Update, Mar. 28, 2017: AdvoServ has a new leadership team and changed its name to Bellwether Behavioral Health earlier this year.
As she waited in a Delaware hospital for her daughter to die, Carla Thomas watched a silent video of the teenager’s last conscious hour.
The video showed Janaia Barnhart, 15, bouncing down the stairs of the group home where she lived, Thomas said. The girl from Hyattsville, Maryland, had mental illness and threw tantrums, but on that September morning her expression suggested the mischievous laugh her mom knew well.
Ahead of her carrying a black garbage bag was an employee of AdvoServ, the for-profit company that owned the home. The worker stepped toward the bedroom where the girl kept her most prized possessions — her MP3 player, movies, magic markers, karaoke machine. Seeing Janaia coming, the worker threw back an arm, shoving her hard against the hallway wall. Janaia, who was 5 feet, 6 inches tall and 227 pounds, shoved back. Both disappeared into the room, which was just big enough for a twin bed and dresser.
Four more workers rushed in behind them. Thirty-two minutes later, according to Thomas, paramedics arrived to find Janaia on the floor, naked, with no pulse.
Since then, Thomas has buried and mourned her daughter. But she has no idea what happened in those 32 minutes. “I still don’t have an inkling, nothing,” Thomas said in an exclusive interview with ProPublica.
Janaia’s death represents another setback for AdvoServ, part of a growing, government-funded industry that provides housing and care nationwide for hundreds of thousands of people with developmental or intellectual disabilities. Both Maryland and Delaware had already sanctioned the company, which is besieged with complaints about its treatment of a vulnerable population and the conditions of its homes.
Thomas’ questions about her daughter’s death have only multiplied since AdvoServ State Director Darren Blough played the video for her on a laptop. The footage didn’t show the inside of Janaia’s bedroom. And during four crucial minutes, a worker opened a closet door and blocked the view of the room’s entranceway.
Staff at AdvoServ gave Thomas conflicting stories, acknowledging workers pinned Janaia down in her bedroom but never explaining why she lost consciousness. Doctors at the hospital told Thomas they did not know why the otherwise physically healthy teenager’s heart had stopped.
Thomas and her lawyer, Julia Arfaa, say that Delaware officials have stymied their efforts to secure basic information. The state attorney general’s office told Arfaa that, while a police investigation was ongoing, it would not allow release of a recording of workers’ call to 911. “Releasing the 911 tape at this time could potentially jeopardize the investigation, because the call contains potentially sensitive information,” said Carl Kanefsky, spokesman for the attorney general’s office. The office will decide whether to file criminal charges after law enforcement agencies have finished their investigations, he said.
A Delaware medical examiner refused Arfaa’s request for initial autopsy findings. Last week, a spokeswoman for the medical examiner said it has not completed the autopsy and will notify Janaia’s family when it does. Delaware state police won’t elaborate on the circumstances of the girl’s death or even release her name.
“We’re blocked,” Arfaa said.
Through a spokesman, AdvoServ declined to discuss what happened to Janaia. The company, which specializes in clients with behavior challenges, said in a statement at the time of her death that its employees were “heartbroken” over her loss.
One worker who was in the home that day, Tosha Skinner, told ProPublica in a brief interview that Janaia was subjected to a “wrap-up behavior” intervention shortly before she stopped breathing. Skinner was present but didn’t participate, she said. It’s not clear what Skinner meant by “wrap-up behavior.” For years, AdvoServ has used “wrap mats,” which resemble full-body straitjackets, on some of its clients. Critics say such mechanical restraints traumatize patients, and most residential programs no longer use them. Delaware bans such tactics in most cases, and Maryland officials have instructed AdvoServ for years not to mechanically restrain children or teens.
An AdvoServ spokesman said last week that no “wrap up” procedure involving mechanical restraints was used on Janaia that day. There were no wrap mats in the house, he said.
For Thomas, the timing of her daughter’s death magnified the pain. The day after the incident, a Maryland official called to say the state had found Janaia a new home — something Thomas had been pushing for. Maryland began removing its 31 students from AdvoServ homes after an unannounced inspection in August found holes in walls, ripped mattresses, dirty kitchens, and broken furniture. One bedroom reeked of urine. A bathroom lacked hot water. Maryland’s contract with the company ended Monday.
Janaia’s death adds to the tragic toll of the privately run residential programs, tucked away in neighborhoods across the country, that have largely replaced state institutions for the profoundly disabled and mentally ill. A ProPublica review last December found that at least 145 kids have died from avoidable causes in residential facilities over 35 years.
