Public Comment on CCI Licensing Rule Changes - Sleeping Rooms  
Dear Committee Members,  
The ACLU of Michigan commends the department for thoroughly reviewing the licensing standards to create more  
robust support for youth within Child Caring Institutions. The ACLU has a long history of working to ensure that lesbian,  
gay, bisexual, transgender, & queer people belong everywhere and can live openly and authentically without  
discrimination, harassment, or violence. We would like to express support for the proposed rule changes, specifically  
protections for youth with diverse sexual orientation, gender identity, and expression (SOGIE) in R 400.4137 on  
sleeping rooms. We endorse the language as written, based on the following:  
1. The vulnerabilities of children with diverse SOGIE are well-documented, and reinforce the need for placement  
consistent with gender identity that prioritizes youths’ views about their own safety. Youth with diverse SOGIE  
often suffer harms as a consequence of rejection and social marginalization1. Due to pervasive rejection and bias  
in their homes, schools and communities, children with diverse SOGIE experience high rates of depression,  
suicidality, substance use, physical and sexual victimization, and homelessness. Family conflict, verbal  
harassment, school bullying, and physical assault constitute the harsh daily reality for too many of these young  
people2. Social conditions for transgender girls of color are particularly brutal. Child caring institutions should  
consider these factors related to physical and emotional safety when making placement decisions, as the rule  
language outlines.  
2. While children with diverse SOGIE are a particularly vulnerable population with unique developmental tasks,  
they also have the same inherent capacity for happiness, achievement, and healthy adjustment as other  
children. Placing children with diverse SOGIE in unsafe or hostile settings exacerbates their isolation, instability,  
and trauma, and significantly compromises their health and opportunities. Placing them with loving, supportive  
adults who provide a safe atmosphere in which they can explore and develop their identities maximizes their  
potential to thrive and become healthy adults. Placements that consider a youth’s diverse SOGIE and prioritize  
youth’s views about their own safety and wellbeing not only nurture children but help protect them from  
negative effects of living in an otherwise unaccepting society. By adopting and implementing gender affirming  
policies and practices, child caring institutions promote the safety, permanency, and well-being of children with  
diverse SOGIE.  
In summary, the proposed language will enhance the wellbeing of youth with diverse SOGIE. We at The ACLU of  
Michigan appreciate the time and effort put into the proposed amendments and ask that you vote in support of the  
changes to R 400.4137.  
Thank you for the opportunity to share our perspective,  
Jay Kaplan, LGBT Project Staff Attorney  
ACLU of Michigan  
1
Brian A. Rood, Sari L. Reisner, Francisco I. Surace, Jae A. Puckett, Meredith R. Maroney, and David W. Pantalone.Transgender Health.Dec 2016.151-  
164.http://doi.org/10.1089/trgh.2016.0012; Pariseau, E. M., Chevalier, L., Long, K. A., Clapham, R., Edwards-Leeper, L., & Tishelman, A. C. (2019). The relationship between family  
acceptance-rejection and transgender youth psychosocial functioning. Clinical Practice in Pediatric Psychology, 7(3), 267–277. https://doi.org/10.1037/cpp0000291  
2
Higa D, Hoppe MJ, Lindhorst T, et al. Negative and Positive Factors Associated With the Well-Being of Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning (LGBTQ) Youth.  
Youth & Society. 2014;46(5):663-687. doi:10.1177/0044118X12449630  
June 11, 2021  
Via email  
Department of Health and Human Services  
333 South Grand Avenue, 5th Floor  
Lansing, MI 48909  
Re: Public Comment to Proposed DHHS CCI Administrative Rule 400.4137– Placement  
Dear Committee Members,  
B. Brown Consulting, LLC commends the department for thoroughly reviewing the licensing  
standards to create more robust support for youth within Child Caring Institutions. My name is  
Bernadette Brown. I’m the founder and president of B. Brown Consulting, LLC, a consulting  
firm that collaborates with government agencies (particularly jails, prisons, military brigs,  
community confinement and juvenile detention facilities), institutions and community-based  
organizations on the development and implementation of policies, procedures and best practices  
that support humane reforms within the youth and criminal justice systems. I’m also a consultant  
to the National PREA Resource Center (PRC). The goal of the Prison Rape Elimination Act  
(PREA) is to eliminate sexual abuse in all types of confinement facilities including adult prisons  
and jails, lockups, as well as juvenile, community, and tribal facilities. The PRC is funded via a  
cooperative agreement between Impact Justice in Oakland, CA and the U.S. Department of  
Justice’s (DOJ) Bureau of Justice Assistance. As a consultant to the PRC, I developed the  
nation’s first LGBTI (lesbian, gay, bisexual, transgender and intersex) and GNC (gender  
nonconforming) training curriculum for those seeking to become DOJ-certified PREA auditors.  
