Her case worker said Tennessee would be a new beginning. Brie Lamarche thought so, too.

Ahead of the flight, she bought floral t-shirts from Charlotte Russe, a pair of shorts for the warm weather and snacks at the airport gate.

She didn’t know the program would be her first of seven placements in two years, at the whim of decisions by New Hampshire’s Division of Children, Families and Youth staff.

Before Tennessee, Lamarche, now 24, was a high school student who loved to dance. She joined her school’s cheerleading team and was fascinated by ancient tales of Egyptian pharaohs.

She also knew DCYF case workers by name as her parents cycled in and out of prison and extended family members shuffled her from one home to the next.

By 15 years old, she had moved into a white shingled house in Madison, with an older foster parent who had no kids of her own.

A lack of licensed families in the state means foster care can be a one-strike-you’re-out system. Lamarche struck out fast, running away within a few months.

In New Hampshire, she then had nowhere to go.

While state leaders assert a child fares best at home, the costly consequences of state spending mean kids like Lamarche are rarely offered that chance. Instead, they are routinely sent to institutions with sterile walls, strict rules and an artificial sense of normalcy.

Kids who enter foster care in New Hampshire are three times more likely to end up in a residential program – like group homes, treatment facilities, hospitals, detention centers and institutional settings – compared to national averages.

The state invests ten times more on residential cases – which totaled $29 million in 2024 and are projected to increase to $52 million by 2027 – than foster care and community-based alternatives.

By the time Lamarche turned 18 years old, she had lived in two treatment facilities, an adult prison (despite being a minor), two hospitals, a youth detention center, a group home and a special education school in Tennessee, Missouri and New Hampshire.

“I was a chess piece just being moved to the next play. I was nothing, I just felt nothing,” she said. “Each plane ride, it seemed to get worse and worse and then worse.”

While state leaders assert that these programs are necessary to care for children with the most complex needs and trauma, lawyers and advocates say New Hampshire’s reliance on residential care is self-inflicted. Often, these programs exacerbate the exact problems the state was seeking to solve in the first place.

Emily Lawrence, the deputy advocacy director at Waypoint, a New Hampshire-based nonprofit, can think of a dozen preventative programs that could keep minors like Lamarche in their communities. Any of them would cost a fraction of the current budget for residential care.

“If you look at the national conversation about reducing waste and fraud and money, this to me is very ripe for that,” she said. “It is thousands of dollars cheaper to keep kids in the community than to send them to residential.”

A Monitor analysis found:

■New Hampshire Children are routinely sent out of state for care, with some placements in neighboring New England communities and others as far as Florida, Oklahoma and Arkansas.

■Despite federal reports detailing abuse in facilities run by Acadia Healthcare and United Health Services, the two hospital companies are the main providers of out-of-state care for New Hampshire kids.

■The state of New Hampshire has still reecertified facilities, namely the Cedar Ridge Behavioral Hospital in Oklahoma, after published federal reports of sexual abuse.

■The certification process for vetting out-of-state facilities is largely dictated out by facilities themselves, containing promotional material absent any meaningful scrutiny from the state.

■Although state employees have set goals to reduce New Hampshire’s reliance on residential care over the next few years, budget proposals continue to invest in institutions at a rate ten times higher than community-based services.

‘It felt like months’

A thick velcro quilt substituted Lamarche’s clothes, and a mat on the floor served as a bed. The cell was small, not to mention crowded. Two other older women twice her age lived there, too.

Lamarche was 17-years-old, being held in an adult prison in Missouri, 1,200 miles away from home. She faced assault charges after attacking a staff member at the residential facility where she was living.

In the eyes of the Missouri court, she was no longer a juvenile. Under New Hampshire law, she was still a kid and the state was her parent.

Her story started with a plea, begging case workers to remove her from her father’s care. She had met him for the first time on her 13th birthday. Not long after, federal drug charges sent him back to prison for another eight years.

Her first placement in foster care was cut short after her foster mom stopped her from attending her grandmother’s funeral.

A missing persons alert jolted the state to be on the lookout for a 16-year-old with long black hair and a diamond piercing on her bottom lip as she hid in the woods in Nashua for three days.

“I turned all my grief into anger,” she said. “That was the only way I could channel grieving somebody I had lost and someone I couldn’t say goodbye to.”

The runaway report was a black mark in her case file that would continue to grow over the next few years. She was told no other foster family or any residential program in New Hampshire would want to take a chance on a girl who might bolt.

The only option, according to her caseworker, was to enroll in a residential program in Tennessee. She’d have a bed to sleep in, food to eat and 24/7 supervision.