At least 62 died after being restrained. In the last five years or so, however, as most group home providers adopted less hands-on methods for handling conflicts, restraint-related deaths became exceedingly rare — with news articles reporting only one or none a year.
Owned by a private equity firm, Delaware-based AdvoServ reported last year that it cared for about 700 children and adults in that state, Florida, and New Jersey, and was expanding into Virginia. It had about 60 people age 21 or younger in Delaware programs. Delaware put AdvoServ on probation in March, and increased visits by state workers to company facilities. A lawsuit pending against AdvoServ in state court in Delaware alleges a teenage boy from Maryland was left unsupervised and raped repeatedly by other clients during more than four years in the company’s homes. Workers dislocated a vertebra in the boy’s neck while restraining him, according to his family.
AdvoServ has grown in the past two decades despite a stream of complaints of abuse and neglect. As far back as the 1990s, the state of New York removed its children from AdvoServ’s predecessor, Au Clair, because its inspectors had found children living in trailers that smelled of urine and feces. Officials elsewhere have repeatedly backed off from disciplining the company, which is aided by well-connected lobbyists that include prominent former state legislators. The company in recent years successfully lobbied against a Congressional bill that would have limited the use of restraints in schools.
Janaia was not the first teenager to die under AdvoServ’s care. In 1997, a 14-year-old autistic boy with epilepsy was found dead in his bed at the company’s Florida facility with low levels of anti-seizure medicine in his blood. In 2013, a 14-year-old autistic girl died at the same Florida complex after a night in which she was restrained — at times fastened to a bed and chair—while she vomited repeatedly. In that case, video of the girl’s final hours was accidentally deleted, AdvoServ officials said.
Thomas, a certified medical assistant for the elderly who lives in a Maryland suburb, has learned more about the company’s problematic track record since her daughter’s death.
“If I knew it was that bad, I would have signed her out,” Thomas said.
Born in Washington, D.C., Janaia was diagnosed in first grade as bipolar and schizophrenic, with attention deficit disorder. She was hospitalized more than 20 times when she became a danger to herself or others, and lived in residential treatment centers in Maine, Tennessee and Maryland. At one facility about five years ago, Thomas said, a worker put Janaia in a chokehold and dragged her across the floor. Janaia sometimes attended schools, but they struggled to deal with her disorders.
For all her troubles, Janaia had playful moods when she teased others and played pranks. She earned A’s in classes, when she tried. She loved Michael Jackson, animals, dancing and flowers. She was affectionate — a “hugger” — and needed to be reminded sometimes not to invade people’s personal space. She had no serious medical problems, having outgrown childhood symptoms of asthma. Her family called her “Nae Nae.”
“She had her moments,” her mother said, “but she was very lovable.”
In recent years, too, Thomas was pleased that her daughter was learning to recognize that her temper was about to flare. Janaia would let her mother know that she needed help. “It’s like a teakettle when you boil it,” Thomas said. “She knew when she was ready to explode.” Janaia’s mother, stepfather, brother and two sisters had started taking her out more, even bringing her with them on a skiing vacation last winter.
Though AdvoServ bills itself as a last resort, Thomas said it was a less restrictive setting than earlier placements. She said the state sent Janaia there three years ago largely because AdvoServ offered schooling.
At AdvoServ, Janaia lived with other girls in a modest ranch home with white siding and maroon shutters on a quiet country road southwest of Wilmington, just a half-mile from the historic mansion where AdvoServ’s founder first opened a boarding school for autistic children in 1969.
On a typical day, the home and its basketball court out back bustled with activity, as workers came and went and buses ferried the girls in the white house and an adjacent brick one to school. Sometimes, girls burst out of the homes and ran into the neighborhood, according to a local resident. Workers would chase them and often restrain them. Onlookers watched with unease, hoping no one would get hurt. “When I see that going on, I do try to keep my eyes on them,” one said.
Thomas visited her daughter once a month, bringing electronics, music, supplies for arts and crafts, and foods, such as canned ravioli and instant oatmeal, that her daughter preferred over what AdvoServ provided. Sometimes, they’d stay in a hotel for the weekend and get her hair done, or go clothes shopping.
This summer, Thomas worried that Janaia was backsliding. Other girls in the home were bullying her, Thomas said. During a fight with two of them, Janaia had grabbed a plastic fork and stabbed one in the ear. Police viewed Janaia as the aggressor and arrested her, her mother said. AdvoServ responded by having Janaia spend time after school in an adult home, instead of the youth home where she slept.