LGBTQ and GNC youth are overrepresented in the juvenile justice system. While LGBTQ youth  
comprise about 7%-11% of the U.S. population1, they account for approximately 20% of the  
youth in detention.2 A shocking 57.9% of girls in detention facilities in the U.S. identify as  
“sexual minorities” which means that they are either lesbian, gay or bisexual (39.4%), or state  
that they are attracted to other girls (18.5%).3 Data compiled by the Bureau of Justice Statistics  
(BJS) from the National Survey of Youth in Custody uncovered that non-heterosexual youth  
reported a “substantially higher” sexual victimization rate (10.3%) by other youth as compared to  
1 Estimates in studies quantifying the number of LGBTQ and GNC youth in the general population vary depending on the terms that both youth and researchers use in surveys, as well  
as the categories included, e.g., sexual orientation, gender identity, and/or gender expression.  
2 Irvine, A., & Aisha Canfield. (2016). The Overrepresentation of Lesbian, Gay, Bisexual, Questioning, Gender Nonconforming and Transgender Youth Within the Child Welfare to  
Juvenile Justice Crossover Population. Journal of Gender, Social Policy & the Law: Vol. 24: Iss. 2, Article,  
http://digitalcommons.wcl.american.edu/cgi/viewcontent.cgi?article=1679&context=jgspl.  
3 Wilson, B. D.M. Wilson, Jordan, S.P, Meyer, I. H., Flores A. R. Flores, Stemple, L., & Herman, J. L. (2017). Disproportionality and Disparities among Sexual Minority Youth in Custody,  
https://williamsinstitute.law.ucla.edu/research/safe-schools-and-youth/lgbtq-youth-disproportionately-incarcerated-in-the-u-s-juvenile-justice-system/  
1420 Washington Blvd, Suite 301, Detroit, MI 48226  
bbrown@bbrownconsulting.com  
www.bbrownconsulting.com  
(718) 928-4237  
heterosexual youth (1.5%).4 While BJS did not collect these data on transgender youth in  
detention facilities, the rates for transgender adults are extremely high: 26.8% of transgender  
people detained in jails and 39.9% of transgender people detained in prisons report being  
sexually victimized.5 Thus, LGBTQ youth are at great risk of harassment and victimization in  
detention facilities. Moreover, appropriate placements for transgender and intersex youth are  
critical to protecting their safety and well-being, and should not solely be based on their sex  
assigned at birth (see also PREA Standard §115.342).6 We also commend the language which  
states that placement/housing decisions may not be based on complaints of staff or other youth.  
These decisions are based on safety, not on any one person’s personal opinion about gender  
identity. The DOJ’s PREA Working Group also reiterated this with guidance that they issued on  
March 24, 2016, which states that “…a facility should not make a determination about housing  
for a transgender or intersex inmate based primarily on the complaints of other inmates or staff  
when those complaints are based on gender identity.”7  
We would like to express support for the proposed rule changes, specifically protections for  
youth with diverse sexual orientation, gender identity, and expression (SOGIE) in R  
400.4137 on sleeping rooms. We endorse the language as written, based on the following:  
1. The vulnerabilities of children with diverse SOGIE are well-documented, and  
reinforce the need for placement consistent with gender identity that prioritizes  
youths’ views about their own safety. Youth with diverse SOGIE often suffer harms as  
a consequence of rejection and social marginalization8. Due to pervasive rejection and  
bias in their homes, schools and communities, children with diverse SOGIE experience  
high rates of depression, suicidality, substance use, physical and sexual victimization, and  
homelessness. Family conflict, verbal harassment, school bullying, and physical assault  
constitute the harsh daily reality for too many of these young people9. Social conditions  
for transgender girls of color are particularly brutal. Child caring institutions should  
consider these factors related to physical and emotional safety when making placement  
decisions, as the rule language outlines.  
2. While children with diverse SOGIE are a particularly vulnerable population with  
unique developmental tasks, they also have the same inherent capacity for  
happiness, achievement, and healthy adjustment as other children. Placing children  
with diverse SOGIE in unsafe or hostile settings exacerbates their isolation, instability,  
4 Beck, A. J., Cantor, D., Hartge, J., & Smith, T. (2013). Sexual victimization in juvenile facilities reported by youth, 2012. Washington, DC: US Department of Justice, Office of Justice  
Programs, Bureau of Justice Statistics, http://www.bjs.gov/content/pub/pdf/svjfry12.pdf  
5 Beck, A. J. (2014). Sexual victimization in prisons and jails reported by inmates, 2011–12: Supplemental Tables: Prevalence of Sexual Victimization of Among Transgender Adult  
Inmates. Washington, DC: US Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, https://www.bjs.gov/content/pub/pdf/svpjri1112_st.pdf  
6 National PREA Resource Center, https://www.prearesourcecenter.org/implementation/prea-standards/juvenile-facility-standards.  
