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Publication Date

4-2025

Document Type

Article

Abstract

On June 22, 1999, the Supreme Court of the United States issued a monumental decision in the history of the disability rights movement in Olmstead v. L.C. by Zimring. As people with disabilities, especially those with mental health conditions or developmental disabilities, were frequently institutionalized without much of any thought to allowing them to be a part of the community, the Olmstead decision changed all of that, at least in terms of the acknowledgment of the legal right to a placement in the least‑restrictive environment whenever possible and cementing into legal protections the understanding that community integration was firmly established as a hallmark of disability rights. But twenty‑five years later, while there have been many victories in community integration, there have been equally as many disappointments, with many people with disabilities around the country waiting years on state waitlists for community placements. There is no equality across states when it comes to how the Olmstead decision has been implemented. “Since [Olmstead], states have made [different] amounts of progress on supporting people with disabilities in the most integrated settings possible.” Most recently, the American Network of Community Options and Resources’ (ANCOR) 2024 Case for Inclusion report is illustrative of this continuing challenge. “Nationally, there were 497,354 people on state waiting lists for home‑ and community‑based services (HCBS) waivers.” One particular segment of people with disabilities facing such challenges in securing community placements is children with behavioral health disabilities, as evidenced by recent litigation efforts. “Children with behavioral health disabilities are individuals up to the age of 21 who have a diagnosable serious emotional disturbance, mental illness, and/or substance use disorder. This population includes children with co‑occurring intellectual or developmental disabilities.” Globally, it has also been acknowledged that children with disabilities who become institutionalized face the potential for even greater evils in the potential for both abuse and neglect. In addressing these needs, the framework of social determinants of health (SDoH) can be utilized as providing access to these services in a community setting. This can be critical in order to decrease the incidence of these children experiencing social isolation and loneliness as the population of children is one known to be greatly impacted by these issues.

This Article is an attempt to modernize Olmstead’s impact by looking at its implementation through a SDoH lens in examining the recent challenges involving children; specifically, as social connection through community, which is an acknowledged SDoH defined as “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality‑of‑life outcomes and risks.” One of the domains included in the SDoH framework is social and community context in Healthy People 2030. If we are to see the true realization of Olmstead, it is necessary to emphasize more about the importance of community in relation to health, in fact, the significant correlation between social connection and better health outcomes which includes the impact on the health and development of children. How could, and should, this framing be used in litigation or policymaking to maximize the realization of Olmstead for children with disabilities, particularly those with behavioral health disabilities?

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