Thomas wanted the state to find her daughter a new facility. The mother worried Janaia wasn’t supervised well enough and feared the consequences if she tangled with other girls again. Thomas didn’t like the adult language and behavior Janaia was picking up from the older clients.
On the doorstep of her brick row house in Wilmington last week, Skinner — the AdvoServ employee — said she saw Janaia every day at the group home.
“Janaia was my baby,” she said. “She was my child, every single day. This is crazy.”
After Skinner cited the “wrap-up behavior” used on Janaia, she was asked to explain what the term meant. She said she had “nothing to hide” but didn’t know if she was allowed to talk to a reporter. After calling a supervisor, who advised her not to speak, she went inside her house and closed the door. Attempts to reach other workers involved were unsuccessful.
On Monday September 12, Thomas was driving to work in Washington, D.C., when her cell phonerang. An AdvoServ staff member told her that when two workers went to Janaia’s room to help her dress, the girl had lost control of her bladder and bowels and passed out. Workers had called 911 and Janaia had gone into cardiac arrest.
Thomas turned her car around, picked up Janaia’s older sister and drove frantically toward Delaware. En route, she learned that her daughter was being moved to the Nemours Alfred I. duPont Hospital for Children in Wilmington.
At the hospital, Thomas said she spoke to Janaia’s case manager at AdvoServ, who told her a different version of events: Her daughter, the case manager said, had been placed in a hold before becoming unresponsive.
She then headed for the intensive care unit, where a phalanx of AdvoServ administrators greeted her at the elevator and expressed their sympathies. A doctor told Thomas that her daughter appeared to be brain-dead, and was on a respirator. For the next two days, Thomas kept vigil at her Janaia’s bedside. She didn’t leave to shower or rest.
On the second day, a Delaware detective told Thomas he had watched the video and interviewed staff. According to the workers, as recounted by the police officer to Thomas, Janaia had been very aggressive that morning. Family visits were a privilege residents could lose, and workers were considering punishing her by not letting her see her mother that Friday as planned. She became angry. Ordered to clean her room, she attacked the staff member carrying the trash bag and grabbed her hair.
The other staff members hurried to pull the girl off the worker, and put her in a hold until she calmed down and was talking to them. They were helping change her out of her soiled clothes. Janaia, who was lying down, asked them to take her glasses and put them on the dresser. She then turned her head to the side and passed out. Workers dialed 911.
The workers told police they had done a proper hold with one worker on each arm and leg, and no one pressing on her chest. The detective told Thomas that the workers’ stories matched, and that it appeared there was no foul play, she said.
Delaware state police declined comment on what the workers told them.
Thomas, however, is skeptical. On the video, Janaia did not look angry until the worker shoved her. Thomas said that it would be unusual for her daughter to lose control and then suddenly calm down and start talking. And the bedroom was so small it seemed impossible that the four heavyset women she saw on the video could perform the restraint as they described it to police, Thomas said.
“I’m not buying that,” she said. Workers were supposed to be trained to defuse such conflicts before they occurred — instead of escalating them, she added. “They’re trained to deal with behaviors like this.”
She pressed AdvoServ officials until Blough, the AdvoServ state director, showed her the video. Company representatives told her specifics such as the exact time when police had left the group home that evening. But they said they didn’t know what had happened in the fateful 32 minutes in her daughter’s bedroom.
Thomas searched for clues as she waited in her daughter’s hospital room. She found a fingernail-shaped nick on one of Janaia’s fingers and a bruise on a knuckle. There was an unexplained mark in the center of Janaia’s chest that looked like a puncture wound.
On Wednesday September 14, Janaia’s heart stopped. Thomas stayed with the body for five hours. She rubbed her daughter’s hair and cut a lock as a keepsake, noticing dried blood in one ear.
As the hours ticked past, dark bruises emerged on her daughter’s left leg, below the knee. A nurse told her bruises often became more pronounced after death.
The white house near the unincorporated community known as Kirkwood was silent on a recent day. A single SUV was parked in the driveway and no one came to the door.
Thomas said AdvoServ returned Janaia’s clothes, neatly laundered, and other possessions.
Among the items was a composition book her daughter kept as a journal. Thomas noticed several sheets had been ripped out. Scrawled on a remaining page was a haunting passage that reminded Thomas how hard her daughter had tried to curb her temper and pay attention to the adults in her life. “I listen to my mom and dad,” Janaia wrote, according to Thomas’ recollection. “Because if you don’t listen, you get hurt.”