R.I. officials break ground for residential care campus for girls with behavioral health needs

An architectural rendering shows what the state's new residential facility for adolescent girls in Exeter will look like. (Courtesy of DBVW Architects)

A new behavioral health care campus for adolescent girls who would otherwise have to seek treatment outside Rhode Island is coming to state owned land in Exeter.

The 16-bed facility is slated to open in spring 2026, but Gov. Dan McKee, a few of his cabinet members and an assortment of state legislators celebrated with a groundbreaking ceremony Tuesday afternoon on Exeter’s Main Street on the state-owned Ladd Center Campus , home to several state buildings and the site of a former mental institution .

The $45 million facility will serve girls ages 13-18 who receive behavioral health care services through the Department of Children, Youth and Families (DCYF). Funding for the campus comes from a three-year capital projects appropriation. The design for the campus features a pair of eight-bedroom suites, classrooms and a media center, visiting areas, office space and activity rooms. A fitness center, sports field and outdoor courts are also included.

“We know that Rhode Island needs more residential treatment beds for young women — not in another state, but here, in Rhode Island,” McKee said in a statement. “In this state-of-the-art facility, these youth will be able to receive the care they need, with the ultimate goal of reunifying them with their families.”

Rhode Island lacks such a facility for girls with serious mental health issues that can be treated in a non-hospital setting. The new facility will also provide educational services alongside psychiatric care.

A total of 29 adolescent girls were placed at treatment centers out of state for behavioral health care as of April 2024. While the number has varied slightly it “has largely remained stable over time,” Damaris Teixeira, a DCYF spokesperson, told Rhode Island Current in an email. In March 2023, there were 21 adolescent youth in out-of-state placements, and in January there were 32 girls out-of-state.

Sen. Alana DiMario, a Narragansett Democrat and mental health counselor, said in a phone interview Tuesday evening that the new facility’s female focus is comparable to existing programs for adolescent boys at the Rhode Island Training School, “which is a place where they are able to be kept safe, to receive appropriate treatment, [and] their educational needs are met.”

“By creating a facility here in Rhode Island, what that means is their educational continuity can be better, their connections with their family and community and treatment providers can be maintained,” DiMario said. “It provides for better outcomes overall, because the ultimate goal of a facility like this is for stays to be very short.”

The groundbreaking follows a difficult season for young girls’ behavioral health in Rhode Island, in which youths have been kept too long in hospitals or sent out of state for residential care because of a lack of local treatment facilities.

In May, U.S. District Attorney Zachary Cunha announced a joint federal investigation accusing DCYF of “warehousing” kids with behavioral health conditions at Bradley Hospital in East Providence with no clear action plan for their discharge, with some remaining there for hundreds of days. In June, DCYF decided to pause construction of an addition to St. Mary’s Home for Children, a North Providence psychiatric residential treatment facility, after a tumultuous period of highly-publicized scandals involving abuse, neglect and administrative malpractice.

Psychiatric residential treatment facilities are a federally-specified form of youth residential care with exacting standards. Ideally, these facilities serve as a step down from hospitalization and prevent warehousing. This special form of care is precisely what St. Mary’s was contracted to provide. It’s also what the new Exeter facility is expected to continue, DiMario said.

The new Exeter campus is not classified as a psychiatric residential treatment facility because the number of beds is 16 or under, said Stephanie Menders, a spokesperson for the Executive Office of Health and Human Services, the parent agency to DCYF.

Psychiatric residential treatment facilities are covered by Medicaid, a rare exception to a longstanding exclusion of inpatient psychiatric care since the program’s inception in 1965. Typically, the “Institution for Mental Diseases rule” prohibits coverage for behavioral health facilities with more than 16 beds.

“Reimbursement limitations are directly in relation to the IMD rule,” Menders said. “In general, children who are eligible for Medicaid – whether or not they are in DCYF custody – would be able to receive services in this setting if medically necessary, and the state can claim federal match for those services.”

“Because the residential facility is expected to provide behavioral health treatment, keeping the bed count capped at 16 will ensure that Rhode Island can access federal Medicaid funds for the services provided,” Menders added.

In a follow-up email on Wednesday, Menders clarified that the new facility “is designed for youth who do not require the intensive inpatient care offered by a Psychiatric Residential Treatment Facility (PRTF),” and is meant to contribute to a “comprehensive continuum of care” for diverse behavioral health needs. Still, PRTF status “can be pursued at any time,” Menders said.

Ideally, a suitable vendor will be able to replace St. Mary’s Home for Children and continue delivering psychiatric residential treatment services, DiMario said. But there will still be gaps in certain kinds of care in the state, she noted.

“Adolescent youth who may need inpatient care for eating disorders, which is a very specialized type of treatment — they might still need to go to the specialized facility that does great work on that in Massachusetts,” DiMario said. “There still may be situations where the best type of treatment for a youth in care might be an out of state placement, but it will be far fewer.

Construction for the project is being handled by general contractor Gilbane Building Company and project manager Peregrine Group LLC. DBVW Architects in Providence has designed the campus and buildings. A request for proposals for health care service vendors had not been uploaded to the state’s vendor portal as of Tuesday evening.

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This article was updated Thursday morning, Aug. 15, to include additional comments from the Executive Office of Health and Human Services.