At the time, her only way to cope was listening to music. But the program took her iPod away.

Again, she tried to break free, digging under the fence that lined the facility. Within a matter of months, she was kicked out. Her caseworker was back on a plane, escorting her to a new program in Missouri.

Missouri was marked by a long line of doors that looked like an intensive care unit on a hospital floor and vinyl panels that checkered the floor.

She broke ceiling tiles and pulled the fire alarm. She landed in the hospital, too, after swallowing miniature pencils in an attempt to escape.

New Hampshire case workers sent her here. They were also responsible to come pick her up.

“Every day I was in there it felt like months. I was doing whatever I could to just get out of there,” she said. “I wasn’t safe. That was the most trauma that I have ever been through… I blamed DCYF for a long time. I’m like, ‘You guys allowed this, you guys gave me trauma when you guys were supposed to protect me from it.’ ”

‘Get them to a place that’s safe’

When Lamarche was in the state’s custody, care for kids looked vastly different.

In 2016, a complete overhaul of the child protective system was underway after a series of high-profile deaths of kids in care. Over a hundred kids were sentenced to jail at the Sununu Youth Services Center at a time, and New Hampshire had no facility that provided in-patient psychiatric care.

Today, the population of sentenced kids hovers at around a dozen. Families have access to mental health support through a designated Children’s Bureau for Behavioral Health. State lawmakers, judges, lawyers, advocates and department heads meet regularly to talk about shortfalls and strengths of care for kids in oversight meetings.

National nonprofits have celebrated this work too, showcasing New Hampshire’s approach to children’s services as a “21st-century model.”

Amidst these improvements, though, the use of residential programs has remained constant. An average of 355 children were in institutional care each year from 2020 to 2024.

Patricia Tilley, an associate commissioner for the Department of Health and Human Services, is quick to set the record straight. Residential care in and of itself is not bad, she said.

The state works with 100 programs across the country, some contracted with an Executive Council signature, others certified with a state employee sign-off.

These live-in programs are a necessary component of care for kids who have likely already experienced trauma, she said.

“Just by the nature of their trauma, by the nature that we are in guardianship of them,” she said. “We are at the behest of foster parents who have different abilities to wrap their arms around a child with challenging health conditions, a child with challenging psychiatric conditions, challenging behaviors.”

It’s also an expensive choice.

Residential cases cost $63,000 on average in 2024, according to budget requests. In coming years, that will only increase to $118,000 by 2027.

Residential rate increases and a loss of Medicaid funding meant budget requests included $18 million through the next two years, as well. In comparison, rate increases to boost pay for foster families are below $1 million.

The state expects foster care and in-home support to become more costly, too. Budget predictions account for more than a 75 percent increase in the average price per case.

By 2027, foster care, which was $4,200 per kid in 2024, would be $7,800. In-home care is projected to rise from $6,100 to $10,700 in the next three years.

Last year, New Hampshire spent $53 million on care for children in state custody. Kids in residential programs made up 9% of the population but received 54% of all money spent.

To Tilley, it’s hard to parse out who foots the bill to send children to these facilities. In some cases, Medicaid covers costs or school districts help contribute to educational components.

Still, each program comes with a defined daily cost of attendance.

Rates at two facilities in Florida are $840 and $970 a day respectively. In Oklahoma, a hospital charges $750 per day.

Last year, the state approved $365 million in contracts with 14 programs in New Hampshire, Massachusetts and Vermont over the next two years – which only accounts for one-third of the facilities the state works with. The figure is a spending cap, meaning the state only pays for what they use and can’t exceed this number, but still illustrates the upper echelon of the cost of care.

Daily rates are a skeleton of the true cost incurred when sending children to live-in facilities. Transportation to get them there and mandated visits from staff throughout treatment are added factors.

The state has set a goal to reduce the number of children in state custody who are in residential care by 10 percent by December 2026. To do so, Tilley and department leaders talk about the need to have more kids in foster care or kinship settings, living with extended family or friends.

This fall marked the first time that the number of kids in kinship outpaced foster care, a trend celebrated by the agency.

At the same time, a department request to create a therapeutic foster care program – reimbursing families at far higher rates to serve kids with the highest needs – was met with no bids from providers.

Still, the long-term outlook of placing kids in home-like settings can be hindered by the immediate need to find a bed for children in state custody as soon as possible.

“That’s in part where all the heart is. Let’s get them to a place that’s safe. Safe for them, safe for the community,” said Tilley. “And then we can sort of take a breath like, okay, they’re safe.”

