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RI violates civil rights of children with behavioral health disabilities. “An utter void in crisis services”

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United States Attorney Zachary A. Cunha District of Rhode Island held a press conference yesterday to announce that the state of Rhode Island – and DCYF, specifically – has violated federal civil rights laws by “routinely and unnecessarily segregating children with mental Health and/or developmental disabilities”. The violations note the placement of children at Bradley Hospital, for periods of time long passed recommended guidelines.

The report leaves the situation for these children, particular young girls, out in the open for the state, with adequate funding, staffing, and program options for severely in-need children demanding immediate attention. A response from the state, according to Cunha, must come in 10 days.

State of Rhode Island Found to be in Violation of Federal Disability Laws for  Over-Hospitalization of Children with Behavioral Disabilities in State Care

Statement from United States Attorney Zachary A. Cunha District of Rhode Island

An investigation by the United States Attorney’s Office for the District of Rhode Island and the United States Department of Health and Human Services Office of Civil Rights (HHS OCR) has found that the State of Rhode Island has violated federal civil rights laws by routinely and unnecessarily segregating children with mental health and/or developmental disabilities at Bradley Hospital, an acute-care psychiatric hospital, announced United States Attorney Zachary A. Cunha and HHS OCR Director Melanie Fontes Rainer.

As detailed in a Letter of Findings transmitted to Rhode Island Governor Dan McKee and Ashley Decker, the Director of the Rhode Island Department of Children, Youth and Families (DCYF), the federal government’s comprehensive, multi-year investigation found that, rather than complying with its legal obligation to provide services in the most integrated setting appropriate to the needs of these children, the state has instead left them hospitalized at Bradley for far longer than is necessary.

While Bradley Hospital inpatient admissions are designed to last only one to two weeks, the federal investigation concluded that children with behavioral health disabilities in DCYF’s care were often forced to languish in the hospital for weeks, months, and, in some cases, for more than a year, despite being ready for discharge, and despite the fact that these children would be better served in a family home.

The investigation found that DCYF failed to ensure that children with disabilities were able to access the intensive in-home and community-based services they need, and failed to facilitate prompt discharges from Bradley Hospital to family homes, resulting in extended and unnecessary hospitalization, or risk of future hospitalization, all in violation of federal law, specifically Title II of the Americans with Disabilities Act and Section 504 of the Rehabilitation Act of 1973.

“It is nothing short of appalling that the state has chosen to warehouse children in a psychiatric institution, rather than stepping up to provide the community care, support, and services that these kids need, and that the law requires,” remarked U.S. Attorney Zachary A. Cunha.  “I am hopeful that the findings we announce today will spur swift action by the state to meet its obligations under federal law, and far more importantly, to ensure that the civil rights of these children are upheld.”

“Children with disabilities should be able to come home to the love and support of their families and not be confined to an institution for months on end,” said Assistant Attorney General Kristen Clarke of the Justice Department’s Civil Rights Division. “We will continue our vigorous enforcement of the ADA to ensure that children with disabilities can receive the community-based services they need to live with their families and participate in their communities.” 

“Today’s finding follows on the heels of the Office for Civil Rights’ efforts to strengthen access to care for people with disabilities like these children,” said HHS OCR Director Melanie Fontes Rainer. “We must do better by our children and the communities we serve, and States and others must follow federal civil rights laws to ensure every child can access care free from discrimination. As we approach the 25th anniversary of the Olmstead decision, today’s action also emphasizes our commitment to continue to protect the critical right of individuals to live in their own homes and communities.”

As detailed in the government’s Letter of Findings, from January 1, 2017, through September 30, 2022, a staggering 527 children either in DCYF care and custody, or receiving services voluntarily through DCYF, were admitted to Bradley Hospital. Of these 527, 116 were hospitalized in a single admission for more than 100 consecutive days; 42 were hospitalized for more than 180 days; and seven children were hospitalized for more than one year. Many of these children were subjected to these avoidable and unnecessarily lengthy hospitalizations at Bradley because DCYF failed to provide the community-based services they need. Keeping a child hospitalized for an extended period when their needs could be served in a less restrictive setting only serves to exacerbate the child’s acute needs. Indeed, the investigation found that extended hospitalization often traumatizes the children as well as their families.

According to the Letter of Findings, DCYF also does not plan for hospital discharges in a way that places children in the most integrated setting appropriate to meet their needs. DCYF’s failure to look for placements in a family home setting with services leads both to delayed discharges and to inappropriate placements post-discharge, which, in turn, often leads to subsequent hospitalizations. 

This joint investigation by the United States Attorney’s Office and HHS OCR was conducted by Assistant U.S. Attorney Amy R. Romero and Equal Opportunity Specialist Erin Walker of HHS. 

The ADA, Section 504, and the Supreme Court’s ruling in Olmstead v. L.C., require state and local governments to make services available to people with disabilities in the most integrated setting appropriate to their needs, regardless of age or type of disability. Enforcement of Title II of the ADA, Section 504, and the integration mandate of the Olmstead decision, is a priority of the Department of Justice and Department of Health and Human Services. 

RI Developmental Disabilities Council response

In response to RINewsToday’s request last night, Kevin Nerney, Esq., Executive Director, RI Developmental Disabilities Council issued this statement:

“Unnecessary institutionalization in hospitals, rather than supports and care in the community, continue to violate the civil rights of children and adults with disabilities. The news today from the Department of
Justice is not unexpected. The Developmental Disabilities Council, working with our DD Act partners (Disability Rights Rhode Island – DRRI and the Sherlock Center on Disabilities) have identified Olmstead
violations in Rhode Island and we know DRRI has been involved in ongoing investigations of these Olmstead violations. Based on this, we have advocated for the state to correct these injustices with an Olmstead plan. For far too many years the state has delayed the planning and implementation of an Olmstead plan. This must be addressed immediately.”

Additional information about the ADA can be found at www.ada.gov, or by calling the Department of Justice’s toll-free ADA information line at 800-514-0301 or 800-514-0383 (TDD). For more information on Section 504 of the Rehabilitation Act and how it protects individuals with disabilities, visit:  https://www.hhs.gov/civil-rights/for-individuals/disability/index.html. For more information about OCR’s Olmstead activities, visit:  https://www.hhs.gov/civil-rights/for-individuals/special-topics/community-living-and-olmstead/index.html. 

Read the Letter of Finding

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