7 See National PREA Resource Center, https://www.prearesourcecenter.org/frequently-asked-questions/does-policy-houses-transgender-or-intersex-inmates-based-exclusively.  
Thought the language uses the term “inmate,” the rule also applies to youth (residents) in juvenile facilities.  
8 Brian A. Rood, Sari L. Reisner, Francisco I. Surace, Jae A. Puckett, Meredith R. Maroney, and David W. Pantalone. Transgender Health. Dec 2016.151-164,  
http://doi.org/10.1089/trgh.2016.0012; Pariseau, E. M., Chevalier, L., Long, K. A., Clapham, R., Edwards-Leeper, L., & Tishelman, A. C. (2019). The relationship between family  
acceptance-rejection and transgender youth psychosocial functioning. Clinical Practice in Pediatric Psychology, 7(3), 267–277. https://doi.org/10.1037/cpp0000291  
9 Higa D, Hoppe MJ, Lindhorst T, et al. Negative and Positive Factors Associated With the Well-Being of Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning (LGBTQ) Youth.  
Youth & Society. 2014;46(5):663-687. doi:10.1177/0044118X12449630  
and trauma, and significantly compromises their health and opportunities. Placing them  
with loving, supportive adults who provide a safe atmosphere in which they can explore  
and develop their identities maximizes their potential to thrive and become healthy  
adults. Placements that consider a youth’s diverse SOGIE and prioritize youth’s  
views about their own safety and well-being not only nurture children but help  
protect them from negative effects of living in an otherwise unaccepting society. By  
adopting and implementing gender affirming policies and practices, child caring  
institutions promote the safety, permanency, and well-being of children with diverse  
SOGIE.  
In summary, the proposed language will enhance the well-being of youth with diverse SOGIE.  
We at B. Brown Consulting, LLC appreciate the time and effort put into the proposed  
amendments and ask that you vote in support of the changes to R 400.4137.  
Thank you for the opportunity to share our perspective. Please do not hesitate to contact us with  
any questions.  
Kindly,  
Bernadette E. Brown  
President  
June 11, 2021  
Department of Health and Human Services  
Attn: MDHHS-AdminRules@michigan.gov  
RE:  
Comments by Disability Rights Michigan (DRM) to Proposed Rules for Child Caring  
Institutions, Rule Set #2020-39 HS  
Disability Rights Michigan (DRM) is the private, nonprofit, nonpartisan protection and advocacy  
agency serving people with disabilities in Michigan. DRM's mission includes advocacy and  
monitoring of child caring institutions to address the needs of youth with disabilities in those  
places.  
DRM supports many of the proposed changes in the proposed regulations, including:  
•
•
planning to reduce and eliminate use of restraint and seclusion in Section 159(1);  
the immediate ban on particularly dangerous and noxious forms of restraint in Section  
159(2) and 159(3);  
•
•
•
the May 1, 2022 ban on nonemergency restraint in Section 159(10);  
the narrowed definition of emergency restraint in Section 160; and,  
the process and May 1, 2022, ban on seclusion in Section 162.  
These changes are long overdue and consistent with the recommendations from the Annie E.  
Casey Foundation report.  
Unfortunately, the regulations do not reference or address other important Casey Foundation  
recommendations. Those recommendations call for broad cultural change, authentic  
engagement of youth and families, and disaggregated data reporting. Other than a broad staff  
training requirement, there are no outcome-based or transparent requirements for any of  
these activities in the regulations.  
Further, much of the success of the state's efforts to eliminate restraint and seclusion from  
these facilities rests on the state itself. The Casey Foundation recommends the state drive  
cultural change, develop and enforce contract performance standards, collect and report data,  
monitor and oversee performance, pre-approve outsourcing, enforce active case management,  
create a specialized oversight team to support change, and enforce rules (particularly with  
regard to repeat offenders and serious violations). The rules have no reference to these state  
roles as they relate to CCIs and their compliance.  
The most recent report of the Dwayne B. settlement monitor highlights the inadequacy of  
current state corrective actions, despite over a decade of court oversight:  
The monitoring team found that [CCI corrective action plan] content and follow-up was  
often ineffective and deficient, lacked specificity, and did not remediate risk to children.  
Frequently repeated violations of a serious nature, such as physical intervention or  
improper restraints causing injuries, recurred despite the CAPs, and at times the CAPs  
did not address prevalent underlying issues that posed a serious risk of harm to  
children’s safety. (p.29)  
MDHHS acknowledged these issues in September 2020, recognizing the clear “need to expedite  
adverse licensing action in response to repeat non-compliance or safety violations” (p.7), but  
the proposed rules lack clear, transparent standards and procedures to ensure accountability  
and enforcement. Absent adequate state oversight, there is no assurance that a future tragedy  
will be prevented.  
