A 2021 lawsuit against the state of Alabama over the state’s practice of unnecessarily institutionalizing children with mental health disabilities in psychiatric residential treatment facilities, PRTFs, appears to be coming to a close after a preliminary settlement agreement was reached late last week.
The lawsuit, brought against the state by the Alabama Disabilities Advocacy Program, Children’s Rights and the Southern Poverty Law Center, SPLC, accuses the Alabama Department of Human Resources, DHR, of violating the Americans with Disabilities Act, ADA, by “isolating children in highly rigid and often dangerous settings instead of meeting their mental health needs in a loving home or community-based setting.”
The plaintiffs cited research showing that children placed in PRTFs experience worse life outcomes than their non-institutionalized peers, with experts who testified in the case finding that Alabama’s failure to require standardized clinical assessments led to children being improperly institutionalized, resulting in worsened conditions rather than improvements.
Now, per the terms of the settlement, Alabama will be required to institute standardized assessments for children at risk of PRTF placement, requiring physician certification of need in 95 percent of cases. Additionally, the state agreed to implement six-month quality reviews to ensure children’s care plans meet professional standards and to place children in community-based and family-like placements, including kinship care and therapeutic foster care, when appropriate. Meanwhile, the state will cap congregate care in shared living facilities at no more than 7 percent of children in state custody.
Attorneys for SPLC and Children’s Rights celebrated the preliminary settlement in official statements, while also acknowledging that more work is needed to ensure the best conditions for Alabama’s children.
“All children and young people deserve to grow up in community with their communities,” said Claire Sherburn, senior supervising attorney, SPLC. “But when the state relies on highly restrictive PRTF placements to serve children with disabilities, those children lose out on that chance. And they lose out on the chance to be kids — to go to their community schools with their friends and neighbors, play team sports, explore, pursue hobbies, and be in relationship with the people who love and care for them. This settlement safeguards children with disabilities in Alabama from entering and languishing in segregated institutional placements when they could and should be receiving the support and services that they need in their communities. We celebrate this victory, and we also know that there is so much work to be done to ensure that all children in the deep south can thrive.”
“This agreement is a long overdue win for children and families across Alabama,” said Lindsey Frye, senior staff attorney at Children’s Rights. “Children with disabilities deserve to grow up in safe, loving family homes, not locked away in institutions. For too long, Alabama’s overreliance on psychiatric facilities has inflicted lasting harm. This settlement affirms that the ADA protects children from unnecessary institutionalization and guarantees their right to services that help them thrive at home and in their communities. It marks an important step toward bringing Alabama in line with federal law and the standards of care every child deserves.”
The settlement will now go before a federal judge for approval at a fairness hearing, with the court determining the final certification of the class and settlement.
Earlier this year, the U.S. Department of Justice found that Alabama unnecessarily segregates children with physical disabilities in nursing facilities and hospitals. A series of lawsuits filed in 2023 also accuse DHR and the Alabama Department of Education of violating the ADA by segregating children with disabilities in on-site “schools” at residential treatment facilities and depriving them of educational opportunities provided to their non-disabled peers.
