‘Appalling failure’: Investigation finds R.I. has ‘routinely’ segregated children with disabilities by institutionalizing them

The investigation, which focused on a period between January 2017 through September 2022, found that 527 children in the care of the state’s Department of Children, Youth, and Families had been admitted to Bradley for short-term stabilization care. Those inpatient admissions for kids in crisis are supposed to last only one to two weeks, to stabilize an emergency. But the average length of a Bradley hospitalization for children in DCYF care was 51 days.

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,” a news release from the Department of Justice said.

Cunha said the state was in violation of Title II of the Americans with Disabilities Act, and Section 504 of the Rehabilitation Act of 1973. Section 504 and the Supreme Court’s ruling in Olmstead v. L.C., mandate states and local governments make services available to people with disabilities in the “most integrated setting appropriate to their needs,” and regardless of age or type of disability.

“Unjustified isolation is a form of discrimination based on disability,” said US Health and Human Services Office of Civil Rights Regional Director Susan Rhodes during Monday’s press conference.

Of the 527 children, 115 were hospitalized on a single admission. Another 116 were hospitalized for more than 100 days; 42 children were hospitalized for more than 180 days; and seven were hospitalized for more than a year, according to Cunha’s office.

Almost 40 percent, or 197 of these 527 children, were hospitalized at Bradley more than once during the scope of the investigation.

“That’s time with no meaningful access to family, friends, and the comforts of home, the chance to play, and go to school — to be a kid instead of a patient in a locked ward,” said Cunha.

One child who was 9 years old at the time of her first admission, spent 826 days across five admissions during the period of the US Attorney’s investigation. Another, who was first admitted at 14, had 11 separate admissions for a total of 706 days. Five children were just 5 years old when they were first admitted, and one was hospitalized for 126 days over the course of five years.

“The state failed to meet that obligation — not in isolated instances,” said Cunha. “Not sporadically, but repeatedly, unjustifiably, and with dire consequences.”

Bradley is owned by Lifespan Corp., the state’s largest health care system, and is Rhode Island’s only acute-care psychiatric institution intended for short-term admissions. Cunha confirmed that his office was not accusing Bradley Hospital of “any wrongdoing.”

Cunha’s office and the US Department of Health and Human Services Office for Civil Rights sent a letter to Governor Dan McKee and DCYF director Ashley Deckert (who was appointed in May 2023, after the investigation took place) detailing these findings. Cunha said he expects the state to respond to the letter within 10 days.

McKee spokeswoman Olivia DaRocha called the letter and the investigation’s findings “troubling,” and said that it identifies “long-standing issues where improvements are clearly needed.” But DaRocha also cited the “national shortage” of home and community-based behavioral health services, and said that the McKee administration has taken actions to improve its placement system.

“We understand that more must be done,” said DaRocha. “We will continue to seek short- and long-term solutions to provide each child with a behavioral health disability the appropriate services in the most integrated setting.”

In a statement to the Globe, DCYF spokeswoman Damaris Teixeira said the agency agreed with the report, and that “more work is needed.” She also said that since November 2022, DCYF has worked with Bradley and Hasbro Children’s hospitals to expedite discharges to appropriate placements “as quickly as possible.”

DCYF also launched the Mobile Response and Stabilization Services, which provides time-limited, on-demand crisis intervention services in any setting in which a behavioral health crisis is occurring, including homes, schools and emergency departments. Depending on the need, Teixeira said, the stabilization component may include a temporary, out-of-home crisis resolution in a safe environment. Since its launch, 90 percent of youth in the program did not require psychiatric hospitalization, she said.

DCYF, Cunha said, has been cooperating with the investigation, but that “larger, systemic failures have led to a situation in which children with disabilities, rather than receiving the integrated community care that they need, are being warehoused.”

The state, Cunha said, “must do better by some of the most vulnerable among us” or face a lawsuit.

For years, advocates have condemned how DCYF has relied on the use of psychiatric beds in hospitals. St. Mary’s Home for Children, a nonprofit founded in 1877 within the Episcopal diocese, is the only psychiatric residential treatment facility for children in Rhode Island. The state has spent more than $29 million since 2019 in its contract for children in state care. But the home has faced vast problems including physical and sexual abuse, neglect, understaffing, and mismanagement. DCYF stopped placing children at the facility in late November after a boy running away from the home was hit by a jeep. Last week, the board of directors for Tides Family Services agreed to take over all operations at St. Mary’s.

Cunha pushed back on the premise that constructing new facilities and adding more beds for this population would solve the problem. In many cases, DCYF and other agencies have built community- and home-based programs that were not maintained. In other cases, the state reduced its funding of these programs, he said.

The state is investing approximately $45 million to expand in-state residential bed capacity, including with a facility in Exeter that will serve 16 children, said Teixeira. Lawmakers also appropriated $11 million for the building of a 12-bed psychiatric residential facility.

Rhode Island is one of a handful of states — but the only one in New England — that do not have an Olmstead plan in place. An Olmstead plan coordinates and funds supervised, affordable, and supportive housing options for people who live independently with SSI/SSDI benefits and housing vouchers, educational and employment supports, transportation, home modification, criminal justice representation, community and home-based services, and various treatment options, among other supports.

Not having an Olmstead plan, or some type of alternative, leaves the state vulnerable to enforcement by the US Justice Department for violating the Americans with Disabilities Act, or ADA.

“An Olmstead Plan — if done correctly — will help prevent the unnecessary institutionalization of all Rhode Islanders,” Laurie-Marie Pisciotta, the executive director Mental Health Association of Rhode Island, told the Globe on Monday.

Tanja Kubas-Meyer, the executive director of the Rhode Island Coalition for Children and Families, said the state needs a “well-resourced system of supports and services to prevent problems from escalating into crises that require hospitalization,” including in investments related to assessment, evaluation, and increased community behavioral health capacity to “change the trajectory for the children of our state.”

“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,” said Cunha.

This story has been updated to include comments from Governor Dan McKee’s administration; the Rhode Island Department of Children, Youth, and Families; and the Rhode Island Coalition for Children and Families.

Alexa Gagosz can be reached at alexa.gagosz@globe.com. Follow her @alexagagosz and on Instagram @AlexaGagosz.