The state of Maine is moving ahead with plans to develop residential psychiatric treatment facilities for children, but advocates and health care are still weighing in on whether supporting youth with the most severe behavioral health needs is the appropriate step. Opinions among providers are divided.
On Wednesday, the Maine Department of Health and Human Services announced: request for proposal At least 16 beds for youth with behavioral health needs, such as substance use disorders, intellectual disabilities, developmental disabilities, or identified treatment needs related to problematic sexual behavior. We are asking for the establishment of a facility.
Psychiatric residential treatment facilities (PRTFs) are not hospitals, but provide intensive psychiatric care to children and youth under the age of 21 with severe emotional and behavioral disorders.
State spokeswoman Lindsey Hames said in an email that the state created the request for proposals as a result of an initiative passed by the Legislature as part of the 2024 supplemental budget.
“The goal is to provide care that avoids children and youth spending long periods in hospital emergency departments or being admitted to out-of-state facilities further from their homes,” Hames said. .
Disability Rights Maine, which advocates for people with disabilities in Maine’s schools, workplaces, and public spaces, was quick to criticize the plan, saying that by issuing an RFP, Maine would “introduce a failed treatment model. “This trend is on the rise,” it said in a written statement. Maine’s children are at risk of further harm. ”
But the president and CEO of Sweeser, a Saco-based behavioral health nonprofit, said the organization is considering bringing such programs to Maine as a way to bring children served out of state closer to home. He stated that he is promoting the construction of new facilities.
“This also helps address children who end up languishing in the ER for weeks, if not months, because the severity and illness cannot be managed at home or in their current children’s residential facility.” Jane Van Bramer said. , President and CEO of Sweeter.
RFP follows settlement
The RFP is an agreement between the state of Maine and the U.S. Department of Justice that states that the state violates the Americans with Disabilities Act by unnecessarily isolating children with behavioral health disorders in hospitals, residential facilities, and facilities. The announcement comes a week after the department agreed to end a federal lawsuit it filed in September. Juvenile detention center in Maine.
The settlement said Maine must strengthen community-based services to keep children with behavioral health issues out of the home.
“Given the historic agreement reached last week with the Department of Justice, it is based on the premise that all children can meet their needs in their homes and communities when provided with appropriate behavioral health services. We need the time and resources for the state of Maine to build new institutional beds for children,” said Atlee Riley, chief attorney for the Maine Office of Disability Rights Advocates.
“Maine should instead focus on meeting its obligations under the agreement, and that can only be done by developing and delivering a community-based system of services.”
2019 Maine Disability Rights Staff visit children in Maine I have an out-of-state placement with PRTF in Arkansas. They found that children were not receiving the important treatment they deserve and were instead receiving one hour of individual therapy per week from a clinician. The group said in a statement Thursday that they were primarily confined to cinder block units and had little or no structured program.
Nancy Cronin, executive director of the Maine Council on Developmental Disabilities, said her organization also has concerns about PRTF’s plans in Maine. She said she has heard support for the model from hospitals and behavioral health providers, but that children who might be able to receive help in a less restrictive environment have other ways to better meet their needs. He said he was worried that he would end up in an institution even though he could be well met.
“I’m concerned that people think this is going to be a silver bullet,” Cronin said. “I’m concerned that at a time when we need to build these beds and really work on providing continuity of service, we’re going to be full and we’re going to have a waiting list.”
Cronin said Maine has a problem with children with behavioral health issues struggling to get their needs met. “That’s why the settlement was reached and it will solve some of the problems,” she said. “PRTF is a very restrictive program and I’m worried it won’t accomplish what people want.”
Hames, the Department of Health and Human Services, said the state is committed to ensuring a comprehensive continuum of care for Maine’s children and youth, a wide range of services to meet their needs, from early intervention to treatment and crisis services. He said he is trying his best. And as outlined in the settlement reached last week, Hames said the state will continue to expand community-based services for years to come.
“PRTF is part of a continuum of care and serves a small number of children and youth who have severe behavioral health needs and require an intensive level of clinical care and treatment based on a clinical diagnosis. limited,” Hames said.
Is PRTF necessary?
PRTF is a locked, secure residential facility that sits “halfway between a hospital and a child residential program,” said Van Bramer, CEO of Sweeser.
“Although it is a little less restrictive than a hospital, it is a safe alternative for children who are experiencing very high levels of visual acuity,” she says. “This is a closed, structured clinical setting. This is not a secure correctional facility, but a clinical program with active treatment on a daily basis. There is physician supervision, there is a prescriber, and there is clinical There are doctors there and they are being treated and it is a safe environment.”
Less restrictive child residential programs are “really open programs” where children are free to run away or leave the program, potentially exposing them to drug use, human trafficking and other troubles, Van Bramer said. he said.
Sweeser helps children get services in their home communities near family and friends, but she said that’s not always safe or appropriate. “(PRTF) is not a good environment for children to grow up in or a long-term solution,” she said. “It’s something that should be used for a few months and then the kids should step down. But I believe there are some kids for whom this is appropriate.”
last year’s proposal Directing the state to implement PRTF in Maine has garnered support from hospitals and health care providers, including MaineHealth and Northern Light Health, who say high-needs youth are currently draining emergency room resources. He said they could be better served by PRTF.
Van Bramer said Sweeser is awaiting further information from the state regarding MaineCare’s reimbursement rates for the proposed facility before deciding whether the organization will submit a proposal. The state has proposed $2 million in capital costs to establish PRTF, and Van Bramer said the organization has an existing building that could be renovated with the money.
“But if the daily amount is not sustainable, we will not apply,” she said. “So we look forward to seeing what comes out about that.”
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