Finally, the Casey Foundation report concludes, in order to best serve youth and the community  
and prevent tragedy in the future, the long-term trajectory of this system is to downsize. There  
is no regulation in the proposed rules that governs facility size and no process for downsizing  
large programs.  
In short, while the rules have significant positive elements, they still do not address several  
issues of importance. The major structural deficiency this rule package does not address is the  
need for consistent and effective oversight and accountability by the department. Without any  
codified oversight, it is unclear that the positive changes proposed in this package will result in  
change. That must be corrected by outlining the responsibility and process by which the  
department will assure every licensed entity complies with the licensing rules or has its license  
timely revoked. This deficiency and other issues must be addressed through additional  
rulemaking.  
Thank you for the opportunity to comment. Please contact Mark McWilliams, Director of Public  
Policy and Media Relations, in our Lansing office at mmcwilliams@drmich.org or (517) 487-  
1755 for more information.  
To: Michigan Department of Health and Human Services, Children’s Service Agency,  
Division of Child Welfare Licensing  
From: Jeana Koerber, Ph.D., BCBA-D, LBA Executive Director of Autism Services and  
Calvin Gage, MA, BCBA, LBA Clinical Director of Autism Services  
Date: June 10, 2021  
Re: Comments on proposed rules for Child Caring Institutions: Rule set 2020-39 HS  
First, we commend the department for the many improvements to the rules that govern child  
caring institutions in the state of Michigan that are contained in the proposed rules; most notably, a  
focus on LGBTQ+ youth and to further ensure seclusion and restraint are only used in emergency  
circumstances. Unfortunately, there seems to be a disproportionate focus on youth who may reside  
in child caring institutions as a result of a placement in the foster care system. The proposed rules  
do not adequately address youth who may reside in a child caring institution due to extenuating  
circumstances resulting from a developmental disability. Youth may be placed in child caring  
institutions by community mental health entities if the facility only serves youth diagnosed with  
developmental disabilities. While we recognize that these facilities are not plentiful in the state of  
Michigan, they represent a crucial service to this population, most notably for youth with a diagnosis  
of Autism.  
Individuals diagnosed with Autism can often engage in challenging behaviors that cause  
harm to themselves or others. While we recognize that our program is uniquely designed to care for  
individuals who engage in the most severe forms of these behaviors, there are other child caring  
institutions that also support youth with autism or other developmental disabilities who have  
challenges residing in their familial homes for a period of time. There are several proposed rules  
that would make it very difficult for providers, and potentially impossible for some providers, to  
continue to provide services to this vulnerable population of youth in Michigan. Without child caring  
institutions that can serve this population, these youth will be “caught” in the state’s emergency  
rooms or psychiatric placements. Other youth may be sent out of state for the care they require,  
further separating them from their families. As this is already happening at an alarming rate, we  
cannot further limit providers' ability to provide care to this group of children.  
When youth are placed in a child caring institution through a community mental health  
placement, facilities are required to follow the Michigan Mental Health Code and rules set forth  
through MDHHS Behavioral Health and Developmental Disabilities Standards. Child caring  
institutions are also required to follow Act 116 of 1973 for Child Care Organizations. We implore the  
authors of the rules to cross-reference the documents linked at the end of this document to  
ADDRESS 9616 Portage Road ● Portage, MI 49002 PHONE 269.250.8200 FAX 269.250.8339  
www.autismtreatmentresearch.org  
ensure that definitions are consistent and to collaborate with the Behavioral Health and  
Developmental Disabilities department at MDHHS lead by director, Allen Jansen. This will ensure  
providers are not placed in a situation of either following Act 116 or the MDHHS Behavioral Health  
and Developmental Disabilities Standards at the risk of violating a child caring institution licensing  
rule, or vice versa. For ease, rules that we have identified as areas of conflict with Act 116, or the  
MDHHS Behavioral Health and Developmental Disabilities Standards are detailed below.  
We have also noted other rules, that while written with positive intent, may be quite difficult  
for providers to comply with. We have noted those rules and potential barriers to implementation in  
a separate section below.  
We appreciate the time and effort the authors of the proposed rules have already invested in  
this process. We are confident that our comments will be taken seriously and implemented in these  
rules so we can ensure a strong provider network for our most vulnerable children with  
developmental disabilities. If any further information or insight would be helpful, we are happy to  
discuss or provide additional input into this important endeavor. Our contact information is provided  
below.  
