The transfers of the seven who remain there are expected to be completed next month, although three have asked to stay, DHS officials said. No parent has asked that a child be moved.
"The goal remains to find suitable accommodations to meet the very complex emotional and psychological needs of these children," acting DHS Commissioner Arthur C. Evans Jr. said.
Neither employee in the Leach case is there now, DHS noted.
DHS and the city's Family Court judges send children in their custody to Chad. Last month, Administrative Court Judge Kevin Dougherty ordered eight children removed and has since transferred others. Dougherty could not be reached for comment yesterday.
Chad still has a valid license but may not accept new admissions, Tennessee child-welfare officials said.
"The suspension of admissions that we put in place in June remains in effect indefinitely," said Jill Hudson, a spokeswoman for the Tennessee Department of Mental Health and Developmental Disabilities. Her office is awaiting the results of a state investigation, she said.
Experts agreed that placing difficult children could be tricky.
"Although it seems outrageous and inconceivable that the city would not have acted sooner to move the children, moving them has its own consequences," said Richard Gelles, dean of the School of Social Policy and Practice at the University of Pennsylvania.
Unless the children are in immediate danger, he said, the city wouldn't move them without making sure they could be placed in a suitable facility.
Marc Cherna, who directs the child-welfare agency in the Pittsburgh area, said the medical examiner's report underscored the need for Philadelphia officials "to try to change their practice to keep their kids close to home."
Meanwhile, Edith Pearce, an attorney for the Leach family, said yesterday that the District Attorney's Office in Tennessee had told her that it was "seeking to make sure justice was done."
The district attorney there, John Carney, was not available for comment.
Tennessee child-welfare officials cited Chad staff for needlessly provoking Leach into a fight. He was calming down in his room when a worker ordered him to leave. The two struggled, and a second staffer joined in. The two told investigators that they had followed Chad policy by placing Leach in a prone restraint as outlined by the Handle With Care program.
Bruce Chapman, 55, the president of the company that trained the workers, said his restraint technique should never result in a death when properly applied.
"There is nothing in Handle With Care that would account for that," he said of the strangulation finding.
Chapman advocates the use of restraints at a time when states such as Pennsylvania are reducing reliance on them.
He runs a Web site called "Compassionate Neanderthal," which he said illustrated that even Neanderthals had enough sense to intervene physically when children were a threat to themselves or others.
The problem of abuse at residential facilities is not isolated, according to a report released yesterday by the Government Accountability Office. The GAO found thousands of allegations of abuse, including some deaths, at residential treatment centers across the country between 1990 and 2007.
Allegations included 1,619 incidents of abuse in 33 states. In a review of just 10 deaths, the office found ineffective management and reckless and negligent operating practices. The findings relate to boot camps, academies, and wilderness therapy programs, among others.
While most states license such facilities, some don't, and there are no federal regulations.
"There is a Russian roulette quality to these places, because there are no national standards that these facilities have to meet," Penn's Gelles said.
Contact staff writer John Sullivan at 215-854-2473 or firstname.lastname@example.org.