Maine hasn’t yet inspected out-of-state youth mental health programs after reports of rampant abuse

In the months following a scathing federal investigation that detailed maltreatment at out-of-state programs where Maine youth are receiving mental health treatment, state health officials have yet to conduct in-person inspections of those programs, a spokeswoman said.

Health officials, however, will soon resume regular in-person visits to youth at state-funded residential programs outside of Maine, said Lindsay Hammes, press secretary for the Maine Department of Health and Human Services.

Those visits “were limited due to the pandemic” in March 2020, she said.

The state “is reinstituting regular site visits and reviews to out-of-state facilities beginning in September, during which it will conduct quality assurance to ensure that the programs are meeting the state’s standards of care,” she said.

The explanation comes after health officials gave lawmakers vague answers at a meeting in July about how the state had responded to the findings of a two-year investigation conducted by the U.S. Senate Committee on Finance.

The committee’s 135-page report , released in mid-June, detailed rampant instances of maltreatment, substandard care and poor oversight at youth residential programs operated by the country’s four largest for-profit behavioral health providers, which provide intensive treatment for some of the country’s most behaviorally challenged adolescents.

Maine pays to send youth to three MaineCare-enrolled programs mentioned in the Senate investigation, including two in Arkansas featured prominently during a hearing on Capitol Hill, the Bangor Daily News reported on June 18. MaineCare is the state’s Medicaid program.

Lawmakers who serve on the Blue Ribbon Commission to Study the Organization of and Service Delivery by DHHS questioned officials from the Maine Department of Health and Human Services about their oversight of out-of-state children’s residential programs during a public meeting on July 10, after Rep. Margaret Craven, D-Lewiston, said she read the BDN article and found it “upsetting and worrisome.”

Lawmakers established the commission in mid-2023 to study the operations of the state’s largest government agency, which oversees contracts with out-of-state programs.

But at the meeting, state officials avoided directly answering lawmakers’ questions and, at times, misspoke about how many youth were enrolled in programs found to have inadequate treatment and put children at risk of abuse.

Afterward, the department denied the BDN an interview to clarify those remarks and ask more detailed questions about the state’s oversight of out-of-state programs. Hammes provided largely indirect or vague responses to written questions from the BDN.

Sen. Joe Baldacci, D-Bangor, who serves on the commission, said in an interview that he believes there should be stronger independent oversight of youth in out-of-state programs and noted that he proposed unsuccessful legislati on to establish such a mechanism in the previous legislative session.

“We don’t have adequate oversight, so we don’t have the best information about how our kids from Maine are being treated,” he said during the meeting in July.

Atlee Reilly, the legal director of Disability Rights Maine, a legal advocacy firm, also urged the state in the BDN’s June article to immediately meet with children at programs mentioned in the report, saying that its findings seemed to “rise to the level of something you need to check out for yourself.” Colleagues of his had previously raised concerns with the state about one of them, Millcreek Behavioral Health in Arkansas, after they visited it in 2019.

The programs that were investigated appear to be serving only a small number of the 70-or-so Maine children who are currently receiving treatment outside of Maine because they struggled to be admitted to an in-state program, often due to the severity of their behavioral challenges, including aggression or defiance.

At the July meeting, Dean Bugaj, the department’s associate director of children’s developmental and behavioral health services, inaccurately told the commission that only one Maine youth currently resided at a program mentioned in the report. He did not specify which program.

He said his staff were “taking this very seriously and looking into this to assure” that the young person was safe.

The review was “ongoing,” Bugaj said, adding that “I have not heard that the youth has been treated as the report has alleged. If that were the case, we would absolutely be very concerned and jump on that.”

His answer was incomplete. At the time of Bugaj’s comments, two of the three MaineCare-enrolled programs — SandyPines Residential Treatment Center in Florida and Millcreek Behavioral Health, the Arkansas program — that were mentioned in the Senate investigation were serving Maine children, according to a handout provided to the commission. Health officials said that confidentiality laws prevent them from specifying how many youth go to each program.

“Mr. Bugaj’s comment was an inadvertent error,” Hammes said. “The Department appreciates the opportunity to clarify.”

Bugaj did not directly answer a question from Craven about whether the department had visited any MaineCare-enrolled programs mentioned in the report since it was published. He also did not provide specific details about how the department had responded to its findings.

Rather, he gave general descriptions about how the department vets programs before enrolling them in MaineCare. Officials review their licensing documents, require programs to complete a questionnaire about their treatment model, and seek to understand how they engage families to ensure youth are able to transition back home, he said.

State behavioral health officials keep tabs on the progress of a child’s treatment during meetings with the program’s staff and child’s parents. Maine child welfare officials, who work for a separate division of the department, are also responsible for monitoring the welfare of children in state custody.

“At times, site visits are initiated. They have not been a required step in terms of being able to enroll programs [in MaineCare] historically, although, from my perspective, I want my staff to have eyes on,” Bugaj said. “As we are working forward, under my leadership, eyes on, site visits, those are a priority.”

Maine also has a system in place to respond to concerning events a child might experience out of state, Bugaj said. As with in-state providers, out-of-state programs agree to tell Maine health officials when such episodes take place, such as a child being physically abused or breaking a bone.

Depending on the allegation, “we initiate a conversation with the program and programmatic leadership, their administration, to understand not only what occurred, how it occurred, what their follow up and response is, what their plans are to mitigate any future challenges,” Bugaj told the committee.

“[We] really work to not only understand and hold accountable to assure that there is nothing that could happen again that led to what the incident was,” he said.

States where programs are located and the federal government, which operates Medicaid, a major funding source for residential treatment, also provide oversight, Hammes said. But she added that “the Department agrees that strengthening its oversight is important.”

The Senate investigation argued the existing state and federal oversight measures have been inadequate at stopping abuse and ensuring high quality care.

At least one of the providers targeted in the Senate investigation, Universal Health Services, which operates SandyPines Residential Treatment Center in Florida, publicly disputed that its facilities are unsafe, NBC News reported .