‘The current level of dysfunction in segregating youth with mental health needs is exacerbated by the lack of adequate access to intensive in-home services and mobile crisis services… The proposed consent decree offers to address only one small part of this much bigger problem that our lawsuit tackles.’
This story was originally published in the Rhode Island Current, a publication partner of Ocean State Stories.
PROVIDENCE — Under a tentative agreement released Thursday by U.S. Attorney Zachary A. Cunha, Rhode Island has pledged reforms to its child welfare system, soothing a federal dispute over how the state cares for youth needing intensive behavioral health care.
In May, Cunha announced the findings of a yearslong investigation by the U.S. Department of Justice (DOJ) and the U.S. Department of Health and Human Services Office of Civil Rights. The federal agencies found that the Rhode Island Department of Children, Youth and Families (DCYF), which oversees foster care as well as facilitation of youth mental health services, had “warehoused” children and teens at Bradley Hospital, keeping youth institutionalized for longer than was needed.
The warehousing practices constituted a violation of civil rights, the DOJ argued, as the young inpatients were discriminated against because of their disabilities. The new agreement requires the state to enhance its transition planning for youth who are discharged, drawing a clear roadmap for more community-based services.
While Cunha noted that progress was possible with the agreement’s reforms, he acknowledged Thursday morning that the changes were hardly a panacea.
“Success is not a court filing,” Cunha told reporters at a press briefing. “Success is getting kids who don’t need to be there out of a locked ward and back into safe homes and communities with a chance to laugh, to play, to learn and to have a childhood. But today is an important step towards that goal.”
The consent decree, filed in the U.S. District Court of Rhode Island, still needs approval from a federal judge. Its provisions also require reinforcing home-based care and crisis intervention resources, as well as increasing providers of therapeutic foster care, cited as a woefully underused resource during the original presentation of findings in May.
The DOJ complaint, filed alongside the consent decree, states that DCYF violated the Americans with Disabilities Act by prolonging youths’ stays at Bradley Hospital in East Providence. Federal law requires that people with disabilities not be unnecessarily segregated, and psychiatric institutions are categorically “segregated,” the complaint explains, since inpatients receiving acute care there “typically do not interact with people other than patients and treatment staff, and their day-to-day life is highly restricted.”
“The vast majority of children with behavioral health disabilities in the care and custody of DCYF are appropriate for and qualified to receive services in the community,” the complaint reads. “The vast majority of those at Bradley Hospital have been deemed ready for discharge to a more integrated setting by their treatment team.”
Cunha reiterated what he said in May, however, that the DOJ is not alleging wrongdoing on Bradley’s part. “This case is not about Bradley hospital’s conduct,” he said. “We have not and we do not allege that the hospital has engaged in any wrongdoing.”
A court-appointed monitor will oversee the state for the next five years to ensure compliance with the agreement’s terms. A federal judge will have ultimate oversight of compliance, Cunha said. He added that the state has also agreed to have a third-party consultant assess the state’s “existing systems capacities and limitations.”
The state will use that assessment, as well as input from a stakeholder advisory group, to help draw up an action plan for the requisite changes. The monitor will OK the plan.
“Early termination of the decree is possible, and frankly, given what that would imply, would be welcome, but that will only happen if compliance by the state is not only achieved, but sustained,” Cunha said.
‘Only one small part of this much bigger problem’
The settlement follows a separate, federal class-action lawsuit against the state filed by disability advocates in November, which made similar allegations of failing to provide adequate care for Medicaid-eligible children with behavioral disabilities. The class-action suit remains pending in federal court, with no substantive filings since the initial complaint on Nov. 13, according to court documents.
The three organizations that filed that class-action lawsuit — Disability Rights Rhode Island, Children’s Rights and the ACLU of Rhode Island — responded to the consent decree in a joint statement Thursday. While they “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,” according to the statement, the DOJ’s efforts don’t go far enough.
“The current level of dysfunction in segregating youth with mental health needs is exacerbated by the lack of adequate access to intensive in-home services and mobile crisis services… The proposed consent decree offers to address only one small part of this much bigger problem that our lawsuit tackles…[and] also lacks specific benchmarks for addressing the problem, and saves the adoption of actual implementation plans for a later time,” the statement argued.
A dearth of community or home-based mental health care for youth has been a recurring theme in advocates’ calls for reforming Rhode Island’s child welfare system. Margaret Holland McDuff, the CEO of Family Service Rhode Island, told Rhode Island Current in an interview in October that residential treatment has historically suffered from offering lower wages than those promised by managed care organizations or inpatient institutions.
“This agreement will build upon and further advance the behavioral health system transformation work already underway,” Gov. Dan McKee said in an emailed statement Thursday. “As demonstrated by our Administration’s launch of Certified Community Behavioral Health Centers and mobile crisis response, the State of Rhode Island has been, and will continue to be, committed to serving children with behavioral health needs.”
The Rhode Island Coalition for Children and Families, which was named as a participant in the settlement, made a statement on Thursday afternoon praising the agreement as “a significant step forward.”
“However, we must underscore the magnitude of the work ahead,” wrote Executive Director Tanja Kubas Meyer. “Complying with this consent decree is no small task and will require careful planning, investment of new resources, and a commitment to comprehensive improvements in how the state’s children’s behavioral health system operates.”
Misty Delgado, a DCYF spokesperson, offered a statement via email late Thursday afternoon.
“Through this consent decree, the Department of Children, Youth & Families and the United States are advancing a shared goal of fostering and strengthening community-based services for children with behavioral health disabilities, so they are treated in the least restrictive setting that is appropriate to meet their needs,” Delgado wrote.
“The eyes of this office, the eyes of a federal judge, and equally importantly, I hope and believe the eyes of the public will remain on this issue to ensure that no child in our state is deprived of their civil rights in this way,” Cunha said.
