Cassandra Sanchez hadn’t left the parking lot before she hit send on the email.

The two boys living at the Bledsoe Youth Academy in Tennessee needed to return to New Hampshire immediately.

Sanchez, New Hampshire’s child advocate, expected a home-like setting for two Granite State children who were living at the facility to receive intensive mental health care.

Brochures promised weekly therapy, monthly field trips and family visits where the program would help cover travel and hotel expenses.

Instead, she found a prison-like setting with barbed-wire surrounding the outside and a culture of shame, humiliation and retaliation inside.

One boy hung his head while forced to eat lunch alone on a sticky carpet outside the typical cafeteria. A New Hampshire kid teared up, recounting that staff told him, “you’re here because your uncle raped you.”

From her rental car, she wrote to New Hampshire state leaders with an immediate demand: Bring the two boys home. They were back within the month.

The Office of the Child Advocate has served as a critical eye over care for children in New Hampshire since it was created in 2018.

The independent watchdog agency’s work might be short-lived.

The proposed state budget – which will go before the full House for a vote on April 10 – would eliminate the Office of the Child Advocate entirely.

“We’ve been told, ‘we’re looking to cut as much as we could.’ So I knew that,” said Sanchez. “I did not know that repealing our statute and eliminating the office was going to be an option.”

Several other budget provisions will also make it hard for the state to meet its goal of reducing residential care by 10 percent by the end of 2026. House lawmakers have proposed delaying the right to legal counsel for children in dependency proceedings, eliminating an online resource center and cutting Medicaid reimbursement rates by 3%.

‘No oversight entity’

Brielle Gage had bright blue eyes and pierced ears. Sadee Willott hadn’t turned two yet.

Both toddlers were killed by their mothers in 2014 and 2015, respectively. Despite documented reports of abuse to child protective workers, the girls remained in their homes until their deaths.

Lawmakers promised better protection and oversight. The Office of the Child Advocate was one of a few immediate reforms.

With access to all case records and the authority to independently investigate any child protection policy or practice in the state, the office brought transparency to the state’s child welfare system, which otherwise remains cloaked behind confidentiality. Sanchez and her staff office responded to 349 complaints and reviewed nearly 3,000 incident reports, most of which were uses of restraint and seclusion or related to residential facilities from July 2023 to June 2024.

The work also entails routine visits to children in residential settings -- from Hampstead Hospital to the Sununu Youth Services Center and other facilities both inside and outside the state.

In one out-of-state visit last year, Sanchez’ office checked in on a child at a psychiatric residential facility in Oklahoma, after all placements in New England were denied. They found the child was over-medicated and staff were not following New Hampshire state laws on consent to medication.

The child was returned to New Hampshire after the visit.

At its inception, New Hampshire was the 14th state to introduce the ombudsman-like advocate for children. Sanchez is the second person to hold the position after Moira O’Neill stepped down in 2021. Today, 33 states in the country have a similar office, according to the National Conference of State Legislatures.

While comparatively new, the child advocate is an integral part of state government that Governor Kelly Ayotte wants to see protected, even in lean times while her own commission on government efficiency looks for savings.

“That’s really important to me, and so I don’t agree with what the House did in eliminating the child advocate and position,” Ayotte said in an interview. “I think that role is important to make recommendations as to how we can further improve our child protection system.”

Ayotte is now looking to Republican Senate President Sharon Carson, who was instrumental in establishing the office in 2018, to make sure the position is reintroduced in the next phase of the budget process.

“It’s really important that we protect children, and I think that is an important priority,” Ayotte said. “It certainly was prioritized in my budget. And I would hope that the Senate would address this issue.”

Carson declined an interview for this story.

The state knows what happens when institutional abuse goes unchecked. New Hampshire has a horrific past of child abuse in the state’s Youth Detention Center, where almost 1,300 former juveniles claim they suffered at the hands of state guards.

On average, 350 children in New Hampshire are sent to residential treatment facilities, according to a Monitor analysis. While most of these programs are in New England, a handful of minors are sent away to national programs, where little oversight exists on day-to-day operations and conditions. Some children said the treatment they were supposed to receive felt more like incarceration and only added to their trauma.

Prior to the child advocate’s visit to Bledsoe in Tennessee, state employees from the Division of Children, Youth and Family had made their own trips. They reported no concerns.

Without her office to scrutinize and continue to monitor activity in these facilities, Sanchez wonders what the state could be liable for.

“The oversight we provide, what we identified at Bledsoe, the YDC lawsuits and how much the state is paying out because of the abuse that went on for far too long, there was no oversight entity in the state at that time,” she said. When we’re really talking about what would be missing without our office here, let’s look back at what was going on in the state before we existed.”

Sanchez’s work is backed by federal data.