References:  
Act 116:  
http://www.legislature.mi.gov/(S(eame3rjt143yvpz1401ihdve))/mileg.aspx?page=GetObject&objectn  
ame=mcl-act-116-of-1973  
MDHHS Behavioral Health and Developmental Disabilities Standards:  
https://www.michigan.gov/documents/mdhhs/Technical_Requirement_for_Behavior_Treatment_Pla  
ns_702787_7.pdf  
Contact Information:  
Jeana Koerber, Ph.D., BCBA-D, LBA - Executive Director of Autism Services  
jkoerber@resopp.org or 269-250-8242  
Calvin Gage, MA, BCBA, LBA - Clinical Director of Autism Services  
cgage@resopp.org or 269-250-8249  
Rules that are in conflict with Act 116 or MDHHS Behavioral Health and Developmental Disabilities Standards:  
Rule  
number Wording  
Conflict  
In Act 116.7229(D) this is defined as an emergency safety situation. In the  
MDHHS standards this is listed as emergency interventions, for which one  
is physical management. Under physical management in the MDHHS  
standards, this is the language “Physical management shall only be used  
on an emergency basis when the situation places the individual or others  
"Emergency Restraint" means the onset of an unanticipated or severely at imminent risk of serious physical harm. To ensure the safety of each  
aggressive behavior that places the youth or others at serious threat of  
violence or injury if no immediate intervention occurs  
consumer and staff, each agency shall designate emergency physical  
management techniques to be utilized during emergency situations.”  
4101(J)  
4101(S)  
Act 116 722.122B(G) does not define mechanical restraint in this manner,  
“Mechanical restraint” means a device, materials, or equipment attached nor do the MDHHS behavioral health and developmental disabilities  
or adjacent to the youth’s body that he or she cannot easily remove that standards. Both Act 116 and MDHHS have an exclusion for the use of  
restricts freedom of movement or normal access to one's body.  
devices used for protective equipment and anatomical support.  
In Act 116 722.122B(H) does not define personal restraint in this manner.  
Act 116 has an exclusionary list of items that do not meet the definition of  
personal restraint that are omitted here.  
MDHHS standards discuss this under physical management which is  
defined as “A technique used by staff as an emergency intervention to  
restrict the movement of a recipient by direct physical contact to prevent  
the recipient from seriously harming himself, herself, or others. NOTE:  
Physical management shall only be used on an emergency basis when the  
situation places the individual or others at imminent risk of serious  
physical harm. To ensure the safety of each consumer and staff, each  
Personal restraint means the application of physical force without the  
4101(W) use of a device, that restricts the free movement of a youth's body  
agency shall designate emergency physical management techniques to be  
utilized during emergency situations”  
A term defined in the act has the same meaning when used in these  
4101 (2) rules  
This statement again justifies that the definitions in this document should  
match the definitions in Act 116  
Rule 157. (1) An child caring institution shall implement a behavioral and  
calming plan that includes all the following:  
(a) Development of agency-based crisis prevention and intervention  
strategies that are strength-based and non-coercive. The plan will be  
This is stating that the agency has a behavioral and calming plan that  
used to support staff development and assist youth in self-regulation and covers all individuals. This goes against person centered planning and  
social skills. An agency plan will include all the following:  
(i) On-site, sensory-based interventions that will be made available to  
youth.  
(ii) A physical environment that promotes comfort and healing.  
(iii) Access to a youth’s support team, which may include peer support.  
(iv) Youth engagement with family.  
(v) In the absence of family, developing a community of support for  
youth.  
(vi) Opportunities to teach youth dispute resolution, conflict mediation,  
and negotiation skills.  
individualized plan of service. Behavior and calming plans should be  
individualized per the youth. MDHHS Behavioral Health and  
Developmental Disabilities Administration already has established  
guidelines for what should be included in behavior treatment plans with a  
focus on evidence-based practices. Some of the listed interventions may  
not be considered evidence-based practice depending on a youth’s  
diagnosis (e.g. sensory-based interventions). We advocate that the  
language found in the MDHHS Behavioral Health and Developmental  
Disabilities standards for behavior treatment review committees Revision  
FY17 be mirrored in these rules. This will ensure that the most appropriate  
(vii) Staff awareness and inclusion in each youth’s behavior and calming evidence-based interventions are used for the individual served based on  
plan that is updated regularly, as needed. their functional behavioral assessment and diagnosis.  
4157a  
(c) Development of an individualized behavioral and calming plan for  
each youth that includes:  
(i) Safety and calming strategies unique for each youth, including options  
for support tools.  
(ii) Utilizes trauma responsiveness and best practices.  
Again, the MDHHS document linked above already contains criteria for  
developing a behavior plan. We propose that these two documents be  
(iii) A youth-centered prevention plan incorporating input and ideas from linked. Even if youth are not receiving services through the community  
the youth and family. mental health (CMH) provider while they reside in the CCI, oftentimes  
(iv) Strength-based and non-coercive crisis prevention and intervention when they return to the community, they are served through CMH  
strategies that will be used to assist a youth in self-regulation and social programs. Continuity in the guidelines for behavior plan development is  
skills.  
crucial for continued progress when the youth returns to a community  
placement.  
4157c  
(v) Options for fresh air, movement, and exercise.  
