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On December 17, 2020, the United States Department of Justice Civil Rights Division (DOJ) opened an investigation into whether the State of Nevada subjected children with behavioral health disabilities to unnecessary institutionalization in violation of Title II of the Americans with Disabilities Act (ADA). The DOJ released a report on October 4, 2022, finding that Nevada violated the ADA by failing to provide adequate community-based services. The State demonstrated an over-reliance on institutionalization, placing children in segregated settings in hospitals and residential treatment facilities.
Through the investigation, the DOJ found that children experienced frequent and lengthy stays in institutions, many staying longer than the State’s self-reported average of nine to twelve months. Some children were even placed in out of State treatment facilities, hundreds of miles away from home in highly restrictive and segregated settings, even though many of them were eligible for, and open to, receiving community based services. As a result of intensive in-home support, therapeutic foster care and other family-based support being unavailable, and mobile crisis response and intensive care coordination programs having capacity issues and increased response times, children were forced to seek care from hospitals when institutionalization was avoidable. The Department found that the State’s lack of effective oversight and management of its Children’s Behavioral Health System contributed to the unnecessary institutionalization and segregation of children. Among the actions were: the State’s failure to ensure the availability of and access to key community-based behavioral health services; maintain an adequate provider network for those services; and connect children with those services to prevent institutional placements. These failures were despite the fact that the State’s service system was designed to provide services such as therapy, behavior supports, crisis services, and care coordination. The state also failed to connect children who entered institutional settings with appropriate services to support their return to the community, and failed to ensure appropriate discharge planning to prevent unnecessarily long stays and readmissions.
The DOJ recommended several remedial measures to comply with Title II of the ADA by reasonably modifying its service system. These measures included: 1) ensuring that community-based services were sufficiently accessible and available to prevent unnecessary institutionalization, 2) ensuring that the array of services was available statewide as required by Medicaid, 3) exercising robust oversight of providers, 4) assessing children at serious risk of institutional placement for community services and quickly connecting them to appropriate services, and 5) working with children and families when a child entered a segregated setting to facilitate discharge and transition back to the community.
As of October 2023, the parties were working towards a resolution in the form of an agreement that would include remedial measures the State agreed to take on.
Simran Takhar (10/12/2023)
Last updated Aug. 30, 2023, 1:26 p.m.Docket sheet not available via the Clearinghouse.
State / Territory: Nevada
Case Ongoing: Yes
United States Department of Justice
Public Interest Lawyer: Yes
Filed Pro Se: No
Class Action Sought: No
Class Action Outcome: Not sought
Causes of Action:
Special Case Type(s):
Prevailing Party: None Yet / None
Nature of Relief:
Source of Relief:
Disability and Disability Rights: