Roberta Opheim, state ombudsman for mental health and developmental disabilities, said the children's behavior "was a cry for help by children in mental anguish.” (Star Tribune/The Minnesota Star Tribune)

A St. Cloud child treatment center with a history of regulatory violations has been cited for failing to prevent three teenage residents from "daily and persistent" head-banging over a period of weeks last May, which resulted in multiple concussions, facial injuries and head trauma.

The St. Cloud Children's Home, a 60-bed treatment center for children with depression and other mental health problems, was cited for neglect and ordered to pay a $1,000 fine, according to an investigation released last week by the Minnesota Department of Human Services.

State investigators found that the three children banged their heads against walls and windows "to the point of bleeding" and required medical attention. At least two of the children received emergency medical treatment; they also sustained black eyes, swollen faces, headaches and abrasions. The children, who were ages 14 to 16 at the time, suffered from a wide range of mental health conditions, including depression, post-traumatic stress disorder and suicidal thoughts.

Investigators concluded that staff knew the children were banging their heads violently but allowed the behavior to continue after a manager asserted that it would not cause permanent or serious brain damage. At one point, the three children were escorted to their bedrooms to prevent others at the facility from copying them, the report said.

This marks the fifth time since last December that the St. Cloud Children's Home or its staff have been found responsible for neglect, state records show.

In July, a 12-year-old resident with a history of self-injury got onto the roof four times, sustaining burns to both feet. Another child fractured a finger while being placed in a physical hold by staff but was not taken for medical care for eight days. Late last year, a 13-year-old child was dragged by staff across the floor, sustaining two rug burns, after breaking some of the facility's windows. And in 2013, the state temporarily placed the home's license on conditional status after investigators documented several incidents of inappropriate sexual contact between residents.

The state's latest determination is unusual because it holds the treatment center, not individual staff members, solely responsible for neglect.

In the last fiscal year, the department substantiated 349 cases of maltreatment at group homes, child care centers and other state-licensed programs; but in two-thirds of those cases, only individual staff members were found responsible. The provider, or facility, was held solely responsible in just 16 percent of the cases, state data show.

Regulators took the rare action in the head-banging incidents because the neglect appeared so pervasive. "Staff persons at all levels of authority were aware of the [children's] head banging yet failed to take action and failed to prevent [the children] from head banging and sustaining serious injuries …," the state wrote.

One of the children engaged in head-banging as a way to "scramble" scary thoughts and as a way to "pass out" in order not to be scared, the state report said. Another child began the behavior after sharp objects were taken away.

"This was a cry for help by children in mental anguish," Roberta Opheim, state ombudsman for mental health and developmental disabilities, said of the behavior. "What they should have been doing is spending some intensive, one-on-one time with those children to find out what was going on and trying to keep them safe."

A spokeswoman for Catholic Charities, which runs the treatment center, said the facility plans to appeal the agency's finding, saying the state investigation failed to reflect "all the information" shared by the facility to investigators.

"We really feel like the hard work and the professional care of our staff was not reflected" in the state report, said Trina Dietz of Catholic Charities. "We took many, many measures to provide the safest care for these kids."

The treatment center conducted an internal review and determined that its policies and procedures were adequate and followed, and there was not a need for additional training as a result of the investigation, the state report said.

In the May incidents, there did not appear to be a consistent approach to dealing with the children's behavior. At times, the children were placed in restraints when they banged their heads, or staff members intervened by placing their hands behind their heads. However, at many other times, children were allowed to continue the behavior for long periods, investigators found. The noise was loud enough that it could be heard throughout the locked cottage where the children lived, an employee told state investigators.

"The head banging lasted approximately one hour and was 'very' troubling to hear," according to a staff person, who did not intervene.

State investigators found that facility managers either instructed staff to allow the head-banging, or to not intervene until there was "imminent" damage. One manager told staff that children had a "right" to engage in the behavior and would not sustain a traumatic brain injury. Another staff member said the children "would not lose their intelligence quotient [IQ]," and that it was not possible to know the long term effect of head-banging.

Chris Serres • 612-673-4308

Twitter: @chrisserres