The MDHHS guidelines do not allow for restraint to be written into  
treatment plans as this would not be considered emergency use if it is  
planned.  
In the event a restraint occurs, must be [...] done in a manner that is  
consistent with the youth's treatment plan.  
4159(5)  
If a personal or mechanical restraint is used, staff must use the permitted  
methods of personal and mechanical restraint, appropriate techniques  
for use of restraints, and the child caring institution must provide  
Again, this would not be allowed per the MDHHS guidelines. Staff must  
use the least restrictive technique that would safely address the situation.  
guidance to staff in deciding what level of restraint to use if that becomes This may include the reactive strategies but reactive strategies cannot  
necessary. include physical management.  
4159(6)  
Emergency restraint.The use of emergency restraint as a lifesaving  
response of a youth will be limited to:  
(a) An emergency response to protect the youth or others from  
immediate serious physical harm, as that term is defined in section  
136b(1)(f) of the Michigan Penal Code, 1931 PA 328, MCL 750.136b.  
(b) When all other interventions in the agency crisis prevention and  
intervention plan and the youth’s individual safety and calming plan have  
been utilized but fail to protect the youth or others from serious physical  
harm.  
(c) The emergency restraint must not last longer than needed to end the  
threat of serious physical harm.  
(d) Staff must continuously monitor the youth’s breathing and other signs  
of physical distress and take appropriate action to ensure adequate  
respiration, circulation, and overall well-being.  
(e) The youth must be released immediately when an emergency health The penal code referenced here references child abuse. This would  
situation occurs or a situation that presents physical distress occurs  
during the restraint. Staff must obtain immediate medical treatment for  
the youth.  
indicate you could only use emergency restraint if the danger was to  
another child. That is not consistent with Act 116, the MDHHS guidelines,  
or the definitions provided earlier in these proposed rules.  
4160(a)  
Rules that may pose challenges to providers during implementation of the rules:  
Rule  
number  
Wording  
Barrier to Implementation  
Youth who have autism typically benefit from earlier intervention. If  
their behavior is already severe enough at age 8 to warrant out of  
home treatment, it will only increase intensity. Limiting the age range  
Rule 133. A child under 10 years of age may not remain in a child caring  
institution for more than 30 days, unless this stay is documented to be in the for these youth may actually increase the length of stay in out of  
best interest of the child. home placements then reduce them.  
4133  
(e) Dispensing medication, including methods for dispensing medication when In emergency situations often physician assistants (PA) or nurse  
the youth will be off site, for example, all-day outings, parenting time, and practitioners are writing prescriptions. During routine visits, our youth  
court appearances. Prescription medication, including dietary supplements, or are also often being seen at a family health center so a licensed  
individual, special medical procedures must be given, taken, or applied only  
4142(2e) as prescribed by a licensed physician or dentist.  
physician is often not writing prescriptions. We propose the language  
be written in a way to include these professionals.  
Insurance companies will not authorize a visit less than every 6  
months unless medically indicated. Using a 6 month timeline does  
not give providers time to schedule an appointment. For 12 month  
appointments, a 14 month timeline is given to allow time to schedule  
the appointment in line with insurance regulations. We propose the 6  
(3) [Dental] Reexamination must be provided at least every 6 months unless month timeline be changed to 8 months to give providers scheduling  
4147(C)  
4149(3)  
greater frequency is indicated.  
time.  
A CCI must provide any special diet that has been prescribed by a licensed  
physician  
Same issue as indicated in rule 4142(2e). Many dietary needs come  
from a PA or another profession that isn't specifically a licensed  
physician  
Rule 150. (1) Child caring institution staff must contact the youth’s parent or  
legal guardian, the licensing authority, and the caseworker within 12 hours,  
and provide a written report to the same parties within 24 hours of any of the  
following:  
(a) Any accident, illness, or mental health crisis that requires emergency  
medical attention, hospitalization, or both.  
(b) Attempts at self-inflicted harm or harm to others that causes injury.  
(c) Attempted absent without leave or escape from the institution.  
(d) Incidents or allegations of sexual abuse or other forms of sexual  
misconduct.  
(e) Behaviors that result in contacting law enforcement.  
(f) Any use of prohibited methods of discipline under R 400.4158.  
(g) Any use of lockdown procedure under R 400.4165.  
