Improving services for children with Serious Emotional Disorders in Idaho
Jeff D. v. Otter is a federal class action lawsuit filed on behalf of Idaho youth with serious emotional disturbances. The Jeff D. lawsuit sought to end the harmful practice of unnecessary institutionalization by seeking to enforce children’s right to access mental health treatment and educational services in the least restrictive setting. Initially filed in 1980, advocates secured an early victory when, in 1983, Idaho agreed to provide individualized and community-based services to children with serious emotional disturbances. However, after nearly three decades of unmet promises by the state and protracted litigation between the parties, advocates have struggled to hold Idaho accountable for complying with the settlement agreement. Young Minds Advocacy is working with other advocates and the State of Idaho to finally achieve access to intensive, home and community-based mental health services.
When the lawsuit was filed, community-based intensive mental health services in Idaho were almost entirely lacking. As a result, many children were placed involuntarily in institutional settings, including adult psychiatric wards and out-of-state facilities. This damaging practice violated the state’s obligation to serve children in the least restrictive environment appropriate to meet their mental health needs as required under federal and state law.
One of the named plaintiffs, Jeff D.*, was seventeen years old at the time of the lawsuit and had spent over two years under involuntary commitment in a public mental health hospital. Prior to his hospitalization, Jeff D. cycled through several foster care placements as social workers struggled to find appropriate services in the community to treat his mental illness. When these efforts proved unsuccessful, Idaho committed Jeff D. against his will to State Hospital South, where he was housed with adult patients. Some of these adult patients included sex offenders and other dangerous criminals who were committed to the hospital by the criminal justice system. While Jeff D. was hospitalized, Idaho failed to provide him with appropriate mental health treatments and educational services and, as a result, Jeff D.’s condition deteriorated significantly.
Jeff D. v. Otter was filed in August 1980 as a federal class action lawsuit on behalf of indigent Idaho youth with severe emotional and mental disabilities. The suit sought declaratory and injunctive relief against the State of Idaho for failure to provide adequate care in violation of the United States Constitution, the Idaho State Constitution, and several federal and state statutes.
In 1983, the parties reached a settlement agreement. As part of the settlement, the State of Idaho committed to provide individualized, community-based mental health services for Idaho’s youth. The agreement also provided that the District Court would have continuing jurisdiction to enforce the settlement until the Court was satisfied that the problems identified in the lawsuit were adequately addressed. In April 1983, the District Court entered the parties’ settlement agreement as a consent decree.
Over the next three decades, the plaintiffs struggled to implement the settlement agreement. After years of inaction and non-compliance by Idaho, the plaintiffs succeeded in having the District Court enter two additional consent decrees in December 1990 and again in December 1998, both affirming Idaho’s continuing obligation to provide community-based mental health services to children.
In another skirmish that began in 2006, the District Court found that the State had substantially complied with the consent order and dismissed the case; plaintiffs appealed the decision. In August 2010, the Ninth Circuit Court of Appeals reversed the District Court’s order, reinstating the consent decree.
In 2013, the parties agreed to set aside active litigation and enter into a mediated negotiation process. Working with local counsel Howard Belodoff, Young Minds’ attorneys played a central role in the mediation between the parties, including helping to secure stakeholder participation in the process.
In June 2015, Idaho Governor “Butch” Otter signed a settlement agreement to improve access to intensive mental health services for thousands of children and youth. The District Court approved the settlement agreement on June 29, 2015. Once fully implemented the agreement could provide as many as 9,000 Idaho children with improved access to community-based mental health services.
The agreement commits the state to taking a number of concrete steps to develop and implement a sustainable, coordinated, and comprehensive mental health system for youth, including:
- Creating a statewide process, across all child-serving systems, to identify and screen youths for unmet mental health needs;
- Providing a comprehensive array of community-based services and supports to children when medically necessary;
- Delivering services using a consistent approach that engages families, youths, and their support systems; and
- Monitoring and reporting on service quality and outcomes for youths.
The settlement anticipates implementation over a four-year period with three additional years of monitoring to ensure sustained performance of the service delivery system. Upon successful completion of implementation and monitoring, the lawsuit will be dismissed.
In May 2016, the United States District Court of Idaho issued an order approving the State of Idaho’s Implementation Plan, which outlines concrete steps Idaho will undertake in order to reform the state’s mental health system for children. The implementation plan was developed over several months in collaboration with state agency representatives, plaintiffs’ counsel, and community stakeholders.
Highlights from the Implementation Plan include:
- New Services Roll Out Starting as Early as 2017:
Children who meet eligibility criteria under the terms of the Jeff D. Settlement Agreement will be entitled to a comprehensive array of community-based mental health services and supports. New and enhanced services will be made available across the state in a phased approach. New services will be added as early as 2017, beginning with the rollout of enhanced respite services and newly developed partial hospitalization.
- Common Assessment Tool Implemented Statewide:
By January 2018, the Department of Health and Welfare (DHW) will begin using a new assessment process utilizing the Child and Adolescent Needs and Strengths (CANS) tool. The CANS tool helps identify both the strengths as well as the needs of a young person, helping mental health providers leverage the youth’s assets and abilities in their own recovery. Idaho will implement the CANS tool statewide across several child-serving systems, allowing for better coordination of treatment planning and more efficient service delivery. More information about the CANS tool is available here.
- Implementing Child & Family Team Approach:
DHW and community providers will use a new practice model for treatment planning and decision-making. Known as the Child and Family Team (CFT) approach, the model uses youth and family input as the driver in service planning, empowering them to take a more active role in their own treatment. The CFT approach also emphasizes a teaming process that brings together individuals invested in a child’s mental wellbeing to collaborate in developing a treatment plan and help coordinate service delivery.
Visit http://youthempowermentservices.idaho.gov/ for more information on the ongoing collaborative effort to implement a new system of care for Idaho children and youth with Serious Emotional Disturbance (SED).
*Jeff D. is not the plaintiff’s real name. The Courts use a pseudonym to protect the child’s identity.