RI DCYF must build supports for children with mental health issues, feds say
PROVIDENCE – The state Department of Children, Youth and Families has reached a consent decree with federal authorities over allegations that children with behavioral and mental health disabilities were being illegally housed at Bradley Hospital for weeks, months and even more than a year.
U.S. Attorney Zachary A. Cunha on Thursday announced that the U.S. Department of Justice, in collaboration with the U.S. Department of Health and Human Services Office of Civil Rights, had reached a proposed agreement in which the state pledged to provide children with behavioral health disabilities community-based services that will allow them to stay in their homes, and to recruit therapeutic foster families for children with a higher level of need.
“Providing these services is the state’s obligation,” Cunha said.
Under the Americans with Disabilities Act, “there is a clear legal obligation on states to provide services and programs for individuals with disabilities in the most integrated setting appropriate to the individual’s needs.” The consent decree is intended to remedy the state’s alleged noncompliance with the ADA and transition children back to the community and prevent children with behavioral health disabilities from prolonged psychiatric hospitalizations.
The state’s compliance with the decree will be overseen by a monitor and U.S. District Chief Judge John J. McConnell Jr. for five years. If the state falls out of compliance, it could be found in contempt.
A spokeswoman for DCYF did not respond immediately to an email inquiry about how the plan would be unrolled and the estimated cost of the measures.
Feds allege unnecessary segregation of children with disabilities
The Department of Health and Human Services launched an investigation in 2021 after receiving complaints about the lengths of stay for children in DCYF care who were admitted to Bradley. The Department of Justice joined the probe in 2022.
In May, Cunha unveiled findings that Rhode Island’s unnecessary segregation of children with behavioral health disabilities in a psychiatric hospital violates federal civil rights laws. Instead of placing children with such disabilities in intensive in-home or community-based programs, DCYF has been overrelying on hospitalizations.
“Rhode Island has failed, miserably and repeatedly, to meet its legal obligations to children with mental-health and developmental disabilities,” he said.
More:‘Appalling’: Feds accuse RI DCYF of ‘warehousing’ children at Bradley Hospital. What to know.
Federal prosecutors on Thursday filed a complaint in U.S. District Court alleging that the state failed to ensure that children with disabilities had access the intensive in-home and community-based services, and failed to facilitate prompt discharges from Bradley, resulting in extended, unnecessary hospitalization, or risk of future hospitalization, in violation of federal law.
The complaint was filed simultaneously with the proposed consent decree.
Who will be checking if RI is compliant?
Under the decree terms, a monitor will be assigned to assess the state’s plan to implement the changes within two weeks of the court approving the agreement. The monitor, whom the state will pay up to $250,000 a year, will report to McConnell.
An independent consultant will review progress and make recommendations to the monitor.
The state will identify children in the “focus” population, namely children admitted to Bradley within the last year; those currently admitted to the psychiatric hospital or residential treatment facility; and others who have had three or more emergency room visits in the last year.
Within 180 days of the court’s approval, the state will provide an overview of the focus population and open cases, and an accounting of community-based supports in Rhode Island, as well as details about the number of therapeutic foster homes statewide.
The decree also calls for the state to include in its annual budget a request for a flexible fund – or “flex fund” – to address barriers to returning children to the most integrated setting appropriate to their needs that cannot otherwise be addressed through community-based services.
What will the state have to do?
Under the proposed consent decree, which is subject to court approval, the state agreed to do the following:
- Help children now hospitalized at Bradley transition to family settings and receive services at home, if their needs can be met in the home, with the assistance of an assigned transition coordinator
- Provide children and families with service planning and care coordination to improve the likelihood that children recently hospitalized can be successful at home
- Improve access to intensive in-home services, including in-home individual and family therapy, behavioral services, and therapeutic mentoring
- Address current or future shortages of therapeutic foster families and community-service providers, including providing payment rates and support, to enable children they serve to return to or remain in family settings
- Provide prompt mobile crisis interventions to help children avoid entering hospitals
- Monitor outcomes and timeliness of services
- Continue to provide a crisis hotline, such as currently provided through 988, that is available throughout the state and staffed 24 hours per day, seven days per week so that callers can be connected to a mental health professional.
Feds: RI allegations part of nationwide trend
Susan Rhodes, regional manager of the health and human services civil rights office, said the allegations in Rhode Island are part of a pattern nationwide.
“We’re seeing an unfortunate trend across the country where children are being housed,” Rhodes said.
The consent decree should serve as a model for other states, she said. “This settlement is critical,” Rhodes said, adding “We really did a good job on this particular case.”
ACLU files class-action lawsuit
The consent decree comes as the state faces a class-action lawsuit by Disability Rights Rhode Island, the American Civil Liberties Union of Rhode Island, and the New York advocacy group Children’s Rights that is intended to force change after years of “glaring failures in Rhode Island’s behavior health system for children and youth.”
That complaint cited children being hospitalized for more than a year. Children are being forced to live in locked residential facilities far from home and parents are unable to find behavioral health care services to keep their child in the community.
The three organizations on Thursday called the consent decree a first step, but emphasized that much more needs to be done.
“Our organizations applaud any effort to address the state’s serious and long-standing failure to protect the rights of children with disabilities from harsh, unnecessary, and counter-productive institutionalization. But the existing problem is far broader than children or youth who are admitted to Bradley Hospital for mental health treatment instead of appropriate community-based settings. There are many, many other RI children and youth placed in other restrictive residential care settings when their mental health conditions could be, and the law requires them to be, adequately treated in less restrictive family-like settings,” they said.
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