Maine must strengthen its community-based services for children with behavioral health challenges to keep them from being placed outside the home, according to an agreement with the U.S. Department of Justice filed Tuesday in federal court.

The agreement ends a lawsuit filed in September by the federal agency, which said the state has been violating the Americans with Disabilities Act by “unnecessarily segregating children with behavioral health disabilities in hospitals, residential facilities and a state-operated juvenile detention facility.”

Maine officials were put on notice in 2022 about alleged violations of the ADA, and the Justice Department filed suit this year after failing to see adequate progress.

Kristen Clarke, an assistant attorney general with the Justice Department, said the agreement ensures “that children with disabilities can live at home surrounded by the love and support of their families rather than isolated away in facilities.

“We know that too many children with behavioral health disabilities end up in juvenile justice settings or in out-of-home placements, often in different states far from their families, disrupting their lives in ways that can cause permanent harm,” she said. “Under this agreement, more children will have access to community-based services and in-home behavioral health services so that they can grow up surrounded by family and loved ones.”

Gov. Janet Mills, in a written statement announcing the agreement, said her administration has been working for more than two years to address the concerns.

“I shared many of the U.S. DOJ’s concerns, many of which preceded my administration, and we have worked closely with the Legislature to invest hundreds of millions of dollars to strengthen the system – important reforms which we believe in and we that we continue to implement,” she said.

Mills said she believed the state would have prevailed had the matter gone to trial but that a settlement was a better outcome.

“Protracted, expensive litigation would only have detracted from what’s most important – continuing to improve our children’s behavioral health system,” she said.

The agreement requires the state to appoint or hire within 120 days a children’s behavioral services integration coordinator who will monitor the state’s compliance. The state also must begin developing an implementation plan within 120 days that details strategies and evaluation metrics. The plan is required to be updated biennially and will be subject to scrutiny by an independent reviewer. That reviewer will file annual reports.

The agreement will be in place for six years and terminated only once the state is in substantial compliance.

Advocates have for years argued that staffing shortages in Maine’s behavioral health system contributed to a lack of services. The lawsuit detailed wait lists with hundreds of children who didn’t receive care for months or more than a year in some cases. It also alleged that Maine crisis responders have told some parents to call the police when they needed assistance.

“Children will be assumed capable of having their needs met with a family, in a family home,” the settlement says. “A family home means an integrated, non-disability-specific setting in which children live with a family who help the child go to school, recreate and receive services.”

No recent case highlights the state’s lack of services more than 13-year-old Abby Bedard, of Bingham, who spent 10 months in the emergency department at Reddington-Fairview General Hospital in Skowhegan because there was no available option for her care. Bedard has cerebral palsy, gets seizures from epilepsy, and has numerous mental and developmental health challenges, including an intellectual disability, suicidal ideations and behaviors she can’t control, such as harming herself and assaulting her parents.

Bedard finally moved into a group home in Orono last month.

Other disabled children have been held at Long Creek Youth Development Center in South Portland, the state’s only juvenile detention facility, often because parents or caregivers can’t safely keep a child at home.

All Maine children under the age of 21 who are eligible for behavioral health services and are at serious risk of out-of-home placement are covered by the agreement.

The agreement also says the state will furnish all services “in an individualized manner consistent with the preference, goals, needs and abilities of each child and their family.” It retains the rights of parents or guardians to pursue services outside a family home if they choose.

It’s not clear how much money the state might have to spend to come into compliance. The agreement does call for improving payment rates and supports for community providers to help address current and future workforce shortages, and asks the state to provide prompt mobile crisis intervention to help children avoid entering emergency departments or law enforcement contact.

Mills said her administration already has made unprecedented investments to strengthen behavioral health services for children.

Since the Justice Department’s initial inquiry in 2022, the Maine Department of Health and Human Services has reduced the total number of children in residential treatment from 290 to 192 and has reduced out-of-state care numbers from 250 to 69.

The department also has reduced the wait list for home and community-based services by 42% and reduced the wait list for rehabilitative and community support services by 21.8%, according to the administration’s statement.

BEGINNING OF A LONG ROAD

“I’m pleased that the U.S. DOJ and the department have agreed on a path forward to strengthen Maine’s children’s behavioral health services. The settlement allows the department to prioritize the critical work needed to improve access to services over litigation,” DHHS Commissioner Sara Gagné-Holmes said in a written statement. “The state of Maine agrees that it has an obligation to protect and care for children with disabilities and behavioral health needs, and that’s why we’ve dedicated years of time and investments to rebuild Maine’s children’s behavioral health services.

Nancy Cronin, executive director of Maine’s Developmental Disability Council, said she’s optimistic about the agreement but called it only a “framework.”

“It’s going to take some real infrastructure building,” she said. “This settlement is very clearly the beginning of a long road.”

Cronin also said that the state can’t lose sight of the many children who are still on a wait list for services right now.

“They don’t go away while we plan and restructure this system,” she said. “I won’t be happy or satisfied until I see children getting their needs met on a regular basis.”