An investigation from the U.S. Senate uncovered widespread abuse in children’s institutional facilities run by four major hospital providers. New Hampshire routinely sends kids to these facilities, which are located across the country, despite the documented concerns.

“We need to continue to follow up. It’s something that I hope to be able to dig into,” U.S. Senator Maggie Hassan said in February. “We need to make sure our kids are getting the very best care and with the very best oversight we can.”

The conversation among New Hampshire House lawmakers to cut funding for the one oversight office lasted four minutes.

Rep. Rosemary Rung, a Merrimack Democrat, said eliminating the office would be the direct antithesis of the $150 million approved for settlement funds for the Youth Detention Center.

“This is one of those positions, one of those offices that actually is a cost savings to us in the long run,” she said. “It’s pennywise and pound foolish to get rid of this.”

Rep. Dan McGuire, an Epsom Republican, had no response to Rung. He also did not respond to interview requests for this story.

He’d been tasked with cutting $200 million from the state budget as the chair of a state finance committee. Cutting the child advocate would be $2 million right then and there. Besides, Sanchez’ was due for reappointment in 2026, he said.

‘Wreaks havoc with kids’

Until last year, New Hampshire was one of six states that did not offer legal counsel to children in dependency hearings.

These are children who are victims of abuse and neglect, subject to placements in residential treatment facilities nationwide.

When then-governor Chris Sununu signed a bill into law last July reversing course - ensuring that children were entitled to attorneys beginning in July 2025, lawyers like Karen Rosenberg, the policy director at the Disability Rights Center New Hampshire, took a sigh of relief.

“These are children who are in the most precarious, vulnerable situations. They’ve already been yanked out of their homes. They’re being looked at being yanked out of their communities, their schools, away from their friends,” Rosenberg said. “When they’re in these really challenging times, they will have an attorney who will be able to ensure that their voice is clearly articulated and that the court hears them.”

This change may not come to fruition until 2027, though, with Ayotte’s budget delaying the start date for two years.

To Ayotte, the delayed start will allow the state to further study the new policy change in a “tough budget environment,” she said, and prioritize funding direct services for children.

Rep. Mary Jane Wallner, a Concord Democrat, disagrees. She proposed shortening the delay, bringing the law into effect on January 1, 2026.

“I think it’s really problematic,” said Wallner. “The longer you delay it, the more likely it won’t happen.”

To Rosenberg, the delay in counsel also hinders the state’s ability to keep children closer to home – a sentiment that was also cemented in law last year.

Last July, Sununu signed legislation that stated the best residential placement for kids was one that was less restrictive and closest to home. The bill also increased oversight on these facilities, a direct response to Sanchez’ visit to Tennessee.

In the two years since Bledsoe, the facility name has become a common lexicon among lawmakers and advocates -- referring to a worse-case scenario situation for kids in state care.

Among a list of reforms issued by the child advocate, one contained a larger call to action: To end all out-of-state residential placements beyond the New England region.

That request has yet to be fulfilled with children placed in programs in Alabama, Arkansas, Florida and Louisiana as of February. Current budget proposals also threaten that goal.

Advocates and lawyers often make the case that with access to community-based services, the use of residential facilities could be brief, if at all necessary.

While mental health providers celebrated a 3% increase to Medicaid reimbursement rates in 2023 budget, this year House finance committee members voted to decrease the rate by the same margin.

To Rosenberg, that will be a detriment to accessing care at home.

“It is important for children and adults, for everyone to be able to receive services in the community and not have to be ripped out of their homes and put in residential programs,” she said. “It wreaks havoc with kids, and if the idea is to reduce the use of residential places, we need to have community-based services available.”

Locating these at-home options could soon be more challenging, as well.

Last fall, the state launched the Children’s Behavioral Health Resource Center – an online website that allows families and providers to navigate mental health resources in the state. The tool allows users to search by location, age, intervention, symptom or diagnosis. There is also a filter for providers that accept Medicaid.

The site costs $1 million to maintain over the two-year budget.

Ayotte said the recommendation to shutdown the website was made from the Department of Health and Human Services before she took office.

“When we were looking at the priorities within the budget, we wanted to make sure we could preserve direct services to the most vulnerable people,” she said. “We believe that there’s other ways we can promote information and provide information to families that are looking for it.”

Sanchez argues these slight cuts will come with high costs.

It’s hard to quantify the absence of something, she said. But knowing what state care looked like prior to her office, and the investment in mental health services for kids that have progressed in recent years, inventions early on can make or break a child’s involvement with the state as an adult.

“How do we avoid outcomes that lead children to need to rely on the adult system?” she said. “When you have those safeguards in place, the long-term outcomes are less costly.”

 

Michaela Towfighi can be reached at mtowfighi@cmonitor.com. 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