‘No one’s going to want the child’

Lisa Wolford, a children’s welfare lawyer who has represented system-involved kids for two decades, can describe Lamarche’s case without looking at her specific file.

It’s a routine pattern of events – a child in New Hampshire’s care is sent to a residential facility, only for their actions to escalate in response to the isolation. They’re frustrated that they’re removed from their family, friends and school and lash out.

Wolford, who founded the Children’s Law Center of New Hampshire in 2021, has heard the same refrain – there’s no other place for the kid.

“Our experience is that there often is no discharge plan when the child is experiencing significant emotional and behavioral dysregulation, because the DCYF position is no one’s going to want the child,” she said. “No foster home is going to take this child.”

From there, a cycle of placement after placement begins until they age out of the system at 18 years old. At that point, they’ve been removed from their community for years, with more trauma and new mental health diagnoses.

This pattern is spelled out in a court case, too. An ongoing lawsuit filed in 2021 accuses the state of unnecessarily institutionalizing older teenagers with disabilities. The class action suit, which is set to go to trial in 2026, claims kids are sent to placements with no specific treatment plan and kept for longer than necessary.

New Hampshire is not alone in this critique.

Maine’s behavioral health system routinely places kids in settings that don’t serve their needs, according to the U.S. Department of Justice investigation from 2022. Like New Hampshire, findings reiterate a dependency on residential programs that separate kids from their families and communities.

In part, it’s the product of providers’ business models, as well.

Last year, a federal investigation uncovered that children were held at maximum capacity facilities run by four major providers – Universal Health Services, Acadia Healthcare, Devereux Advanced Behavioral Health and Vivant Behavioral Healthcare – with under-qualified, barebones staff to turn a profit.

Reports of abuse and neglect were also rampant, including a sexual assault case at a behavioral hospital in Oklahoma that specializes in care for LGBTQ children.

In July, the state re-certified this hospital as a destination for Granite State kids. From 2022 to 2023, New Hampshire sent three children to the hospital, according to the Department of Health and Human Services.

Programs run by Universal Health and Acadia make up 18 of the 30 national facilities that New Hampshire has approved.

Investigations highlight the horrors of these facilities. But through her clients, Wolford sees the everyday stress of placements, too. There’s kids who miss out on playing on sports teams after they’re removed from their community. There’s others who long to live with a grandparents in a nearby state, but don’t understand why they can’t

It’s a practice that’s highly disruptive, she said. But she imagines it’s hard to end without a legislative mandate to do so.

‘I was happy at one point’

By the time Lamarche settled at the Davenport School in the Northern New Hampshire town of Jefferson, a now-defunct special education school, she had two high school credits. Her former classmates were set to graduate that year.

At Davenport, which is located north of Mount Washington, she enrolled in online classes and was able to complete her degree. For the first time, she earned privileges to be an independent teenager, relishing in the trust to go to the grocery store.

“It felt great. I never experienced that before,” she said. “They didn’t give up on me. They didn’t see me as that runaway. They did take that leap of, ‘We’ll see if this works for her,’ and it did.”

But after years of shuffling between placements, her mantra on her 18th birthday was simple: “I want you guys out of my life.”

For Lamarche, independence meant cutting ties with her DCYF case worker and sleeping under bridges in Manchester. She experienced homelessness for two years before she picked up the phone and called the state for help.

Now she lives in an upstairs unit of a duplex in Rochester. Her four cats – Apollo, Hennessey, Tiger and Blaze – climb the window sills. A stick and peel Yoda poster was the first thing she hung in the kitchen.

She’s started to tell her story publicly, too, travelling to the U.S. Capitol with the National Runaway Safeline and in staff training sessions with DCYF. Each time, she wears a necklace with her late grandfather’s ashes.

But this public work masks the fact that Lamarche says she feels jumpy in large crowds and nervous around most people – the direct result of a situation that could have been, and should have been, completely avoided if she had another chance in foster care, she said.

“I still have a lot of trauma that’s ongoing and I don’t think I am ever really going to heal from it unfortunately,” she said. “It’s sad because that’s the only option that DCYF had at the time.”

Stacks of old photos are helping stitch together a childhood that isn’t defined by a thick case file.

In one, she’s at her kindergarten graduation, posing in blue robes. In another, she’s six or seven, with her arms around her late grandmother, a short brunette bob and a snaggle-toothed smile.

“I don’t remember me as a kid,” she said. “So reliving the moments of just like, I was happy at one point. That’s really cool.”

This story was produced with help from USC Annenberg Center for Health Journalism’s 2024 Data Fellowship. To read the full series visit: https://nnedigital.ac-page.com/concordmonitor-sent-away-2025