All of our youth in care have several attempts at self-inflicted harm or  
(2) The death of a resident youth to the parent/ or legal guardian, responsible harm to others per day. The same can be stated with attempts to  
referring agency, and the licensing authority as soon as possible must be  
reported immediately to the parent/legal guardian or next of kin, law  
enforcement, the licensing authority, and the referring agency. Child caring  
institution staff must provide a written report to the same parties within 24  
hours.  
leave as youth with autism display a high level of elopement. This  
places an unnecessary burden on providers as they would not be in  
care if they were not attempting to hurt themselves or others. We  
propose that this is addended to “incidents” in b and c instead of  
“attempts”  
4150  
Many of our youth are coming from their homes and plan to return  
home. This seems like a more appropriate statement for the foster  
care contract than the CCI rules  
4155(h)  
Permanency plan and steps that will be taken to achieve permanency  
PENRICKTON CENTER FOR BLIND CHILDREN  
June 11, 2021  
Michigan Department of Health and Human Services  
Attn: MDHHS-AdminRules@michigna.gov  
MDHHS South Grand Building  
333 South Grand River Avenue, 5th Floor  
Lansing, MI 48909  
RE: Proposed Rules for Child Caring Institutions Rule Set 2020-39 HS  
LICENSE # CI820201363  
Penrickton Center for Blind Children established in 1952, serves blind,  
multi-disabled children ages one through twelve. All of our children are  
legally blind with at least one additional disability. Most of children have  
multiple disabilities including seizures, cerebral palsy, brain damage,  
autism, hearing impairments and developmental delay. All services are  
provided to private families at no charge. Penrickton Center does not  
contract with the Michigan Department of Health and Human Services.  
Please note that Penrickton Center is supported solely through private  
donations.  
Following are my comments on the proposed rule for Child Caring  
Institutions. Typeface in black are current rules, red are proposed  
changes.  
Sincerely,  
Kurt M. Sebaly, M.Ed.  
Executive Director  
26530 Eureka Road / Taylor / MI / 48180  
(734) 946-7500 / Fax (734) 946-6707 / www.penrickton.org  
Rule 400.4147 Dental Care  
(1) A licensee Child caring institution staff shall must provide for and document dental  
examinations and treatment for each resident3 youth 1 years of age and older.  
(2) A dental examination within12 3 months prior to admission shall must be documented  
or there shall must be an examination not later than 90 calendar days following admission.  
(3) Reexamination shall must be provided at least every 14 6 months unless greater  
frequency is indicated.  
Rule (1) The requirement that a child must have a dental examination and treatment at age  
1 is not practical. Many children do not even have teeth at age 1; therefore the rule should  
remain, beginning dental exams at age 3.  
Rule (3) This rule places a substantial financial burden on families that do not have  
insurance for this service. In addition, children with multiple disabilities often need to be  
under anesthesia to complete any dental exam or work, which adds additional costs. There  
must be a grace period to ensure insurance will cover the cost of all appointments. The  
current rule as stated “at least every 14 months” is adequate. The time period should  
remain the same, or allow the youth's physician to make an exception.  
Rule 400.4150 Incident Reporting  
(1) Any of the following incidents resulting in serious injury of a resident or illness requiring  
inpatient hospitalization, shall be reported, but not more than 24 hours after the incident.  
Child caring institution staff must contact the youth’s parent or legal guardian,  
the licensing authority, and the caseworker within 12 hours, and provide a written  
report to the same parties within 24 hours of any of the following:  
(a) Any accident, illness, or mental health crisis that requires emergency medical  
attention, hospitalization, or both.  
(b) Attempts at self-inflicted harm or harm to others that causes injury.  
Our issue is specifically with (a) and (b). Penrickton Center has children who engage in self-  
injurious behaviors including scratching, biting, and head banging to themselves and others.  
Our programming focuses on reducing these behaviors. Due to our children’s cognitive  
impairments – it may take years to resolve these behaviors. This rule would mandate, for  
example, that every time a child scratches him/herself we must notify our Licensing  
Consultant. Currently, Penrickton Center notifies a parent of all injuries, including self-  
injurious behaviors.  
Notifying our Licensing Consultant each time a child engages in self-injurious or aggressive  
behaviors is unreasonable. Our Licensing Consultant would be contacted weekly and on  
multiple occasions. Our Licensing Consultant and Penrickton Center staff can spend our  
precious time in a more productive manner addressing the needs of our children and  
families. A more practical approach would be to keep the current rule as written adding (a),  
(c), (d), (e), (f) and (g) or the addition of the word “serious” injury in (b).  
Penrickton Center for Blind Children  
Proposed Rule Set 2020-39 HS  
Page 2  
Rule 400.4101 Definitions  
(x) “Seclusion” means the involuntary placement of a youth in a room alone, where  
the youth is prevented from exiting by any means, including the physical presence  
of a staff person if that staff person's presence prevents the youth from exiting the  
room.  
Penrickton Center has a concern with the definition of seclusion. Penrickton Center has no  
desire to use a seclusion room for our children. However, due to the developmental  
disabilities of our youth, our children on occasion act aggressively toward other youth. In an  
attempt to de-escalate behaviors, we frequently redirect child to a room offering appropriate  
activities and stimulation, calming the child and channeling activity to constructive acts not  
aggressive acts.  
