained twenty (20).
5.03: Contraband and Searches
The program consistently met all requirements for this indicator without exception. 5.04: Transportation
The program consistently met all requirements for this indicator without exception. 5.05: Tool Management
Exceptional (10) All tools were labeled and identified by a number on a shadow-board either on the wall or in the locked tool tower in shadow-board style. This practice included cardboard cut-outs designed to store tools, and so it was readily apparent that a quick visual check could identify missing tools. Kitchen knives are secured on a steel security cable and are identified numerically, while all other items are numbered and locked in a separate cabinet. Further, each shift performs two (2) inventory counts daily. Florida Department of Juvenile Justice
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Documented inventory of all tools and kitchen items were found to be accurate and kept 5.06: Disaster and Continuity of Operations Planning
Exceptional (10) There is documentation of monthly Continuity of Operations Plan (COOP) drills on a variety of events listed in the COOP plan. The drills included analysis/critique, description and a checklist of timelines that outlines the course of action for the program. The program has access to a satellite phone to ensure that all of the provider's programs have a constant line of communication in the event of an emergency. Documentation of an agreement with a food service provider to provide a refrigerated trailer is in place to ensure that in the event of a major power outage or emergency, that the program has adequate food supplies. 5.07: Flammable, Poisonous, and Toxic Items
Exceptional (10) All items had the required Materials Safety Data Sheets (MSDS) in place, as well as a color photo of the corresponding items to ensure accuracy. 5.08: Water Safety
Non-Applicable (NA) The program's policy, procedure, and practice confirm that the requirements for this indicator were not applicable for this program. 5.09: Behavior Management System
A review of ten (10) Room Restriction Reports found that in three (3) instances the staff/youth conversation on re-integration back into general population was not documented. Two (2) of the ten (10) reports reviewed found documentation that the required thirty (30) minute conversations were not conducted timely. 5.10: Behavior Management Unit
Non-Applicable (NA) The program's policy, procedure, and practice confirm that the requirements for this indicator were not applicable for this program. 5.11: Controlled Observation
A review of nine (9) controlled observation reports found that one (1) documented a youth being held beyond the twenty-four (24) hour maximum. One (1) report documented a youth displaying calm behavior and following staff directives for a two (2) hour period, however, rather than being released, the youth was maintained in controlled observation for an additional hour. Florida Department of Juvenile Justice
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Overall Program Performance
COMMENDABLE
Exceptional
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Source: http://www.djj.state.fl.us/docs/quality-improvement---residential/miltongirlsjrf1011.pdf?sfvrsn=2