Alaska is failing to provide legally adequate behavioral health services for youths, often worsening their problems by keeping them institutionalized far from home for long periods of time, according to a U.S. Department of Justice investigation. But local and state officials said some factors beyond their control, such as the national health care worker shortage are hampering the implementation of improvements.
A report of the investigation released Friday states “there is reasonable cause to believe that the State of Alaska violates (the Americans With Disabilities Act) by failing to provide services to children with behavioral health disabilities in the most integrated setting appropriate to their needs.” The problem is especially acute in rural communities and for Alaska Native youths.
Numerous anecdotal examples of youths and families throughout the state are presented.
“One mother from a rural community in Southeastern Alaska told us that the closest provider of the integrated dual-disorder treatment her son needs is over 800 miles away,” the report states. “The mother said that she felt she had no choice but to send her son away from home, starting with an admission to North Star Hospital (in Anchorage) when he was just six years old. Her son has since experienced numerous hospitalizations and residential facility placements, including at a (psychiatric residential treatment facility) in Texas.”
“After living for years in institutions, he has begun to feel like a stranger around his own family, according to his mother. She said that had appropriate community-based services been available to her son from the start, ’it would have made all the difference.’”
The situation in Juneau seems better than the overall findings of the investigation, due to more behavioral services being available relative to the town’s size compared to some other communities, said Amy Simonds Taylor, executive director of Juneau Youth Services. But she said local providers are hurting from some of the same problems — notably a shortage of employees stemming largely from issues related to the COVID-19 pandemic — that are haunting the industry statewide and nationally.
“In Juneau I think we, in large measure, are large enough to keep more kids within the community,” she said. That said, “I think we could use more. I think the need in Juneau is pretty high. I certainly don’t mean any provider is doing a poor job. I simply think there aren’t enough.”
The DOJ report makes a number of recommendations aimed at improving community-level services, including working with tribal stakeholders, local governments and schools to provide adequate “culturally appropriate and responsive” treatment. The department also states its findings are not merely advisory.
“We are obligated to advise you that if we are unable to reach a resolution, the United States may take appropriate action, including initiating a lawsuit, to ensure the State’s compliance with the ADA,” the final paragraph of the report states.
The Alaska Department of Health, in a prepared statement responding to the investigation, referred to “numerous legislative, financial, and collaborative projects” in recent years to address admitted long-standing challenges including a bill (HB 172) signed into law allowing involuntarily commitment of people to crisis stabilization centers, plus expanding experimental, pilot, or demonstration projects through what’s known as Section 1115 Medicaid demonstration waivers.
“These are major milestones, and we remain committed to working with our stakeholders and constituents on additional improvements to the system,” the statement asserts.
The DOJ’s report assesses services between 2018 and the first half of 2022. On July 1 of this year the state split the Alaska Department of Health and Social Services into two entities, with the Department of Family and Community Services now overseeing programs such as foster care and juvenile justice.
“With the creation of the Department of Family and Community Services, the State of Alaska has a greater ability to focus on improving and implementing programs to serve vulnerable populations,” Brian Studstill, communications director for the new department, stated in a written response to the DOJ investigation. “Since the reorganization, the Department of Family and Community Services has focused staff within the commissioner’s office to address improving the complex care system for children in state custody. The department is committed to ensuring that children with complex behavioral health needs receive the services in an appropriate placement setting.”
Taylor said the Medicaid waiver implementation, which the Department of Justice offered qualified praise for in its investigation, is among the examples of circumstances beyond the state’s established behavioral health system.
“Their launch of that was almost concurrent to the pandemic starting.” she said. “One of the things we found was employees were almost frightened to go into people’s homes. No one really felt safe or comfortable trying to do that.”
Department of Justice officials, in addition to reviewing records and interviewing staff at a multitude of health agencies in the state after beginning their investigation in December of 2020, also made two visits to the state in April and May of 2022. The investigation included discussions with more than a dozen Alaska Native tribal organizations, who are trying to cope with a disproportionate number of situations where youths are institutionalized.
“Of the 654 children whom the State reports received acute psychiatric services at a general hospital or psychiatric hospital through Alaska’s Medicaid program in FY2020, at least 300 children are Alaska Native,” the report states.
“Alaska Native children confined to (psychiatric facilities) and other institutional settings are disconnected from their culture, losing opportunities to learn from elders, learn Native languages, learn how to live off the land, and participate in cultural traditions that affirm their identity,” the report adds. “They frequently progress more slowly in treatment, stay at facilities longer, and sometimes run away because they do not want to be there. These children lose their sense of identity while in institutions, we heard from community leaders when visiting Alaska Native communities in western Alaska. After months or years in a highly regimented environment, they often struggle to adjust when returning to their communities.”
The number of Alaska youths at psychiatric facilities declined during the pandemic, but the average length of stays have increased, the Justice Department noted.
“Placements of between six months and one year are common,” the statement notes. “Some children remain in a PRTF for years.”
Local hope the investigation will “help facilitate increased public and private partnerships designed to strengthen and expand services for all children and families throughout the state” was expressed by Eric Gettis, vice president of behavioral health services for Southeast Alaska Regional Health Consortium, an Alaska Native-led organization.
“Finding respite for children and families experiencing behavioral and emotional crises within local Alaskan communities can be incredibly challenging because of the expansive geographic environment, small population size, transportation logistics and oftentimes scarce finances,” Gettis stated in an email. “At SEARHC and across Alaska, we know that Alaska Native families in particular have been negatively affected by the lack of available resources and opportunities. We are well aware of this issue and are very hopeful that the Department of Justice’s findings will help facilitate increased public and private partnerships designed to strengthen and expand services for all children and families throughout the state.”
Juneau Youth Services has at times had to refer youths with severe issues to facilities in Anchorage and a specialized facility in Texas, Taylor said. But “we don’t make those decisions independently. We make those decisions with the parents or guardians before that happens.”
Feedback from the families is uncommon after that, unless the youth needs further local treatment Taylor said. But some youths do contact the agency as “adult graduates.”
“It’s a little slanted because they’re writing to tell us they liked us,” she said. “I’ve never gotten a letter to say they hate us.”
• Contact Mark Sabbatini at mark.sabbatini@juneauempire.com
