Nevada violated federal law by unnecessary institutionalization of children with behavioral health problems – The Nevada Independent


Nevada routinely fails to provide appropriate treatment and services for young people with behavioral health disabilities, and instead has relied excessively on institutional settings such as hospitals or residential treatment facilities to a degree that is likely to violate federal law.

This is according to an investigation by the US Department of Justice, which was published on Tuesday A 25 page report It details the state’s failure to provide “community services” (such as therapy, crisis support, and behavioral support programs) that resulted in “hundreds of children being isolated in residential treatment facilities each year” rather than staying with their families if such services existed.

“The department’s investigation found that Nevada lacks needed community services such as intensive home services, crisis services, intensive care coordination, rest and curative care, and other forms of family support,” the agency said in a news release. As a result, hundreds of Nevada children have been separated for several months, often very far from their homes.”

More than 1,700 Nevada children were admitted to a psychiatric hospital in fiscal 2020, according to the report, and more than 480 received services in residential treatment facilities. But once there, the babies “stay for a long time” – an average of 9 to 12 months in accommodations and institutions. More than a quarter of children admitted to these facilities between August and October 2019 stayed for more than a year.

Longer residential stays are incompatible with a Centers for Medicare and Medicaid Services 2013 BulletinAccording to the Department of Justice report, which says that providing community services is cheaper (saving an average of $40,000 per child per year) and more effective.

The report notes that children who are served in the community typically experience reductions in clinical symptoms, increased emotional strength, better school outcomes and fewer suicide attempts. On the flip side, residential care is associated with “serious harms,” ​​including higher rates of abuse, developmental delays, and emotional attachment disorders.

The report concludes by finding “reasonable reason” that the state’s failure to provide the services constitutes a violation of the Americans with Disabilities Act (ADA) and could lead to a lawsuit seeking corrective action. However, the investigation notes that the state government provided “exceptional assistance, cooperation and frankness” and expressed a willingness to “work with the department to resolve the identified issues.”

The report identified the following pathways by which the state could address ADA violations:

  • Ensuring that community services are ‘accessible and available in sufficient density’
  • Modify state rules and procedures to increase the number of health care providers for children’s behavioral health
  • Enact “strong oversight” on community service providers
  • Provide a rapid assessment of children “at risk of institutionalization”
  • Work with children and parents on a transition plan after they leave treatment facilities or settings

State Governor Steve Sisolak acknowledged in a statement Tuesday that the Justice Department’s investigation found the state to be “underserved,” and said the state government was “committed to working with the federal government and other partners to resolve the issues raised in the report.”

The governor’s statement also noted the millions of federal funds earmarked for Nevada that have been directed toward related programs over the past year, noting that the additional funds were “already created in my recommended budget” for the next fiscal biennium. those Include federal funds $5 million is specifically earmarked for at-home treatment options that aim to keep children and adolescents at home while providing intensive therapeutic and behavioral support services.

“For too long, Nevada has not invested in the right health resources for our children and families — this new report highlights that fact,” Sisolak said in the statement.

During the August meeting of the state’s Interim Finance Committee, lawmakers approved more than $45 million in federal relief funds To support a range of mental health services primarily aimed at improving youth therapies. Assemblywoman Maggie Carlton (D-Las Vegas) described the urgent need for the funds, describing children’s mental health as “a crisis in this case.”

“We can’t wait a year to get started, we have to start now,” she said. “We have a chance. These people have been coming together for over a year to come up with a plan for moving forward in children’s mental health. We will not delay. We need to take action now.”

Investigation Origins

The federal agency opened the investigation in December 2020 based on complaints submitted to the department, which led to a comprehensive review of documents, and interviews with dozens of state officials, community service providers, advocates, and family members of children with behavioral health disabilities and children with health disabilities. Receive services in hospitals or other institutional institutions. Investigators also visited psychiatric hospitals, residential treatment facilities, juvenile justice facilities and a child care home.

The report notes that a lack of access to community services means families and children “frequently turn to hospitals as a first stop for treatment”, and cycle through hospitals.

The report interviewed the mother of a 14-year-old boy, who was unable to obtain the necessary behavioral health treatments, who was admitted to four different hospitals over several years.

“This parent told us that if she had known about the state’s lack of behavioral health services, she would never have moved on [her son] to Nevada,” the report states.

The department’s report also described the state’s use of out-of-state residential treatment facilities as “ongoing,” an ongoing sign of a lack of resources within the state for youth behavioral health treatment.

“In line with what we’ve heard from parents and children, one therapist at an out-of-state residential facility stated that ‘every child here wants to go home,’” the report said, adding that “the clinical staff at the in-state treatment center we spoke to told us that the Nevada kids are It was difficult for them to get out of the hospital due to the insufficient services available to them.”

That assessment was repeated by Nevada officials, the report said, with one telling investigators there was a “mindset” that “children need to go to housing” due to a lack of community services.

Investigators have also criticized comprehensive state services, or “team-based” implementation of individualized care plans for children with complex needs.

The number of children served through Nevada’s system, Wraparound in Nevada (WIN), dropped 60 percent between 2017 and 2020, the report said, amid staff shortages due to low wages and high employee turnover rates. Even for children enrolled in comprehensive services, the lack of additional support – including treatment and psychological care – meant that these children were often without these services.

“The Wraparound doesn’t really do anything. They’re just trying to hook you up with different people,” one parent told investigators. But the problem with Nevada isn’t there. [sic] Lots of services without waiting from 6 to 18 months.”

2019 status report on out-of-state placements, commissioned by AB298 That year passed, I found that the state of Nevada had sent more than 150 children into its juvenile justice and childcare systems Out of state for behavioral health therapy within a year. Some went as far as Georgia and Tennessee. a 2021 version of the report It found that the number had dropped to 53 youths in out-of-state housing facilities, even though that number only includes those covered by Medicaid or paid by the state.

Such out-of-state locations can result in children spending months at a time thousands of miles from home.

The Justice Department report described the experiences of a child named Martin, who “was fit for community services but instead received treatment at two residential treatment facilities.”

After experiencing abuse and family disruption as a child, Martin underwent psychotherapy at the age of eight, before an eight-month stay in a Nevada facility, followed by a seven-month stay in a Colorado facility nearly 1,000 miles from his home in Reno.

“On entering that facility, he stated that his only wish was for me not to be here,” the report read.


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