As Illinois’ child welfare agency works to clear out its remaining patients at a Chicago psychiatric hospital beset by allegations of sexual abuse and assault, problems continue to emerge.

The Illinois Department of Children and Family Services on Monday opened an investigation into a 9-year-old girl’s allegation that a staff member at Aurora Chicago Lakeshore Hospital choked and restrained her.

The girl did not have any bruises or marks, DCFS officials said, and the employee is not currently working on the unit. The report brings the number of DCFS investigations into allegations of abuse or neglect at the hospital to 19 since January.

The girl, who reportedly was provoking other children on the unit before the incident, has been hospitalized at Lakeshore for nearly two months. She was cleared for discharge two weeks ago but remains at the hospital because DCFS has not found her a place to go once she is released. A ProPublica Illinois investigation this year documented what happens to the hundreds of children in state care who spend weeks and months waiting for DCFS to find them a more appropriate placement.

DCFS staff have been stationed at Lakeshore for round-the-clock observation of children in the department’s care since Saturday. The agency plans to continue the monitoring at least until the last of its charges there move out, DCFS lawyers told a federal judge at a hearing on Tuesday. It marked the second time in less than a week that DCFS appeared in front of U.S. District Judge Jorge Alonso to explain what the department is doing to protect the children in its care at the hospital.

DCFS attorneys said the employees doing the monitoring are experienced professionals but acknowledged the strain of continually overseeing the hospital.

“The volatile behavior of children in psychiatric hospitals is always a challenge,” said Neil Skene, special assistant to DCFS Acting Director Beverly “B.J.” Walker. “Adding more staffing to watch each unit 24 hours a day puts more eyes on the situation and adds a layer of safety for our youth at the hospital.”

The American Civil Liberties Union of Illinois, which monitors DCFS as part of a consent decree, had demanded that the agency put in place several safeguards after a ProPublica Illinois investigation first revealed the troubles at Lakeshore. The two groups have been locked in contentious negotiations as they continue to hammer out details of an independent review at the hospital, among other proposals. (The Chicago Tribune also has reported on the issues at Lakeshore.)

At Tuesday’s hearing, the ACLU blasted the agency for providing little or no information on matters the group said were key to the children’s safety. ACLU lawyers argued that the DCFS employees doing the monitoring should have training, clinical experience and knowledge of psychiatric hospitalizations.

“To act as if someone can walk off the street, even with a child welfare background, and understand what to watch for, I think is really misguided,” ACLU general counsel Heidi Dalenberg said. “Would someone know that one of the things to watch for is don’t let two kids sit together under the same blanket?”

Dalenberg was referring to an allegation this month in which two patients, a 14-year-old male and a 16-year-old transgender female, fondled each other under a blanket in a hospital day room while a staff member was present.

The ACLU lawyers also wanted broader access and authority for the court-appointed expert and the University of Illinois at Chicago psychiatrists who will work with DCFS on transferring the remaining dozen or so patients out of the hospital.

Lakeshore CEO David Fletcher-Janzen said the health and safety of the patients is the hospital’s top priority. Children who are in the custody of DCFS often face the most difficult challenges, he said.

“No other hospital provides the level of care that we do,” Fletcher-Janzen said in an email. “That is why so many children who are wards of the state come to our hospital — we provide the absolute best care available. We need to be increasing access for this population and Chicago Lakeshore has always made them a priority.”

DCFS relies heavily on Lakeshore to treat children with severe mental health issues. Last year, 41 percent of the roughly 1,100 children and adolescent patients treated at Lakeshore were in DCFS care, court filings show.

Cook County Acting Public Guardian Charles Golbert said his office represents the majority of the roughly 1,200 children in DCFS care who require hospitalization each year. As of Monday, 10 children at Lakeshore were clients of the public guardian’s office, which filed a flurry of emergency motions in juvenile court asking DCFS to provide detailed and updated reports on each of those children.

“What’s happening there is utter chaos,” Golbert said. “And DCFS has known that for more than a month.”

Both DCFS and the ACLU recommended that Dr. Michael Naylor, director of the behavioral health and welfare program at UIC, weigh in on where children leaving Lakeshore should be placed, although the groups disagreed on the extent of his role.

Children in DCFS’ care have a history of trauma that can worsen with time in an institution, Naylor said. In assessing the care of those children, he said, it’s important to consider whether there are larger, systemic issues at play. When a child languishes in a psychiatric hospital for longer than is deemed medically necessary, their behavior often deteriorates.

Five of the 12 DCFS patients that remained at Lakeshore as of Tuesday morning had been cleared for release and were waiting on the agency to find them placements.

“At some point, a kid begins to think there’s no hope,” Naylor said. “They think, ‘I’m not going to get out of here.’”

Sometimes, even when DCFS finds new placements for children and teenagers at Lakeshore, the transition poses complications.

A 17-year-old who was discharged from Lakeshore on Monday ran away before DCFS could transfer him to a facility some 300 miles away near the Missouri border, according to agency officials.

The teen was walking down an alleyway toward the car DCFS was going to use to drive him to his new placement when he suddenly dropped his bag and bolted. The caseworker ran into the hospital and called the police, hospital officials said. A source with knowledge of the incident said the teen was upset about being sent to a residential treatment facility far from home.

As of Tuesday afternoon, he still was missing.

DCFS asked a judge in Champaign County, where the teen is from, to issue a warrant to find him but instructed that he not be held in detention if located.

“We don’t lock young people in and we don’t shackle them when we take them somewhere, so runaways do happen,” Skene said. “He just spent time in a psychiatric hospital, and he seized a moment to run. Our focus right now is on finding him.”