Shawn was 4 years old when he watched his dad, Jonathan Whaley, keel over at their doorstep from a gunshot wound to his back. He remembers the pool of blood, the paramedics, and the police. Whaley, 34, didn’t make it. Shawn is now 8 years old. He lives with his grandmother and five siblings in one of Hartford’s rundown neighborhoods.
The state’s efforts to direct children in mental health crisis away from emergency rooms, to other services, have fallen short, with major hospitals reporting staggering increases in patient visits since 2013: Up 32 percent at Connecticut Children’s Medical Center, and 81 percent at Yale New Haven Hospital. The children’s hospital (CCMC) reported nearly 3,300 visits last year – 275 a month, on average — with the average length of stay increasing to 15 hours from less than 12 in 2013. “I wish I could say we had made a lot of progress, but we haven’t,” said Dr. Steve Rogers, medical director of the emergency department’s (ED’s) behavioral health unit. “Unfortunately, I think it’s only going to keep trending this way.”
Similarly, Yale saw ED visits by children ages 15 and younger rise from fewer than 750 in 2013 to more than 1,350 in 2016 — and the numbers are running even higher this year, said Dr. Claudia Moreno, medical director for psychiatric emergencies in Yale’s children’s emergency department. At times, she said, all ED beds are full, and children wait on hallway gurneys.
On any day, thousands of Connecticut children need to be given medication while in child care centers, but many providers don’t know how to properly administer the medications, studies show. To change that equation, the Yale School of Nursing developed a curriculum and has trained 75 nurse consultants to teach child care providers on how to correctly give medication to children in their daily care. Child care providers at more than 200 sites have been trained statewide. “We have made some steady progress on this,” said Angela Crowley, a leader in crafting the curriculum and a professor and coordinator in the pediatric nurse practitioner specialty at Yale School of Nursing. “It is really exciting because we did something really innovative.”
State law requires providers who need to administer medication be trained in how to do so, but there is no uniform training method used by all providers, Crowley said.
Experts are focusing more money and attention on the health of young children in Connecticut in an effort to prepare them to be successful in school later on. The efforts include developmental screenings at child care centers, home visits and information hotlines for parents, better collaboration with pediatricians and more support for preschool staff members dealing with emotional and behavioral issues. The idea is that if a child’s basic health needs aren’t met, he or she won’t be able to keep up with academic and social expectations in school. “There’s been a huge interest in addressing early childhood development with the understanding that’s where we get the most bang for the buck,” said Lisa Honigfeld, the vice president for health initiatives at The Child Health and Development Institute of Connecticut. In the last 10 years, there has been “an explosion” of federal funding for early childhood initiatives to get children on track early and prevent spending on remediation down the road, Honigfeld said.
A pilot project to provide coordinated care to children insured by Medicaid resulted in more Connecticut children receiving preventive dental services, mental health care and well-child visits, according to a new report by the Child Health and Development Institute of Connecticut, Inc.
“Care coordination is especially important for children, as they benefit most when their needs are detected early and they receive intervention services,” the report says. “The primary care medical home is an ideal venue for detecting children’s problems at the earliest possible age and connecting families to helpful interventions and supports outside of the primary care site.”
The evaluation of the “Health Outreach for Medical Equality” project, dubbed “H.O.M.E.,” found that adding care coordinators to work with low-income children in the HUSKY insurance program boosted the percentage of Hartford children ages 2 and younger using dental services – 34 percent for those who received care coordination, vs. 25 percent of Hartford children overall. In addition, children who received H.O.M.E. services accessed behavioral and mental health services at a significantly higher rate than the overall Hartford HUSKY population. The increased access to dental and mental health care “pays off tremendously in the long run,” in terms of both health outcomes and cost savings, as problems are addressed earlier, said Lisa Honigfeld, vice president for health initiatives at the Child Health and Development Institute.