These are two of 15 extended-stay facilities in Florida's Statewide Inpatient Psychiatric Program (SIPP) for high-risk kids. They're last resorts for kids referred through DCF's Substance Abuse and Mental Health Program. Judges can order juveniles here, or parents can voluntarily admit them.
According to the latest available tax filings, Citrus receives $25 million a year in contributions and grants. Five of the network's top doctors have salaries north of $200,000. The network's CEO, Mario Jardon, makes more than $400,000.
Citrus is overseen by a 12-person governing board, which until summer 2013 was chaired by Jorge Forte, a consultant who advised entities how to land government contracts. Forte was arrested in August when the FBI alleged that in April 2012, he agreed to accept $20,000 in kickbacks along with his business partner, the mayor of Sweetwater. In November, Forte pleaded guilty to a federal conspiracy charge and was sentenced to one year in prison.
Funding flows to CATS from Medicaid through Florida's Agency for Health Care Administration (AHCA). For the 2012-13 financial year, CATS billed $5.7 million for services. Paperwork provided by one former resident shows that Medicaid was billed $406 per day for the care.
Patients inside earn points for good behavior. According to a "Behavioral Management Program Guide" that is passed out to families, there are five stages — introductory, A, B, C, and D. Points are awarded for maintaining good hygiene, doing chores, going to school classes held on campus, and participating in therapy. With each level come more privileges such as extended time on the phone, later bedtimes, and weekend visits home. Any "maladaptive behavior"earns "a point freeze," the program guide says.
"Corporal punishment and fear-eliciting procedures are strictly prohibited," the guide says. Florida administrative code, however, specifies that facilities can use timeouts in five-minute increments or longer periods of seclusion as disciplinary methods.
The law also allows use of extreme tactics — physical restraints, chemical restraints (medication), and seclusion — when patients are deemed an imminent threat to themselves or others. These three methods are deemed Emergency Treatment Orders (ETOs). They must be ordered by a doctor, and only after other, less-invasive tactics are tried first. The law specifies that restraints and seclusions should last a maximum of two hours. The child must be monitored and guardians notified within 24 hours. Afterward, staff and child must meet for debriefings. The whole process is required to be extensively documented in the child's file. The program guide at CATS explains, "Restraint or seclusion use is limited to emergencies."
"The expected length of stay is four months," the document adds.
Howell first put her son in the Hialeah program in April 2011. Octavious responded well. That December, he came home but soon reverted to his old problems.
After a group home in Boca Raton didn't pan out, an exasperated Howell turned back to Citrus. Octavious, now 14, had aged out of the Hialeah program. CATS seemed like his last option.
"What do I do as a mother?" she wondered. "Allow him to stay home? Or do I put him in a program to try and get him some help so that when he comes back out, he'll be a good man?"
The debate was still roaring in her head as she sat in the Pembroke Pines waiting room.
Samantha Wright wasn't inside CATS 24 hours before she was brawling. The runaway, a husky girl with caramel-colored skin, says she had entered the program with a positive attitude. But after that first day, she dumped any ideas about getting better.
In 2010, Wright was a 15-year-old pummeled by depression who smoked weed and ran the streets. With no parents in her life, she bounced between her grandma's and auntie's houses. Wright was scooped up by police and Baker Acted after running away. A judge shipped her off to the program.
But Wright began having second thoughts when she arrived at the peach-colored single-story building that sat amid a drab checkerboard of industrial buildings bisected by tidy plots of crabgrass.
Wright says that on the first day, she sat silent in the activity room with about 20 other girls. "Oh, this ho thinks she can't talk to nobody," another girl said to a friend before flicking a sour look at Wright. "Yeah, I'm talking to you." Wright claims no staff intervened. And with that, Citrus Health Network's newest resident was on her feet, fists swinging wildly. Staff hauled the frantic girl into a white-walled room.
Wright says she was thrown face-down onto a bed. Her twisting right arm was tied to the bedpost. Then her left. Her right leg. The left.
"I'm going to give you a shot," a nurse told the prone girl. "It's called booty juice."