Investigation: W.Va.'s Mental Health Services for Children Not in Compliance with Federal Law

A federal investigation of West Virginia’s system of care for children in need of mental health services shows the state fails to comply with federal law.

In a 30-page letter to Governor Earl Ray Tomblin dated Monday,  June  1, the U.S. Department of Justice said their investigation shows the state’s mental health care system for children “fails to provide services to children with significant mental health conditions in the most integrated settings appropriate to their needs in violation” of the Americans with Disabilities Act (ADA).

Title II of the ADA requires that “individuals with disabilities, including children with mental illness, receive supports and services in the most integrated setting appropriate to their needs,” according to the letter from the Department of Justice.

Findings of the Department of Justice investigation include:

• Children who depend on the state’s DHHR for mental health services experience high rates of placement in segregated residential treatment facilities, including out-of-state placement, because DHHR has not developed a sufficient array of in-home and community-based services.

• Children who live in the community and need, but do not receive in-home and community-based services, are at risk of unnecessary placement in segregated residential treatment facilities. Certain children with mental health conditions are at heightened risk: status offenders; lesbian, gay, bisexual, transgender, and questioning children; trauma-exposed children; children with both mental health and intellectual disabilities; minority children; older children; and previously placed children.

• West Virginia has not fully implemented its Olmstead plan. It has not developed comprehensive, community-based services for children with mental illness, including wraparound supports that are the standard of care for children with significant mental health needs. West Virginia has not developed statewide community-based crisis services, nor has it effectively diverted children from unnecessary placement in segregated residential treatment facilities.

• West Virginia has taken insufficient steps to reallocate existing resources for mental health services to, and has not taken full advantage of Medicaid support for, in-home and community-based services.

• Child-serving agencies in West Virginia fail to collaborate to address the needs of children with mental health conditions involved in multiple systems. As a result, agencies duplicate efforts, waste limited state resources, and provide fractured care delivery, causing confusion and harm to children and families.

• West Virginia fails to engage families effectively to develop strategies to support children in their homes and communities. Families perceive their interactions with DHHR as more punitive than supportive, undermining the potential to develop strengths in the home and keep children in the community.

• West Virginia continues to fund expensive placement in segregated residential treatment facilities both within the state and out of state, but neglects to develop sufficient community-based services. National data and local providers report that the cost of providing in-home and community-based mental health services ranges from $2,500-$3,500 per month. By contrast, the average cost of in-state placement in segregated residential treatment facilities ranges from $5,623 to $9,088 per month. In addition, out-of-state placements cost West Virginia over $20 million in fiscal year 2012.

West Virginia Department of Health and Human Resources Secretary Karen Bowling issued a response to the letter Tuesday, noting that–in her first days of being appointed to the post in July 2013–she was tasked with a comprehensive review of the department based on an audit of the agency conducted in 2012.
“DHHR has worked closely with the Department of Justice (DOJ) during its assessment and intends to continue to collaborate with the federal government and other stakeholders as we move forward,” said Bowling in Tuesday’s statement. “The DOJ assessment only strengthens our resolve to continue improving West Virginia’s child welfare system.  Looking to the future, we are committed to establishing a strong foundation at DHHR for our successors to build upon.”

Bowling said it wasn’t a complaint that prompted the federal governments investigation, but an analysis of statistics of the number of children in residential treatment facilities away from home. She also pointed to a number of ongoing improvements and strategic efforts to regain compliance with the ADA.

The DOJ said the investigation included four visits to the state (June 2-3, July 28-August 1, September 22-24, and November 3, 2014) to “assess the system of care for children with mental health conditions.” Investigators toured nine in-state segregated residential treatment facilities and two shelters housing children with disabilities.

The federal agency notified the state of the investigation on April 29, 2014.