Scathing report criticizes care at Burien youth mental health center

In July 2024, Washington’s Department of Social and Health Services opened a youth treatment center it dubbed “the first of its kind.”

The Lake Burien Transitional Care facility was supposed to fill an unmet need: treating youth with significant developmental disabilities and mental illnesses in the short term, before sending them back into the community, stabilized and able to live at home with their families.

A year and a half later, a report from the state’s largest disability rights organization revealed grave concerns: children’s basic needs neglected; a lack of supervision leading to inappropriate behavior among youth, excessive physical restraints and a lack of therapeutic treatment.

The Office of Developmental Disabilities Ombuds published the report in January after months of regular visits to Lake Burien. The ombuds office, a program of Disability Rights Washington, the state’s largest disability advocacy organization, investigates places that serve people with developmental disabilities. In addition to spending time at the facility themselves, they interviewed three families and eight residents for the report.

The report described children with unexplained bruises on their bodies, and concerns that staff were intentionally agitating children to justify physically restraining them.

One parent said her child was inappropriately touched by another resident, while in the care of staff who were supposed to be supervising them. The same parent said her child was not fed enough during his stay, and didn’t receive individual therapy for almost his entire time at Lake Burien.

Because the facility’s record keeping has often been “incomplete or missing altogether,” the report said, it was unable to report the precise number of allegations.

And because the facility is not managed by any independent governing body, complaints about abuse and neglect often went nowhere, the report alleged.

“The organizational mismanagement of the facility was pretty astounding,” said Leigh Walters, a regional ombuds and one of the main authors of the report.

The report highlights Washington’s ongoing difficulties in serving some of its most vulnerable youth residents. Families face long waits to find their children a spot at one of the limited facilities that serve youth with acute needs. They may be turned away if their children don’t meet specific criteria or their behaviors are deemed too severe. And when children do enter these facilities, their stays are sometimes more traumatic than therapeutic.

The ombuds office recently met with the state to discuss the report, said Upkar Mangat, the deputy assistant secretary for DSHS’ Behavioral Health and Habilitation Administration. He said the two groups will continue talking over the next few months.

Mangat said his office takes the report seriously and plans to make changes where necessary.

“We believe if we have the care and custody of people, we need to go the extra step, because people are trusting us with their loved ones,” Mangat said. “We’re going to act on it as if it happened, and let’s listen. It gives us the chance to improve.”

He said since the report came out, the facility’s “quality assurance” has become very tight, and the state has increased its oversight. He said he also now spends one day a week working at Lake Burien, and has been doing so for three or four months.

Noah Seidel, a regional ombuds who worked on the report, said the office is still waiting for a formal written response from the state detailing their plans to improve the facility.

‘First of its kind’

The state opened the 12-bed facility in just 90 days, after taking over an unused property on the eastern shores of Lake Burien. The facility has in some capacity housed vulnerable youth for nearly a century — first as the Ruth School for Girls in the 1930s, then as a place for foster children. Until 2021, the property was a treatment facility for youth with serious mental illnesses or behavioral health concerns.

In 2024, DSHS leased the facility to create a transitional program where they could move kids who had languished in emergency rooms and hospital wards into a more appropriate setting.

In a 2022 report about the lack of treatment options for youth in crisis, the ombuds office found there was only one state-run facility specific to kids with developmental disabilities. It could only help three kids at a time. Washington’s “Children’s Long-term Inpatient Program,” which treats kids with broader behavioral health challenges, only had 94 beds for the whole state. A Seattle Times investigation that year revealed that as a result of limited bed space, hundreds of children had been stuck in emergency departments with nowhere else to go.

Since Lake Burien’s opening, disability rights advocates say they’ve seen youth getting out of hospitals sooner. But many are still languishing once they’re at the transitional facility.

“Putting this many youth together — this is just another place where people are getting stuck. They’re not getting that next transition,” said Seidel.

According to the state, 20 kids have been admitted to Lake Burien since it opened. Eight have been discharged, with five returning home and three returning to a hospital.

Linda, a Seattle-area parent whose son spent about two months at Lake Burien, has struggled for years to find help for her son. Adopted from foster care as an infant, he has experienced behavioral health challenges his whole life stemming from trauma and an autism diagnosis. The Seattle Times is using Linda’s first name only, and not identifying her son, because of the nature of some of his experiences at Lake Burien.

