Maine is moving forward with plans to develop a residential psychiatric treatment facility for children that has advocates and health care providers divided about whether it’s the right step to help young people with the most severe behavioral health needs.

On Wednesday, the Maine Department of Health and Human Services posted a request for proposals seeking to create a facility with at least 16 beds for young people with behavioral health needs such as substance use disorders and intellectual and developmental disabilities, or who have been identified as having treatment needs related to problematic sexualized behavior.

A psychiatric residential treatment facility, or PRTF, is not a hospital but provides intensive psychiatric care for children and young people under age 21 with serious emotional disturbances and behavioral disorders.

The state developed the request for proposals as the result of an initiative passed by the Legislature as part of the 2024 supplemental budget, department spokesperson Lindsay Hammes said in an email.

“The intent is to provide care that avoids children and youth ending up in hospital emergency departments for long periods of time or avoids them being placed in out-of-state facilities that are even farther from home,” Hammes said.

Disability Rights Maine, which advocates for people with disabilities in Maine’s schools, workplaces and public spaces, was quick to criticize the plans, saying in a written statement that by issuing the RFP, Maine is “seeking to introduce a failed model of treatment, increasing the risk of further harm to Maine’s children.”

But the president and CEO at Sweetser, a Saco-based behavioral health nonprofit, said the organization has been pushing for such a facility in Maine as a way to bring children receiving services out-of-state closer to home.

“This can also help address the children who end up languishing in ER’s for weeks if not months on end because their acuity and illness are too much to be managed at home or in the current child residential structure that we have,” said Jayne Van Bramer, president and CEO at Sweetser.

RFP FOLLOWS SETTLEMENT

The RFP comes a week after Maine reached an agreement with the U.S. Department of Justice ending a federal lawsuit the department filed in September saying the state has violated the Americans with Disabilities Act by unnecessarily segregating children with behavioral health disabilities in hospitals, residential facilities and at Maine’s juvenile detention facility.

The settlement said Maine must strengthen its community-based services for children with behavioral health challenges to keep them from being placed outside the home.

“In light of the historic agreement reached with the DOJ last week, which is based on the assumption that all children can have their needs met in their homes and communities if provided appropriate behavioral health services, it makes no sense for Maine to spend time and resources building new institutional beds for children,” said Atlee Reilly, managing attorney for Disability Rights Maine.

“Maine should instead focus on meeting its obligations under the agreement, which can only be done through developing and delivering a system of community-based services.”

In 2019, Disability Rights Maine staff visited Maine children in out-of-state placements at PRTFs in Arkansas. They found children were not receiving the critical treatment they were supposed to be getting and instead were receiving one hour per week of individualized therapy with their clinicians. They were largely confined to cinder block units with little to no structured programming, the group said in its statement Thursday.

Nancy Cronin, executive director of the Maine Developmental Disabilities Council, said her organization also has concerns about plans for a PRTF in Maine. She said she has heard support for the model from hospitals and behavioral health care providers, but she is worried that children who might be helped in less restrictive environments could end up in the facility when their needs could be better met in other ways.

“I’m concerned people think this will be a silver bullet,” Cronin said. “I’m worried we’re going to build these beds and they’re going to fill up and we’ll have a waitlist when we really need to work on offering a continuum of services.”

Cronin said Maine has a problem of children with behavioral health problems struggling to have their needs met. “That’s why we have the settlement, and that will solve some of the problems,” she said. “PRTF is an extremely restrictive program and I’m concerned it’s not going to accomplish what people want it to.”

Hammes, from the Department of Health and Human Services, said the state is committed to ensuring a comprehensive continuum of care for Maine children and youth, meaning a range of services that address their needs, from early intervention to treatment and crisis services. And as laid out in the settlement reached last week, Hammes said the state will be continuing to expand community-based services for years to come.

“PRTFs are a part of the continuum of care and are limited to a small number of children and youth who have intensive behavioral health needs and require an intensive level of clinical care and treatment based on a clinical diagnosis,” Hammes said.

IS A PRTF NEEDED?

According to Van Bramer, the Sweetser CEO, a PRTF is a locked and secure residential facility that is “between a hospital and a child residential program.”

“It’s a little less restrictive than a hospital setting, but they really are a safe alternative to children experiencing really high levels of acuity,” she said. “It’s a locked, structured clinical setting. It’s not a secure correctional facility, it’s a clinical program where active treatment is used on a daily basis. There’s medical supervision, there’s prescribers, there’s clinicians and therapy, but it is a secure setting.”

Less restrictive child residential programs are “really open-door programs” where kids can run away or leave the program at will, potentially exposing them to drug use, human trafficking or other trouble, Van Bramer said.

She said that Sweetser supports children being served in their home communities near family and friends, but it’s not always safe or appropriate. “(A PRTF) is not a setting any child should grow up in or a long-term solution,” she said. “It’s something that should be utilized for a couple of months … and then children should be stepped down. But I believe there are children this is appropriate for.”

A proposal last year directing the state to implement PRTFs in Maine drew support from hospitals and health care providers, including MaineHealth and Northern Light Health, who said youth with high needs are currently draining emergency room resources and they could be better served in a PRTF.

Van Bramer said Sweetser is waiting for more information from the state about MaineCare reimbursement rates for the proposed facility before deciding if the organization will submit a proposal. The state is proposing $2 million for capital costs to establish a PRTF, and Van Bramer said the organization has existing buildings that could be retrofitted with that money.

“But if the daily rate is not sustainable, we will not be applying,” she said. “So we’re anxious to see what comes out on that.”