While most of those placements were within New England, some children moved as far away as Arkansas, Missouri and Utah, the report found.

The reasons are many. Some children require special treatment unavailable in Maine, such as residential care for eating disorders. Others, like Lora’s daughter, have behaviors or symptoms that local providers feel unequipped to manage, the report states. Sometimes no placements are available at a given time, because beds are already full or Maine lacks the type of facility required.

But rather than respond by building more institutions to house children with behavioral and mental health needs, the Maine Department of Health and Human Services must intervene in their lives sooner, with services delivered in homes and communities, said Katrina Ringrose of Disability Rights Maine, which advocates for children and adults with disabilities.

Maine’s existing system for treating individuals in crisis is geared toward adults, she said. When kids’ unaddressed mental health challenges escalate into a crisis, many parents have no choice but to bring their son or daughter to the emergency room. After walking through the hospital doors, the chances that the child will need a higher level of care, such as a residential placement, shoot up, Ringrose said. Once a child is in the system, providers are inclined to refer them for that care, and some children’s conditions tend to worsen in a hospital setting.

[First review in two decades shows all the ways Maine failed kids with mental health problems]

Maine is also sending more children out of state to psychiatric hospitals and for longer durations, the report found.

Maine already has more than 100 psychiatric beds for children between four hospitals and roughly 300 beds at residential care facilities, Ringrose said. She “can’t imagine a situation where Maine needs more beds,” she said. Institutionalizing children not only costs much more in the long term than providing less intensive care, but evidence also shows it’s “not what’s best for kids,” she said.

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Many children are waiting months for services delivered in their homes and communities, despite federal law limiting waits to 180 days. And even though some residential facilities have open beds, kids still are left waiting because the facilities can’t hire enough workers to staff the beds, the report noted. Salaries in the often stressful and dangerous field are low, discouraging new applicants and leading to burnout among the existing workforce.

By providing the right services early on — such as day programs at local agencies or aides visiting children’s homes regularly — Maine could limit the number of children in crisis who need institutional care, she said. Some children now in residential care could go home if those services were funded and available, Ringrose said.

But if Maine builds more psychiatric facilities — as former Gov. Paul LePage aimed to do through a now-stalled project in Bangor — “then they’re going to be filled, and there’s a financial incentive to fill them,” she said.

While some children receiving behavioral and mental health services are covered by private insurance, the vast majority rely on MaineCare, the state’s Medicaid program. Every time the state places a child in residential care out of state, it must pay room and board expenses, in addition to covering the actual treatment.

In fiscal year 2019, DHHS estimated it would spend $848,018 for room and board alone. That’s up from $756,00 in the previous fiscal year, though down from a recent high of $972,000 in 2017.