He had spent time at Seattle Children’s Hospital in their emergency mental health wing, as well as at the hospital’s Psychiatric and Behavioral Medicine Unit, a short-term specialized unit for youth in crisis. But he had also been turned away from that service — during one stay at the hospital, his family was told he required one-on-one attention, and they didn’t have the staffing for it. He was sent home, despite having been violent with his family.

“You get to a point where you’re literally in a box and there’s no services,” Linda said.

Lake Burien was recommended as an alternative by a state caseworker. Their son could receive intense individual therapy, speech therapy and Applied Behavioral Analysis, a type of therapy for people with autism.

But within a few weeks of their son’s stay, Linda and her husband said it became clear those services were seldom, if at all, being provided.

According to emails between Linda and the state, her son was not assigned to an individual counselor for six weeks of his stay — nearly the whole time.

In an email, DSHS staff told Linda that her son’s individual therapy was delayed due to scheduling conflicts, particularly when he was off-campus at school during clinical hours. But, Linda said, the facility never even identified a provider for her son.

Linda also said staff didn’t follow her son’s medication plan — which stated he must eat before being given medication, or else his appetite would be suppressed. They soon learned staff were giving him medication a half-hour before he ate.

They also found out that staff at their son’s school observed him eating out of the garbage can. Unlike most residents, their son went off campus to a school for neurodivergent children. Linda said Lake Burien was supposed to give her son breakfast and pack him a lunch and snacks, but weren’t doing so. Because it was summer, the school did not have its usual food services, Linda said.

Her son’s teachers also reported that he had very strong body odor and stained clothing, and was being sent to school in clothing inappropriate for the weather, she said.

Mangat said he wasn’t aware of the details of every specific case, and couldn’t comment on them, but said the things detailed in the report “shouldn’t be happening.”

But he said kids who are sent off campus for school are sent with an appropriate amount of food, and that staff had looked into that claim.

The report also detailed several incidents of children being restrained, such as a staff member pushing a child down, and a child being restrained face down with a staff member putting a knee in their hip. Children were also seen with bruises. The report said a lack of staff training may have led to an overreliance on restraint.

The investigation reports concerns that lead staff was intentionally agitating children to justify physically restraining them,” the report said.

Mangat said staff receive two types of training around restraints. One uses blocking pads, trying to redirect the patient if they are being physically aggressive, but not touching them. The other, he said, requires two staff members to hold a patient. All staff are trained in both methods, he said.

But he said the facility’s use of physical restraints depends on the situation and each child’s treatment plan.

“When everything else fails, like the (noncontact) hold and talking to them, then to protect the client from self-harm or causing harm to others, the staff restrain them,” Mangat said.

Linda said her son’s experience at Lake Burien ended abruptly after a July incident.

She said her son told his father and a driver on the way to school that another resident had inappropriately touched him. Staff were in the room and should have been supervising, Linda said.

When she tried to call her son after she learned of the incident, Linda said staff at Lake Burien tried to prevent her from talking to him. An email from Linda to BHHA staff states that when she called, a staff member told her that her son did not want to talk to her because he was watching TV. Linda said after repeated calls, staff let her talk to her son on speakerphone for less than one minute.

Linda and her husband made a report to the Washington State Department of Children, Youth and Families, as did the school.

But she said they never received any follow-ups.

Shortly after the incident, Linda pulled her son out of Lake Burien.

Mangat, the BHHA executive, said he couldn’t address the specific case. But he said BHHA thoroughly investigates all allegations of abuse and neglect.

Looking ahead

Walters, the ombuds, said they hope DSHS will implement independent oversight of Lake Burien.

That could happen if the facility gets certified as a Medicaid institution, meaning it would get federal funding and have to meet federal standards. The facility also could get licensed by the state’s Department of Health as well as federal surveyors. Currently, only one agency — DSHS — is overseeing it.

In late February, Mangat said the state Department of Health has recommended Lake Burien receive state licensure, but they have to complete some final steps. The agency is also working with the Health Care Authority with plans to apply for a Medicaid match soon.

Walters said while the conditions at Lake Burien are concerning, the problem starts far before that.

“The expectation for families and youth is that these kids have to fail before the level of intervention and the level of support becomes higher,” Walters said. “The emphasis needs to be on bolstering services in the community. Otherwise, this problem is going to keep getting worse.”