RI agrees to consent decree for children with behavioral health disabilities

Rhode Island has reached an agreement with federal authorities to resolve violations of disability laws.

Rather than implementing community-based or intensive in-home care, the Department of Children Youth and Families (DCYF) heavily relied on hospitalization. Given five years under the decree to change how they approach the treatment of these children, the state will ensure care is delivered in homes and communities going forward.

Direct compliance will be overseen by a court-appointed monitor and a federal judge.

During a press conference, Zachary A. Cunha, U.S. Attorney for the District of Rhode Island, detailed the findings that Rhode Island unnecessarily segregated children with these disabilities at Bradley Hospital in East Providence.

Cunha’s office has been working in collaboration with the Department of Health and Human Services’ Office of Civil Rights (OCR) on this issue. At the time, he said the state repeatedly failed to meet its obligations to these children.

In a December press release announcing the consent decree, Cunha referred to a system that has failed to provide appropriate care, saying things must change.

“No child deserves to be isolated indefinitely in a locked psychiatric facility when their condition can be treated at home or in a community setting,” he said. “Our kids, our families, and our communities deserve—and the law demands—better than that.”

The initial investigation began in late 2021 after the Department of Health and Human Services (HHS) received complaints about excessive stays at Bradley. The Department of Justice (DOJ) joined the HHS investigation in July 2022. The two offices collaborated to review thousands of documents and data provided by the DCYF and interviewed numerous staff, law enforcement, families, advocates, and community-based providers.

The DOJ found the state’s “warehousing” practices in violation of federal civil rights laws, which resulted in the consent decree issued in December.

Rhode Island was found to be delinquent in terms of both the American with Disabilities Act (ADA), meant to ensure that all individuals with disabilities have the same opportunities as everyone else, and the Olmstead Act, in which unjustified segregation of individuals with disabilities was determined to be a violation of the ADA.

Olmstead also ruled that people with disabilities should be provided access to care within their communities. Although community-based services were available, children in the psychiatric unit at Bradley were not transitioned in a timely manner, often held weeks, months, or even as long as a year.

According to Cunha’s office, the state has thus far worked cooperatively with the federal government to resolve and remedy the cited violations and agreed to settle the matter without contested litigation.

OCR Director Melanie Fontes Rainer noted, “Twenty-five years after the Olmstead decision, [the] consent decree follows the HHS Office for Civil Rights’ continued efforts to ensure that people with disabilities have opportunities to live and receive needed services in their communities rather than institutions.”

Rhode Island is to follow a multi-pronged approach: transition children currently hospitalized at Bradley to a home setting if their needs can feasibly be met there; coordinate appropriate levels of care and service planning for children and their families, particularly those that have made multiple visits to emergency units; and provide better access to in-home services that include family therapy, behavioral services, and therapeutic mentoring.

The state is also responsible for securing future foster care families and community-based services including payment rates and support to better allow children to stay in their homes. Mobile crisis intervention should be readily available to avoid any unnecessary hospital visits. And, the outcome and timeliness of services must be monitored.

In a separate but related class-action lawsuit, Disability Rights Rhode Island, the American Civil Liberties Union of Rhode Island, and Children’s Rights filed against the state for denying Medicaid-eligible children their right to access appropriate mental healthcare.

They issued a combined statement saying that while the consent decree is a step in the right direction, there are broader issues to address.

“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 that are legally mandated to be available to eligible children and youth under Medicaid. The proposed consent decree offers to address only one small part of this much bigger problem that our lawsuit tackles.”