St. Mary’s Home for Children in North Providence closed its campus in August, along with outpatient and educational services. That left youth in need of home and community-care services without access to treatment. (Alexander Castro/Rhode Island Current)
A trio of advocacy organizations filed a class action lawsuit Wednesday accusing the state of Rhode Island of failing to provide federally mandated behavioral and mental health care for Rhode Island children who qualify for Medicaid.
The 68-page complaint filed in U.S. District Court in Rhode Island relies on the experiences of 10 lead plaintiffs, all of whom are under 18 with mental or behavioral health needs whose care was coordinated by state agencies in charge of administering federal Medicaid and children’s health programs. Disability Rights Rhode Island, the American Civil Liberties Union of Rhode Island, and Children’s Rights, which filed the lawsuit on behalf of the plaintiffs, names Rhode Island Health and Human Services Secretary Richard Charest, and Ashley Deckert, director of the Rhode Island Department of Children, Youth and Families (DCYF), as plaintiffs.
“Despite the urgency and gravity of the crisis, the response has been woefully and consistently inadequate,” the lawsuit states. “As a result, hundreds of vulnerable young people continue to be denied timely access to the behavioral health services they desperately need and are entitled to under federal law. “
Rather than relying on home and community-based care settings better suited to meet their needs, state agencies shuffled children into hospitals and congregate care settings — including some out-of-state — which in many cases worsened their existing mental and behavioral health challenges and violated federal laws, the lawsuit alleges.
“In the process of locating and finding treatment for kids with behavioral health needs, the Rhode Island system actually causes more harm,” Samantha Bartosz, deputy litigation director for Children’s Rights, said in a virtual press conference Wednesday morning.
Spokespeople for the Executive Office of Health and Human Services and DCYF each declined to comment on Wednesday, citing the pending litigation.
A troubled history
The troubles with the state systems set up to care for children with mental and behavioral health are well documented.
In January, the Rhode Island Office of the Child Advocate revealed shocking details of abuse, neglect and staffing problems at the now-closed St. Mary’s Home for Children in North Providence. In May, the U.S. Department of Justice laid out results of its own, multi-year investigation, accusing the state of “warehousing” children with mental health and developmental disabilities at Bradley Hospital, rather than discharging them to home or community-based care systems.
Yet the state agencies that oversee these programs and systems have still not remedied the crisis, forcing the lawsuit as a “necessary resort,” Steven Brown, executive director of the ACLU of Rhode Island, said during the press conference.
As of August 2024, around 80 Rhode Island children were placed in out-of-state residential psychiatric facilities — a 30% increase over 2022, according to the lawsuit. Meanwhile, an October 2024 report released by the Rhode Island Coalition for Children and Families showed that 733 children were on waitlists for behavioral health services between January and June 2023, with wait times ranging from one week to one year.
The 10 named plaintiffs, identified only by their initials, describe more dire experiences.
Take 17-year-old J. “E” L., from Johnston. The gender-fluid teenager, who uses they/them pronouns, is described in the lawsuit as “artistic” with a “sharp wit” and a love of music. They are diagnosed with depression and post-traumatic stress disorder. They were put into St. Mary’s residential treatment program in January 2021, despite their father’s numerous requests for home and community-based care. By March 2023, E.L.’s psychiatrist determined they were ready to be discharged from St. Mary’s. Yet because there was no home or community-based care immediately available, E.L. was forced to remain at St. Mary’s until June 2024, when the center was finally shuttered amid allegations of abuse and neglect. Earlier that year, in February, E.L. was hospitalized for injuring themself, which the treatment team directly linked to their prolonged stay at St. Mary’s.
Then, there’s 6-year-old J.C. The East Providence boy, described by his mom in the lawsuit as “brimming with curiosity,” who loves insects and riding his bike. He also has been diagnosed with autism, anxiety and ADHD, among other mental and developmental conditions, yet his parents’ requests for home or community-based care were never fulfilled. Instead, J.C. has been in and out of hospital settings, and remains in an inpatient psychiatric unit today.
Family matters
The toll of the trauma and inadequate care is felt not only by children, but their caregivers, according to the lawsuit. Rebecca Almeida, a mother of nine, has four children named as plaintiffs in the lawsuit, including a set of 13-year-old triplets. Two of the triplets, both boys, were relocated to congregate care settings in New Hampshire in January and July, respectively. Almeida makes the 2-1/2-hour trek to visit them as often as she can, but it’s not the same.
“I can’t tuck him in at night or help him if he’s not feeling well or talk to him face to face if he’s lonely or just wants to talk to his mom,” Almeida said of one of her sons during the press conference.
One of Almeida’s other children named in the lawsuit, 14-year-old L.A., was hospitalized 12 times between February 2018 and July 2024, spending a combined 542 days in hospital settings, and another 322 consecutive days in residential placement.
Almeida’s garage is filled with bikes that have gone unridden, Christmas and birthday gifts that her children never got to see or play with. Her nine children have not been altogether in years, she said.
And when children are finally able to return home, the intensive services they still need to function and be safe and healthy are often lacking.
Since being returned to Almeida’s home in July 2024, L.A. has “not made much progress due [in part to] services provided just once a week” — far less than the minimum 10 hours weekly required by federal law, according to a provider’s account included in the lawsuit.
When 17-year-old T.C. was sent home to his grandparents in Woonsocket after St. Mary’s closed, there were no therapeutic services to manage his various diagnoses: depression, PTSD, ADHD, anxiety and seizures. Since his return home, T.C. suffered a crisis which ended in a trip to a hospital emergency department because his grandmother’s call to the state’s federally-mandated, 24/7 emergency services hotline went unanswered for two hours.
What’s next
The lawsuit seeks to compel the state agencies in charge of administering behavioral and mental health services to “promptly arrange” home and community-care services for the named plaintiffs. It also requires them to set up the policies and programs to help the other 20,000 Medicaid-eligible children in Rhode Island with diagnosed behavioral health disabilities, many of whom may also qualify for relief under the class-action lawsuit.
State officials praised the launch of six federally Certified Community Behavioral Health Clinics [CCBHCs] at an event in October, which aim to break down barriers to care for mental health needs and substance abuse. But that’s not enough, according to the lawsuit, which also laments the state’s spending of $45 million to build a new, 16-bed residential treatment facility in Exeter for adolescent girls, rather than using the money to bolster home and community care services.
“There is inadequate evidence that defendants have taken sufficient steps, including building the needed service provider capacity, to ensure that CCBHCs will actually deliver on those promised outcomes,” the lawsuit states. “Defendants themselves have acknowledged that ‘not all prospective CCBHCs will begin operations in FY 2025, nor will those that are starting (sic) be fully staffed in FY 2025.’”
Bartosz said the plaintiffs hoped to resolve the case “sooner rather than later,” expressing openness to settlement if the state is willing. If not, the case will wind its way through the court process, with a bench trial at least 18 to 24 months away, Bartosz said.
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