Again, because of the cognitive impairments of our children, they may initially focus on  
wanting to run out of the room. We prefer to have the option to physically stand in the room  
with the child, and redirecting them away from the door, back to the activities in the room.  
This action is viewed as seclusion, and we are prevented from using this technique. Our only  
option is to allow the child to leave the room, which can escalate behaviors and eventually  
force the use of “emergency restraint.” The definition of seclusion should be changed, or  
an exception should be made to allow staff to redirect a small child, or child with cognitive  
disabilities away from a door – without this being viewed as seclusion.  
Penrickton Center for Blind Children  
Proposed Rule Set 2020-39 HS  
Page 3  
Public Comment to Proposed DHHS CCI Administrative Rule – Placement  
Dear Licensing Rules Administrative Committee,  
Michigan Center for Youth Justice (MCYJ) commends the department for thoroughly reviewing the licensing standards to  
create more robust support for youth within Child Caring Institutions. The Michigan Center for Youth Justice (MCYJ) is a  
non-profit organization dedicated to advancing policies and practices that reduce confinement and support trauma-  
informed, racially equitable, socio-economically and culturally responsive, community-based solutions for Michigan’s  
justice-involved children, youth and young adults. We would like to express support for the proposed rule changes,  
specifically protections for youth with diverse sexual orientation, gender identity, and expression (SOGIE) in R  
400.4137 on sleeping rooms. We endorse the language as written, based on the following:  
1. The vulnerabilities of children with diverse SOGIE are well-documented, and reinforce the need for  
placement consistent with gender identity that prioritizes youths’ views about their own safety. Youth with  
diverse SOGIE often suffer harms as a consequence of rejection and social marginalization1. Due to pervasive  
rejection and bias in their homes, schools and communities, children with diverse SOGIE experience high rates of  
depression, suicidality, substance use, physical and sexual victimization, and homelessness. Family conflict,  
verbal harassment, school bullying, and physical assault constitute the harsh daily reality for too many of these  
young people2. Social conditions for transgender girls of color are particularly brutal. Child caring institutions  
should consider these factors related to physical and emotional safety when making placement decisions, as the  
rule language outlines.  
2. While children with diverse SOGIE are a particularly vulnerable population with unique developmental  
tasks, they also have the same inherent capacity for happiness, achievement, and healthy adjustment as  
other children. Placing children with diverse SOGIE in unsafe or hostile settings exacerbates their isolation,  
instability, and trauma, and significantly compromises their health and opportunities. Placing them with loving,  
supportive adults who provide a safe atmosphere in which they can explore and develop their identities  
maximizes their potential to thrive and become healthy adults. Placements that consider a youth’s diverse  
SOGIE and prioritize youth’s views about their own safety and wellbeing not only nurture children but  
help protect them from negative effects of living in an otherwise unaccepting society. By adopting and  
implementing gender affirming policies and practices, child caring institutions promote the safety, permanency,  
and well-being of children with diverse SOGIE.  
In summary, the proposed language will enhance the wellbeing of youth with diverse SOGIE. We at MCYJ appreciate the  
time and effort put into the proposed amendments and ask that you vote in support of the changes to R 400.4137.  
Thank you for the opportunity to share our perspective,  
Jason Smith, Executive Director  
1
Brian A. Rood, Sari L. Reisner, Francisco I. Surace, Jae A. Puckett, Meredith R. Maroney, and David W. Pantalone.Transgender Health.Dec 2016.151-  
164.http://doi.org/10.1089/trgh.2016.0012; Pariseau, E. M., Chevalier, L., Long, K. A., Clapham, R., Edwards-Leeper, L., & Tishelman, A. C. (2019). The relationship between family  
acceptance-rejection and transgender youth psychosocial functioning. Clinical Practice in Pediatric Psychology, 7(3), 267–277. https://doi.org/10.1037/cpp0000291  
2
Higa D, Hoppe MJ, Lindhorst T, et al. Negative and Positive Factors Associated With the Well-Being of Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning (LGBTQ) Youth.  
Youth & Society. 2014;46(5):663-687. doi:10.1177/0044118X12449630  
   
Placement personnel shall not automatically house youth according to their sex assigned at birth.  
(1) The presumption shall be that for transgender and gender non-conforming (TGNC) diverse SOGIE  
youth is that they are placed consistently with their gender identity. In addition to the information  
relevant to placement of all youth, personnel the child caring institution must shall consider:  
(a) The physical and emotional safety of TGNC diverse SOGIE youth and prioritize the youth’s views  
about their own safety.  
(b) Any recommendations from the youth’s regular health care professional service provider team  
about the impact of potential placements on the youth’s health and wellbeing.  
(2) Personnel Child caring institutions may shall not base housing decisions on the complaints of  
personnel staff or other youth when those complaints are based on the youth’s gender identity or  
gender expression.  
;