COLUMBUS (AP) — Combative youth, how guards restrain them and the guards’ failure to coordinate their responses to violent run-ins are all to blame for injuries to juveniles at an Ohio youth prison with the highest rate of such incidents, a study found.

The Department of Youth Services’ six-month review of the Ohio River Valley juvenile center in southern Ohio also said wet and slippery floors sometimes created hazardous situations for falls.

The report said most of the cases where guards had to restrain young people involved juveniles with violent backgrounds, histories of hurting themselves, gang involvement and mental health problems.

“These factors contributed to the likelihood of an incident,” said the review by DYS facility resource administrator Patrick Hurley. “These factors do not justify the injuries, but certainly establish high-risk situations.”

Multiple guards trying to subdue a young person “in an uncoordinated engagement” also resulted in falls that hurt juveniles, the report said.

Portions of the April review were incorporated into a 144-page report released last week that analyzed progress and problems in Ohio’s five youth prisons. The Associated Press obtained the full review through a records request.

Hurley said he didn’t find evidence that guards at the center acted maliciously, but there were cases where their actions were out of compliance with agency policy.

The 144-page report released Wednesday said the rate at which guards injure youths during discipline in Ohio’s five centers is declining but is still too high, and it appears prison staff don’t have the skills to properly conduct hearings about such discipline.

Ohio River Valley sees the most frequent use of force by guards across the system, the report said, due in part to the large number of juveniles and their relatively extensive security needs. Still, the report concluded, “the frequency is disproportionally high.”

Almost all cases of young people breaking bones during restraint happen at Ohio River Valley, the review said. It did not give exact numbers of incidents.

Wednesday’s report also said Ohio River Valley and the state juvenile prison in Circleville have dangerous gang problems.

DYS has until mid-July to formally respond to the report. The agency said last week it is making progress but knows more can be done.

Ohio agreed to make widespread changes following a 2004 lawsuit that uncovered evidence of a culture of violence permeating its seven juvenile correctional facilities, including excessive use of force by guards. U.S. District Judge Algenon Marbley approved the lawsuit’s settlement on May 21, 2008, and set a five-year deadline to fix the problem.

Since then, the number of young people in DYS facilities has continued to drop, thanks in part to a decrease in youth crime and an increasing use of county-run facilities that keep juvenile offenders close to home.