I-Team In-Depth

Pediatric Psychiatric Cases Continue Climbing, Swamping ERs

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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.

Childhood Obesity

Mix Of Programs Helping Low-Income Families Build Healthy Eating Habits

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Connecticut doctors and health care workers are battling childhood obesity by helping low-income families make healthier food choices, and coaching busy parents on fast but healthy ways to feed their children. Children are more likely to be obese if they grow up in low-income families, the U.S. Centers for Disease Control and Prevention (CDC) reports.  And when parents work long hours at low-wage jobs, that can contribute to childhood obesity as well, according to health experts, because time-squeezed parents struggle to provide home-cooked meals and family activities. Colleen Shaddox explores how teens in New Britain learn how to make healthy food choices. The CDC defines obesity as “having excess body fat,” and says it is affected by genetic, behavioral and environmental factors.

Environmental Health

Asthma ER Visits And Hospitalizations Drop In Many Communities

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The rates of asthma-related emergency room visits and hospitalizations dropped in many Connecticut communities, the latest data from the state Department of Public Health show. Overall, 58 percent of communities saw a decrease in the age-adjusted rate of emergency room visits, while 63 percent saw a decrease in the rate of hospitalizations for asthma, according to a C-HIT analysis of the data. Some 36 percent saw improvement in both areas. The data compares age-adjusted rates for each town for 2005-2009 and for 2010-2014 per 10,000 people. Meanwhile, the state’s overall rate for emergency room visits in 2014 was lower than recent years but still was higher than it was 10 years ago.

Social Media

Docs Expanding Their Reach With Tweets

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Despite national debate on whether doctors should use social media, some physicians are forging ahead, using platforms such as Twitter to interact with colleagues, expand their knowledge and even connect with patients. Dr. Nick Bennett, the infectious disease and immunology medical director for Connecticut Children’s Medical Center in Hartford, said he benefits professionally from Twitter. He created his account, @peds_id_doc, a few years ago to see what Twitter was about, and he’s remained a loyal user. Bennett started by following health-related accounts and live tweeting from conferences. He also joined Twitter chats – conversations that use hash tags to link tweets.

I-Team In-Depth

Mental Health Is Main Cause Of Hospitalizations in CT, New Data Show

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Mental disorders surpassed respiratory problems and all other ailments as the leading cause of hospitalization in Connecticut in 2012 for children ages 5 to 14, teenagers and younger adults, according to a new state health department report. The report shows that the number of days that patients with behavioral health problems were hospitalized surged 5.3 percent between 2011 and 2013, to nearly 260,000 patient days. Other categories of hospitalizations, including cardiac and cancer care, declined during that time. The data show five hospitals had increases of more than 12 percent in the number of days that patients with behavioral health problems were hospitalized. The biggest increases were at Yale-New Haven Hospital, which saw the number of patients rise 61 percent, and inpatient days jump 51 percent; and Waterbury Hospital, with 26 percent more patients and a 37 percent increase in inpatient days.

Breastfeeding Rates On The Rise, As Mother-Baby Support Systems Expand

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Candid online posts describing the challenges of breastfeeding fill the Facebook page of Breastfeeding USA’s Connecticut chapter. The daily stream of anecdotes, questions and comments alternate in tone from exasperated to celebratory. “Small victory for today. I actually breastfed in the open with my husband and day care provider in the same room (with a nursing cover, of course), but I haven’t done that yet, so I feel good about it. “

“Any tips to get better pumping results?

Disparities

State Plan Calls for Better Screening, Coordination Of Kids’ Mental Health

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The state needs to enlist pediatricians in screening children for mental health problems, expand school-based counseling services and create regional “care management entities” to help families access treatment, a draft report by the Department of Children and Families proposes. The DCF plan – ordered by state lawmakers in the wake of the Newtown school shootings – concludes that “too many families with children in need of immediate behavioral health services continue to struggle with a fragmented system that is difficult to understand and navigate and lacking in basic capacity across the continuum of services.”

But it stops short of calling for more inpatient and outpatient treatment options, saying more study is needed to identify gaps in care and to see if existing resources can be redeployed.  A key recommendation in the plan is that state agencies “pool” existing resources for children’s mental health – an estimated $300 million to $400 million – and re-direct those dollars in new ways. The report does not include data on the usage of existing mental health services or unmet needs. Instead, it calls for that data to be collected, and for a “high level task force” to be convened to lead a multi-year study and redesign of spending on mental health. The plan, which will be refined in the coming weeks based on public input, is the latest in a series of efforts over the last three decades to fix the state’s disjointed system of mental health care for children.

I-Team In-Depth

Long ER Stays For Kids In Crisis On The Rise

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Just a few years ago, it was rare that children with mental health problems would spend two or more nights in the emergency room at Connecticut Children’s Medical Center. Only 40 children stayed that long in 2010. So far this year, more than 250 children have spent multiple nights in the emergency department (ED) – a number expected to reach 500 by the end of the year. As policy makers work to finalize a statewide children’s behavioral health plan, a report by the hospital, obtained by C-HIT, projects that children with mental health problems will spend a total of 3,085 nights in the ED – more than triple the number in 2010. The average stay is about 15 hours, with some children remaining in the ED for 10 days or more.

Disparities

Medical-Legal Partnership Aims To Help At-Risk Children

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Three months after a new children’s advocacy office opened at Yale-New Haven Hospital, Alice Rosenthal has conquered bedbugs, kept utilities from being shut off, and helped get adequate school support for a kid with severe medical needs. “We’re off to a fast, great start,” said Rosenthal, the attorney on site for the venture. The office is a partnership between the hospital and the Hartford-based Center for Children’s Advocacy, a nonprofit that advocates for the legal rights of children who suffer from abuse, neglect or lack of access to critical services. The partnership takes a holistic approach to care by tackling not only kids’ medical problems, but the issues at home and school that might be preventing them from getting well. Rosenthal, representing the Center for Children’s Advocacy, works with the hospital staff to identify and resolve those issues.

Disparities

Health Care Coordination Key For Kids: Report

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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.