Alabama has reached a settlement in a federal lawsuit that accused it of segregating foster youth with mental health conditions in highly restrictive residential facilities.
The lawsuit, filed in 2021 by three nonprofit litigators, pertained to Alabama’s use of psychiatric residential treatment facilities, or PRTFs. These hospital-like settings are meant to treat youth and young adults with very serious mental illness, and are one of the few exceptions to the prohibition on using Medicaid to pay for institutionalization.
Plaintiffs alleged that Alabama used this setting for foster youth with behavioral issues that do not require institutionalization, and that the state’s array of PRTFs are not safe. The lawsuit noted “numerous reports of staff at PRTFs slamming children against walls, punching and slapping children in the face, using chokeholds, and laying on top of children who are being held face down on the ground.”
In the settlement finalized this week, the Alabama Department of Human Resources has agreed to conduct a “comprehensive assessment” of any youth before being placed in a PRTF to determine the suitability of that option. Their stay in these facilities must now be reassessed at least every six months, and that step-down to a less restrictive setting occurs within a month of when it is recommended.
“Institutional placements have too often operated as restrictive and harmful substitutes for robust community-based support, producing worse outcomes for children while purporting to provide care,” said Claire Sherburne, senior staff attorney at Southern Poverty Law Center, in a statement released this week. “The approved settlement marks a necessary shift towards integration, paving the way for all children to learn, play and grow in their communities — not institutions.”
Children’s Rights, one of the three organizations involved in this case, has a similar federal lawsuit pending against North Carolina, alleging abusive conditions and overmedication in PRTFs used by the state. More than a third of North Carolina foster youth in PRTFs are sent to institutions outside of the state, according to the lawsuit.