Pediatric Psychiatric Cases Continue Climbing, Swamping ERs

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.

Proposed Bill Would End ‘Custody For Care’

State officials and parent advocates gave different versions Tuesday of how often, and why, the Department of Children and Families (DCF) takes custody of children with severe behavioral health problems – and whether the practice should continue. Advocates, including a group of adoptive parents, told the legislature’s Committee on Children that a proposed bill that would prohibit DCF from “requesting, recommending or requiring” that parents relinquish their custodial rights when seeking mental health treatment for their children is needed to stop a practice known as ‘trading custody for care.’ The bill, drafted by state Rep. Rosa Rebimbas, R-Naugatuck, was prompted by an October C-HIT story that described DCF’s use of “uncared for” custody petitions against parents who could not manage their children at home and insisted on specialized residential care. In testimony Tuesday, DCF Commissioner Joette Katz said the agency resorts to taking over custody only in rare cases in which parents refuse to take their children home from inpatient settings or “will not cooperate” with clinician-recommended in-home or community-based treatment services. “We disagree with the notion that DCF requires parents to completely relinquish custody of their children” to receive suitable behavioral health care, Katz said. She acknowledged that the agency has sharply reduced the number of children it places in residential treatment.

Desperate Choices: Giving Up Custody For Care

Ten years have gone by, but Lisa Vincent and her son, Jose, flash back to their goodbye with fresh anguish and faltering voices. He is 21 now, but the 11-year-old boy he was back then easily re-surfaces, all anger and confusion. “I didn’t understand. I was under the assumption I was going back to her,” Jose says. “For a long time, I felt that whole ‘she gave up on me like everyone else did.’ Now, I realize it wasn’t her.

DCF Steps Up Efforts To Prevent Child Deaths, With Foundation Help

The state Department of Children and Families will increase oversight and services to families with parental substance abuse, mental health and other problems who are identified at “highest risk” of a young child dying, the agency announced Monday. The move comes as Connecticut grapples with a high number of child deaths, outlined in a recent report by the state Office of the Child Advocate (OCA). In the report, OCA found that DCF’s response to “at-risk infants” was often insufficient, showing “gaps in risk assessment, treatment planning, case follow-up, and quality assurance.”

DCF said the new effort to target high-risk families came out of its own study of 124 fatalities that occurred between January 2005 and May 2014 of children ages three and under in families with some DCF involvement. The study findings are “prompting changes that will pinpoint families with the highest risks and increase oversight and services for these families,” the agency said in a statement. The study, which compared cases in which a child died to a control group, found that fatalities were less likely when DCF had conducted comprehensive assessments of parents’ needs.

DCF’s Level Of Involvement A Factor In Child Deaths, Review Says

Child deaths in families involved with the state Department of Children and Families are more likely in cases where agency workers have spent less time assessing and interacting with parents, a preliminary review by the agency indicates. In recent legislative testimony, a DCF official said that an ongoing review of 248 cases – half in which a child under the age of 4 had died, and half in which there was no fatality – had turned up a number of “risk factors,” including the young age of parents, addiction and mental health problems, and a lack of “quality” contact with DCF social workers. “We found that, in the comparison or control cases (where no fatalities occurred), we were assessing parents more, we were visiting parents more. The quality of home visits were more of (high) quality than those in which fatalities had occurred,” DCF research supervisor Janet Gonzalez told members of the Committee on Children. That finding “feeds one of our recommendations, in regards to enhancing the assessments that we do of families in the home,” she said.

Child Advocates Want Independent Review of Girls’ Detention Unit

A preliminary review by the Office of the Child Advocate of conditions at the state’s controversial locked treatment program for troubled girls in Middletown raises concerns about the improper use of restraints, inadequate access to mental health services, and inconsistent reporting of abuse and neglect. The report, which was distributed to members of the Connecticut Juvenile Training School (CJTS) Advisory Committee and obtained by the Connecticut Health I-Team, cites concerns that youths in both the 12-bed girls’ Pueblo Unit and the larger CJTS facility for boys have been subjected to inappropriate or unsafe restraint, including the use of “prone restraint” on youths with respiratory problems. Prone restraint means that a person is laid in a facedown position. “I know that DCF (the Department of Children and Families) shares our concern regarding the use of potentially dangerous restraint for children with contraindicated medical conditions,” Child Advocate Sarah Eagan wrote. “Our review of these incident reports raises questions regarding the adequacy of staff training on the use of restraint (and de-escalation strategies), and the effective dissemination of critical information regarding children’s special health care needs.”

The report echoes concerns about the CJTS’ use of restraint that were cited in a report a decade ago by the former child advocate and attorney general’s office. The new review comes just six months after the girls’ facility opened — and as state agencies seek to reduce the unnecessary use of restraint among children.

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

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.

Long ER Stays For Kids In Crisis On The Rise

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.