The U.S. Department of Justice has found that Alaska’s use of residential treatment for youth with behavioral health challenges likely violates the Americans with Disabilities Act by unnecessarily segregating them from society.
If the state does not reduce its reliance on institutional care for these young people, they are at risk of a federal lawsuit to bring them into compliance with the law, department officials warned.
“Each year, hundreds of children, including Alaska Native children in significant number are isolated in institutional settings often far from their communities,” Assistant Attorney General Kristen Clarke of the department’s Civil Rights Division said in a press release. “Most of these children could remain in family homes if provided appropriate community-based services.” Clarke said her division “looks forward to working with Alaska” to bring the state into compliance with federal law, and to “prevent the unnecessary institutionalization of children.”
In a report released last month, the department stated that while community-based behavioral health interventions — including intensive case management, crisis services, home-based family treatment and others — are permitted under Alaska’s Medicaid program, they are not readily available throughout the state, with a particular dearth in rural areas. This leaves the state’s system of care for struggling children and teens “heavily biased toward institutions,” with Alaska Native youth at an increased risk of such placements.
Justice Department attorneys and clinic experts reviewed medical records, interviewed institutionalized youth and met with officials and service providers for the report, and concluded that many of those in residential care could have been effectively treated in their communities if services were provided to them. This “unnecessary segregation” violates federal disability rights law, the report stated.
In 2020, the state spent $83 million on care for more than 800 youth in hospital or residential treatment settings, the department found — one-third of whom were Alaska Native youth. Meanwhile, less than $32 million was spent that year on all community-based mental health interventions.
The report states that even when children are referred to community-based services, the waits are long — up to three months for a Medicaid therapist or psychiatrist, and as long as a year for neuropsychological evaluations — and that oftentimes, children reach a crisis point while waiting.
The federal Americans with Disabilities Act was enacted in 1990 to prevent the discrimination of people with physical, intellectual or behavioral disabilities. The law requires that public entities provide treatment and services in the most integrated settings possible, in a way that “enables individuals with disabilities to interact with nondisabled persons to the fullest extent possible.” In Olmstead vs L.C., the Supreme Court clarified that this required the provision of community-based services.
Steps suggested to bring Alaska into compliance with the ADA include supporting behavioral health services at schools, developing a strategy to identify children at risk of institutionalization and deploy interventions to prevent residential placement, and investing in infrastructure and provider capacity to ensure community-based treatment options are available throughout the state.