State psychiatric facilities are used to “segregate” youth with mental health conditions, complaint says
Alabama’s child welfare agency unnecessarily “segregates” foster youth with mental health problems in a complex of 19 psychiatric institutions, when most could be cared for in the community, according to a class-action lawsuit filed today.
The lawsuit was filed in the U.S. District Court for the Middle District of Alabama Northern Division by three nonprofit litigators: Alabama Disabilities Advocacy Program, the Southern Poverty Law Center and Children’s Rights. The sole named defendant is Nancy Buckner, the current commissioner of the Alabama Department of Human Resources.
“The children we represent are cut off from family and community, without access to their school or to a normal teenage life, denied the chance to play a sport, ride a bike, or sing in the choir — to experience the joys of being a child,” said Christina Remlin, lead counsel for Children’s Rights. “Instead, they have been subjected to assaults, restraints, psychologically abusive punishments, and filthy living conditions.”
At issue is the department’s use of 19 psychiatric residential treatment facilities, or PRTFs, which are one of the few exceptions to federal rules barring the use of Medicaid to pay for institutional care (at least on paper, anyway). The criteria to be accredited as a PRTF is steep, and requires round-the-clock nursing, and an active care plan being overseen by a physician. Many states don’t even have them, while others license dozens.
The Alabama lawsuit alleges that this highly clinical setting is overused on foster youth with behavioral issues that do not require institutionalization, and that the state’s array of PRTFs are not safe. It notes “numerous reports of staff at PRTFs slamming children against walls, punching and slapping children in the face, using chokeholds, and laying on top of children who are being held face down on the ground.”
Some of these treatment facilities are operated by Sequel, the for-profit company that has come under fire for troubling incidents of abusive behavior at facilities it manages around the country. Since the death of teen Cornelius Fredericks at a Sequel-run facility in Michigan, several states have stopped doing business with the company, and it has been forced to shut down a half-dozen of its residential programs.
The Alabama lawsuit alleges that Sequel’s treatment facility in Tuskegee uses a “time-out” room without a toilet or sink to seclude youth for up to 72 hours, and that its Owens Cross Roads facility once held a girl in an isolated room for five straight days.
The state could easily handle the care of nearly all of the hundreds of foster youth who end up at PRTFs in foster homes or other community alternatives, the plaintiffs argue.
“DHR’s continued reliance on expensive, institutional placements is an urgent threat to the well-being of these children and youth and wastes taxpayer dollars,” said Nancy Anderson, associate director at Alabama Disabilities Advocacy Program. “More and better-supported foster families could effectively serve the needs of these children in the community.”
The Alabama Department of Human Resources had not replied to phone calls or emails seeking comment by the time Youth Services Insider published this article.
This is the second time that Alabama Disabilities Advocacy Program and the Southern Poverty Law Center have taken the state to court over its reliance on psychiatric treatments and facilities with foster youth. In R.C. v. Fuller, the lead plaintiff — who was never diagnosed with a serious mental illness — was placed on large doses of psychoactive medications and was shuttled between psychiatric hospitals and group homes for kids with serious behavioral problems.
The settlement in the case focused on making investments in the state’s ability to prevent the removal of children from their parents in the first place, and then providing appropriate placements for those children who were taken into foster care. In 2008, 20 years after the lawsuit was filed, Alabama exited its consent decree in the case.
The number of youth in Alabama foster care continued to decline to a low of 4,435 in 2013, according to federal data. But it has increased significantly since: in March of 2020, just as the coronavirus pandemic was hitting America, there were 7,609 children in care, according to data provided to The Imprint by the state.
The complaint filed today asks for class certification, and that the court require Alabama to “develop and sustain sufficient capacity of community-based placements and services to meet the needs of Alabama’s children in foster care with mental impairments.”
