Last May, Samantha Collins’ drug use, legal problems and dealings with the Connecticut Department of Children and Families forced her to strike a bargain with the agency. In return for allowing social workers to come into her home three times a week to help her stay off drugs, improve her parenting and learn the practical skills needed to function as an adult, DCF would not remove her children. The 26-year-old Somers mother of 2- and 7-year-old boys entered Family-Based Recovery, a program created 10 years ago by DCF, the agency better known, perhaps, for separating families than working to keep them together. Family-Based Recovery, or FBR, is an example of DCF’s dramatic reversal in philosophy and practices, after years of a policy approach based largely on removing children thought to be at risk and placing them in congregate care facilities. “‘Pull and ask later,’” said Kristina Stevens, a former DCF social worker who is now administrator of the agency’s Clinical and Community Consultation and Support Division, which includes a fast-growing array of in-home treatment programs.
As recently as 2011, nearly 1,500 children and youths were separated from their families and were living in 54 group homes and other treatment centers in and out of Connecticut.
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.
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.
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.